Year : 2020 | Volume
: 14 | Issue : 1 | Page : 1--3
Convalescent plasma: Would it prove to be magic potion/boon in the current scenario of COVID pandemic?
Senior Consultant and Head, Blood Bank, Max Super Speciality Hospital, New Delhi, India
Dr. Sangeeta Pathak
Max Super Speciality Hospital, Saket, New Delhi - 110 017
|How to cite this article:|
Pathak S. Convalescent plasma: Would it prove to be magic potion/boon in the current scenario of COVID pandemic?.Asian J Transfus Sci 2020;14:1-3
|How to cite this URL:|
Pathak S. Convalescent plasma: Would it prove to be magic potion/boon in the current scenario of COVID pandemic?. Asian J Transfus Sci [serial online] 2020 [cited 2020 Aug 7 ];14:1-3
Available from: http://www.ajts.org/text.asp?2020/14/1/1/290652
I am reflecting back in time, and thinking what was the time when I was graduating in transfusion medicine. The canvas of life was totally different; it was the time of premobile phone era. I was managing my work so differently than I am doing now. The demand and challenges of life were so different, the intervention of technology has certainly helped all of us, and learning has become much faster and easier. Back then, my work was relatively simpler but demanding, but the last two decades have changed every aspect of our lives. In contrast to it, what has changed in the last 3 months is simply unbelievable – so much of learning and internalization. I would have never imagined myself in this situation, where I would be dealing with a pandemic, and every skill, which I learned and acquired as a person and professional will be put to test. The experience has been truly overwhelming and enriched me as a human being.
This unfortunate situation of COVID-19 has completely changed the dynamics of human life. Its impacts are going to be felt for very long, as none of us know how it will span out. I hope, when we will come out of this challenge, we would be much wiser and socially conscious individuals. We would weigh the developmental process in a much more integrated way rather than in a compartmental way. The virus does not only impact health but also affects our social life, psychological well-being, and economic sustainability. Probably, we would work in more collaborative way, as human life is far more precious and vulnerable. We are standing at a point of no-return and making new rules of living. The way we used to lead our lives so far may become a historical view. So, much has changed in the last few months and I am very tempted to go back in history and find how and where the plasma was used to save human lives. There is a very interesting history. Let me take you through broad and narrow lanes of the journey.
Blood and plasma therapy is one of the oldest therapies, and it goes back to the 17th century, where human blood was used in treating various elements, but it was fairly empirical in nature and did not have enough scientific and clinical evidence. Humans were more dependent on experience rather than evidence. Historical facts are just not only the date and era, but it is much more than that. Its human side is much more interesting and compelling.
The Second World War was a turning point in the history of humankind, the lessons learned were very hard, and there was very heavy bloodshed. It looked insanity had its day. Pearl Harbor attack on December 6, 1941, is a grim reminder of political reality and human cost. So, many soldiers fighting for their lives and looking for better treatment options. This was the day, for the first time in history, plasma products were used in saving the lives of many wounded soldiers. During the same period, Prof. Edwin Cohn from Harvard University worked on the mystery of human plasma. He conducted various studies and found that plasma is a warehouse of many lifesaving proteins, and if these proteins can be harvested, it can save many lives. He harvested albumin from plasma from a process, which is known as Cohn Technology today. This was a revolutionary step, as it totally changed the landscape, how plasma was used in extracting the proteins, based on their characteristics using cold ethanol and low temperature. This was the beginning of the new era; this is the most widely used technology in the plasma fractionation industry.
With this happening around, post-World War II, the world was also dealing with many health and economic challenges. We as humans learned many things and the world was totally changed from many perspectives. And now, after 8 decades, we are at another crossroads and we are dealing with one the most challenging humanitarian crisis. We are dealing with the public health emergency of COVID-19. There is no clinically known treatment for COVID-19, as of today.
This virus has created havoc all over the globe and we are dealing with a totally unpredictable situation. It has travelled across the globe and infected millions of people and claimed many lives. We as a society are trying to come to terms and find solutions to handle it. In this chaos, our learning of the past came very handy, where convalescent plasma (CP) was used in saving the lives from ZIKA and Ebola virus infections and the results indicate that it could help in decreasing mortality to some extent. Although the data were not very conclusive in the sense of clinical outcome, it certainly was encouraging. Although one is not sure about the exact mechanism of CP, especially in the absence of any clinically proven treatment, and looking at the current situation, when the virus has spread across the world and saving human lives is the sole motto.
In the midst of my work, I am also going through a dilemma of use of CP from the COVID-19-recovered patients, as the behavior of COVID-19 is not clear and so is the case of the pattern of antibodies produced in the body. If one looks at the situation today, all over the world, many organizations, companies, and governmental agencies are working very aggressively to find remedies to handle this crisis. Unfortunately, its process is fairly long and complex. This becomes furthermore compounded by the fact that none of us know the exact behavior of this virus, as its mutating pattern is highly unpredictable, and the probability of the second wave of infection is there.
Considering this as a public health crisis, many global companies have already started working on developing specialized immunoglobulin (hyperimmune) for COVID-19, like what is already available, hepatitis immunoglobulin, rabies immunoglobulin, and many more. These specialized immunoglobulins are manufactured from the plasma which is recovered from the patients/donors who have a higher titer of antibodies for a particular agent. This hyperimmune plasma is harvested from a defined population, who are out of the infectivity phase. However, while these efforts are going to take some time before it could be available as a treatment option, we as a society should explore and try to save every life.
In my view, under the current situation, the use of CP is one of the very promising options. All over the world, regulators have taken a very serious view on the use of CP and have allowed clinical trial or use of plasma as an adjunct therapy. It is thought that the use of CP may either stimulate the production of antibodies or act as a catalyst for the production of antibodies against COVID-19. This may help more vulnerable patient population, who have comorbidity factors. It would also be relevant to keep in mind that as and when vaccines or other therapies would develop, it may not be able to reach across the globe because of geographical and economic factors. This has been the experience of the past; as and when new therapies were developed, it took time to reach developing and under-developing countries. Therefore, it is very important for counties to work on use of CP, as it is locally available on an immediate basis and harvested from the local population.
While the global trials on the use of CP are on its way, we as a scientific community must work toward understanding a more scientific basis for the action of CP. More we investigate and understand its mechanistic part, we would be able to help more and more patients. This way we would know and develop our knowledge base for potentially any other challenge. It is a wakeup call at the scientific and policy level, as almost all the countries across the globe were unprepared, to handle such a situation. Our public health policies should also focus on emerging diseases in a consortium; as today we are living in a global world, we travel across the globe for pleasure or work. While we travel, we may be an agent or target of infection. How do we protect ourselves and the people around us?
In the context of this situation, there is an overall decrease in blood supply globally and this impact will be felt for times to come. In parallel to this situation, the demand for blood has also gone down, as all noncritical surgeries have been delayed, fortunately less travel/commute has resulted in a lesser number of accidents etc. This may be a transient phase, on account of the recipient, but patients are going to need blood/blood components in the next few months, and at that time, we as the society may feel all of a sudden shortage of blood supply. This is the time for us to create enough awareness of this situation, so that we are able to infuse enough confidence and enthusiasm in the minds of our blood donors, the way we are doing for COVID-19 plasma donors.
This would be relevant to mention that media has also played a very important role in increasing awareness about plasma therapy. It was very widely covered by the international press, print, and digital media. This has definitely helped in increasing awareness among common men and treating clinicians. A large number of the population was under lockdown and was/is going through the media coverage of the use of CP in the treatment of COVID-19 and it has also brought a sense of social responsibility among many plasma donors. We are looking at a very interesting social process. Many donors are coming forward to donate plasma and doing every bit to save a fellow human being. We are moving toward a society, where these individuals are looking at themselves as a source of lifesaving medicines and contributing in their own way. We must salute them for their priceless and noble contribution to save human lives.
This is also very interesting to note that normally regulators take a very long approval process, but regulators across the globe have taken a very progressive and positive view and granted approvals on fast track mode and this clearly indicates how political will will play an important role in our lives. The overall situation looks quite intimidating and overwhelming. However, somewhere deep down in my heart, I know that the power of human spirit and resilience would write a new chapter in history. The world would never be the same and history will differentiate the pre-COVID era with the post. We have never learned so much about viruses, social life, mental health, economics, and so on, in such a short span of time. I am hoping that this pandemic would make us more compassionate and we will start looking outwardly. We will be caring for others, as now we know how others can change our lives. We will start behaving more responsibly and will remember what is the price tag for being irresponsible is.
The world would formulate/develop new norms of social interactions. This really worries me; we were taught for centuries that humans are social animals, and now all of a sudden in a matter of <2 months, I am distancing myself from my friends, colleagues, and loved ones. A hug or handshake looks too distant and difficult. I am really struggling and trying very hard to come to terms. I love to be with people around; they give me perspective and purpose, both. I need to learn newer methods, whereby I am distancing physically, but I am connecting more strongly, socially, emotionally, psychologically, and bridge the rest with my love and affection. We are in the thick of human/social/economic crisis and we cannot and should not fail. We must succeed.
|1||Starr D. Blood: An Epic History of Medicine and Commerce. New York: HarperCollins Publishers Inc.; 2002.|
|2||Bertolini J, Goss N, Curling J. Production of Plasma Proteins for Therapeutic Use. John Wiley and Sons Inc.; 2013.|
|3||Available from: https://www.wallstreet-online.de/nachricht/12375358-global-plasma-leaders-collaborate-to-accelerate-development-of-potential-covid-19-hyperimmune-therapy. [Last accessed on 20200 Jun 03].|
|4||Available form: https://www.medscape.com/answers/2500114-197453/what-is-the-role-of-convalescent-plasma-in-the-treatment-of-coronavirus-disease-2019-covid-19. [Last accessed on 20200 Jun 03].|
|5||International Blood /Plasma News; May, 2020.|