Some critically ill COVID-19 patients in the Seattle area will soon receive a promising, experimental treatment derived from the blood of people who have recovered from the disease.
Doctors at Swedish Health Services hospitals hope to infuse their first patient with so-called convalescent plasma early this week. Several other hospitals also plan to offer the treatment.
“We’re trying to help those who need it the most first,” said Dr. Livia Hegerova, a hematologist at Swedish. If the treatment seems to help patients being kept alive by ventilators and others in dire condition, its use could be expanded to patients who are not as desperately sick.
Though still unproven for use against the life-threatening respiratory disease caused by the novel coronavirus, a similar approach has been used to fight other infectious diseases, like measles and influenza, for more than a century. It’s based on the body’s immune system, which produces proteins called antibodies to fight infections.
People who have recently recovered from COVID-19 should have high levels of antibodies circulating in their blood that could be used to help others still battling infection, Hegerova explained. It’s not clear yet how powerful the immune response is to the novel coronavirus or how long it lasts.
Swedish, UW Medicine, Providence St. Joseph Health and others are part of a national network of hospitals offering the treatment, organized and coordinated by physicians and researchers at the Mayo Clinic. The Food and Drug Administration issued broad guidelines for emergency use of convalescent plasma, so each hospital didn’t have to apply separately, Hegerova said.
A website for the network says 64 patients in the U.S. have received the treatment so far. Locally, almost a thousand people responded to a call for donors, though most haven’t been symptom-free long enough yet to qualify, said Dr. Anna Wald, an infectious disease specialist at the University of Washington.
Reports from two small trials in China are encouraging, but far from definitive. In one of the trials, five patients who got infusions of convalescent plasma improved within about a week and the virus cleared from their respiratory tracts within 12 days. Ten patients were treated in the second trial, all of whom showed improvement within three days.
But because the patients also received many other types of treatment, including anti-viral drugs and medications to fight inflammation, it’s not possible to attribute the improvements solely to plasma infusions, Hegerova cautioned. Also, there were no controls for comparison.
“The data are really encouraging, but again, not randomized or controlled, but sort of anecdotal.”
Physicians at area hospitals are working with Bloodworks Northwest, which is overseeing plasma collection. The first three units of frozen plasma were sent to hospitals Monday, said Dr. Rebecca Haley, the blood center’s medical director. She declined to say which hospitals received the initial shipments, but a spokeswoman confirmed Swedish received two of the units.
To qualify, donors must have had a positive test result and have been free of symptoms for 28 days. The volunteers will undergo a process called plasmapheresis, which separates blood plasma, the straw-colored fluid, from red and white blood cells and platelets, returning the cells and platelets to the donor.
Elizabeth Schneider, 37, gave plasma on Friday, the first coronavirus survivor in Seattle to do so. She fell ill in late February and tested positive. Her symptoms felt like a bout with the flu, including a fever that spiked at 103. Now she’s now eager to help others.
Donating was “a little uncomfortable,” Schneider said, mainly because she had to sit still for 45 minutes with a needle in her arm. Reinfusing the blood cells and platelets causes tingling and a chill. “It’s definitely not something I would do for fun, but I’m happy to be able to give back to the community and to help someone who’s struggling with this virus.”
Each donor can provide enough plasma to treat three to four patients, Hegerova said. Eligible donors can give plasma multiple times.
Because the virus hit here first, the Seattle area is well-positioned to lead the nation in offering plasma treatment and determining whether it works, Haley said.
“We were the first in the country, we were the first epicenter,” she said. “We are going to be the first blood center that has access to donors who are far enough away from their active infections and are fully recovered so their plasma can be helpful.”
The treatment is not without risks, Hegerova cautioned. Allergic reactions are possible, as are infections and fevers. Also, experience with other viruses like rabies and shingles show that convalescent plasma is generally more effective when given early in the course of an infection, said Wald, who is also working on a research project to concentrate antibodies and perhaps produce a more effective treatment.
Physicians across the country will be observing patients closely, noting response and adverse reactions. So even though the treatment program is not randomized or controlled, it should be possible to draw conclusions about effectiveness, dose and complication rates, Hegerova said.
But convalescent plasma is not likely to be the ultimate answer for treating COVID-19 patients, simply because it is labor intensive, limited by the availability of donors and carries risks, she cautioned. A vaccine remains the best hope for stopping the pandemic and preventing infections.
Anyone with a positive diagnosis for the novel coronavirus who is interested in donating plasma can get more information through Bloodworks Northwest’s COVID-19 donor project website.