It’s the latest development in the effort to use a 19th century treatment to help 21st century patients.
The contract with the DoD’s Joint Acquisition Task Force is to develop a new convalescent blood plasma process that makes more serum-derived products, and faster.
President Donald Trump and US health leaders have done a full court press to encourage people who survived Covid-19 to donate plasma to help those who are sick.
Two weeks ago, on a tour of the Red Cross, Trump implored people to volunteer to donate plasma “as soon as you can.”
“We have a lot of people that would heal, would get better. As soon as you can, please,” Trump said.
A Victorian solution to a modern problem?
Since the Victorian era, doctors have used this treatment to fight severe cases of the flu. The treatment has also shown success with two other deadly coronaviruses – MERS and SARS. Yet it will take studies to prove that it works to treat Covid-19. Absent other treatments, doctors have opted to use the treatment as it was still being studied.
Doctors try the old treatment
When the Covid-19 pandemic hit New York City hard in March, doctors desperate to save patients weren’t sure what might help. Plasma from recovered Covid-19 patients showed some early promise. For professionals used to relying on scientific evidence and established facts, there was — and still is — little to work with.
“We probably changed what we were doing on a daily basis.”
To see what worked, Bouvier and team did a retrospective analysis on data collected from 39 patients.
Even in that small group, convalescent plasma stood out.
“We don’t have definitive answers yet, but we are on the way to getting definitive answers and, I would say, that the evidence, while imperfect, is promising,” Bouvier said.
Convalescent plasma, Woodcock said, is an option that can be “feasible fairly quickly.” Woodcock, said it’s a treatment the government is trying to accelerate, even before the government knows if it works.
Early results in China
Early on, a handful of small studies in China looked promising.
Trying the treatment in the US
Among 25 hospitalized patients with Covid-19, seven days after the convalescent plasma treatment, nine showed some improvement and seven were discharged from the hospital. By day 14, 19 had improved and 11 were discharged. There were no safety issues.
Still, it’s not clear if the treatment was the reason these patients improved; the study results would need to be reproduced in a larger group of patients.
First ‘maybe,’ then ‘possibly,’ now ‘probably’
Dr. Arturo Casadevall, one of the researchers, called convalescent plasma the “good news story” of the pandemic.
“When we first started this effort if you had asked ‘do you think it’s going to work?’ I would have said ‘maybe,'” Casadevall said. “Since then I progressed to ‘possibly,’ and now, I am at ‘probably.'”
Casadevall wants more research to prove it works.
“To really be certain you need to complete the randomized clinical trials,” Casadevall said. “But the good thing has been that there have been multiple reports that have been encouraging, including my clinical trials from Wuhan that had to be stopped prematurely.”
That trial was stopped when the flood of patients slowed to a trickle and there weren’t enough patients to test the therapy.
The number of cases can also impact how much of the therapy is available. Unlike with a monoclonal antibody therapies that can be made in the lab, this treatment relies on volunteers.
“It is a limited resource,” Woodcock said Monday. That’s why there has been a concerted push to get more donors. Even Dwayne “The Rock” Johnson has been enlisted to urge people to donate.
Typically, one donor’s plasma can treat two or three people and the original donor can come back and donate again within a couple of weeks.
But there are only so many donors, Woodcock said, and scientists are starting to think there is only a month-long window in which people have enough antibodies in their blood to help someone else fight the disease. But again, they need more research to know for sure.
But there was no placebo group. Without that comparison, it’s hard to know if the treatment made the difference.
The treatment be a difficult one to get right. Monoclonal antibody treatments, by contrast, are made by scientists in the lab. They pick the antibody that works best in the lab to neutralize the virus and reproduce it in the lab. Such Covid-19 antibody therapies are in clinical trials now, too.
With convalescent plasma, patients get all the antibodies in that plasma, not just those carefully engineered to fight the virus. Every donor’s plasma is a little bit different and some may have more antibodies that protect against the virus better than others.
“Convalescent plasma, I think we need to have more caution about that,” Dr. Anthony Fauci said recently. “You want to make sure you do it right.”
Woodcock, who said the US government is trying to accelerate these plasma drives, thinks there may be an additional benefit to convalescent plasma that goes beyond treating someone’s symptoms.
“I think people feel very helpless in the face of this,” Woodcock said. “This is something that everyone can contribute who’s been infected.”