One of the keys to healing and preventing coronavirus might be hiding in the veins of those who survived the disease. That’s what an emerging network of doctors and researchers from across the country think, and they’re racing to find out whether it’s true.
A network of top docs from Johns Hopkins University, the Mayo Clinic, and other universities, led by Dr. Arturo Casadevall, is trying to set up a study of convalescent plasma—blood serum from those who’ve recovered—to see if the antibodies from those who’ve gotten the disease and lived are a transferable defense. So how does it work?
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Antibodies as therapy
When people get sick and recover from coronavirus and other diseases, their bodies produce antibodies in their bloodstream, which can help fight the disease. By taking blood serum from those who’ve recovered from the disease and giving it to those who’ve either not yet contracted it (or are in the process of fighting it off), you could, in theory, pass along those same disease-fighting antibodies to the recipient. Those antibodies would hopefully take up the fight against the disease in their new host to either stop an infection from starting or lessen its severity.
It’s a practice that’s at least a century old, and now an emergent network of doctors at Johns Hopkins University and other institutions are hoping to study it against the coronavirus in a clinical setting. Dr. Arturo Casadevall, the chair of Molecular Microbiology & Immunology at Johns Hopkins' school of public health, first proposed the idea in a February Wall Street Journal opinion piece. He’s working with colleagues and the FDA to approve a clinical study into its effectiveness.
After Casadevall first published his Journal piece and an academic article in the Journal of Clinical Investigation, other researchers around the country soon saw the value in studying passive antibody therapy against the pandemic.
“Arturo and I started emailing back and forth with his colleagues,” said Dr. Michael Joyner, an anesthesiologist at the Mayo Clinic in Minnesota. Transferring blood from the recovered to the sick may sound strange and medieval to the uninitiated but “that’s not out-there in terms of medical use of this strategy,” said Joyner.
Given his anesthesia background, Joyner was curious about whether the use of convalescent plasma could help reduce pneumonia in COVID-19 patients, help heal them faster, and reduce the demand for in-demand ventilators in hospitals.
Since then, FDA Commissioner Stephen Hahn has cautioned that convalescent plasma is “a possible treatment” and “not a proven treatment.” Nonetheless, he called it “a pretty exciting area” where the agency is “really pushing hard to try to accelerate that.”
Long history
Doctors have used convalescent plasma—a practice known as passive antibody therapy—to treat a range of diseases for decades.
As Casadevall pointed out in his Wall Street Journal piece, one of the earliest uses of convalescent plasma involved a school physician in the '30s using blood serum from those who had recovered from measles on dozens of schoolchildren, only three of whom later developed mild cases of the disease.
More recently—and more relevant to the current outbreak—doctors also used passive antibody therapy during the Severe Acute Respiratory Syndrome (SARS) epidemic. In a very small study, doctors in Taiwan treated three patients suffering from severe cases of SARS—a virus from the same family as COVID-19—with convalescent plasma from the recovered and found that all three, who had failed to respond to previous treatments, survived.
This kind of prior research on convalescent plasma got Dr. Shmuel Shoham, an associate professor of medicine at Johns Hopkins, involved in Casadevall’s ad-hoc network of researchers looking to study its use on COVID-19.
“The reason I got interested in this is that a few years ago I was involved in a National Institutes of Health study that was developed to try and deal with influenza, The reason that was done—it was a proof of concept: can you turn individual blood banks into mini-pharmacies?” Shoham told The Daily Beast. “In a calamity situation, you may lose pharmacies; or if you have a situation like this, a pandemic, you may not have production capacity at one or two places to deal with things. So if a few major hospitals could turn their blood bank into a mini pharmaceutical factory, then that would work.
“We did the study and we learned a lot of lessons. We learned that you can get blood from people, get antibodies from it, and then give it to patients in a safe way for treatment,” he said.
How it’s done
The researchers are still working with the FDA to get approval to study the use of recovered patients’ plasma against COVID-19, and they’ve sketched out how the research will play out.
Joyner outlined what he called three “swim lanes” where they’d like to study its effectiveness. Researchers are hoping to see whether it’s effective in preventing people like healthcare workers who’ve had high-risk exposure to the disease from becoming infected. They’re also curious about whether it can help those who’ve just become infected and had to be hospitalized, either with mild or critical cases of the diseases.
In those cases, Joyner says, the hope is that the plasma could be effective at “keeping people off mechanical ventilation, reducing the need for mechanical ventilation, and shortening hospital stays in an effort to modulate the surge” of patients.
The advantage of the plasma study is that it doesn’t require the development of lots of new medical machinery which could take time to manufacture and distribute. Instead, it largely relies on the existing infrastructure already available to hospitals and blood banks.
That’s not to say that it’s entirely easy. Researchers still need to develop tests so that they can find donors who have enough coronavirus antibodies in their system to make them good donors. But these, Joyner says, are manageable problems.
“You’re going to have to identify potential donors. Make sure that they meet all the eligibility requirements. Make sure that their plasma has enough antibodies. But that’s straightforward stuff,” said Joyner.
The researchers hope to target the study initially within New York City for a few reasons. The explosion in the number of infected—and recovered—patients means that there will be enough donors and patients to study and the city’s blood banks are considered among the more capable in the country.
As with all of the efforts underway to treat COVID-19, it’s important to remember that the use of convalescent plasma is still not yet proven effective and needs more data before we know whether it can actually help. But Joyner says they’re moving fast to get those answers.
“We want to make sure we do this correctly. It’s being done as a research protocol. We’re going to submit it to our institutional review boards. All the top places are setting up expedited review for this sort of thing,” Joyner said.
Trust the process
For Shoham, an immigrant from Israel who became an American citizen, the process of working on the convalescent plasma and seeing a network of so many top scientific minds come together in such a short time period has been heartening.
“To me this has been an unbelievable experience. I’m an immigrant so my love for America is acquired, not congenital. My kids were born here, they were born to love America. I acquired my love for America. Seeing so many different people come together, roll up their sleeves, and put aside competitiveness, egos, territories, and just work a problem,” he said.
“The people that I’ve talked to, these are people who would normally charge a thousand dollars an hour and they’re just talking to me and working through the problem and giving me their cell phones. That’s pretty incredible,” according to Shoham.
Joyner sees studies like this one as part of a layered approach to the pandemic. “The social distancing will help. Listen to Dr. Fauci.” In the meantime, as the world waits on a vaccine, researchers are “working around the clock” to investigate new therapies and see whether or not they’re effective. “We’re not helpless,” he said.
