New York Will Try Convalescent Blood Therapy

On March 17 I wrote:  “A simple and medically feasible strategy is available now for treating COVID-19 patients, transfuse blood plasma from recovered patients.” New York, with other states following closely behind, is now trying the idea.

NBC News: Hoping to stem the toll of the state’s surging coronavirus outbreak, New York health officials plan to begin collecting plasma from people who have recovered and injecting the antibody-rich fluid into patients still fighting the virus.

Gov. Andrew Cuomo announced the plans during a news briefing Monday. The treatment, known as convalescent plasma, dates back centuries and was used during the flu epidemic of 1918 — in an era before modern vaccines and antiviral drugs.

Some experts say the treatment, although somewhat primitive, might be the best hope for combating the coronavirus until more sophisticated therapies can be developed, which could take several months.

The FDA acted quickly to approve the therapy on an emergency case-by-case basis, although it’s not clear to me that legally they should be involved at all given the therapy seems more like an off-label use of blood plasma than a new drug.

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Will they ask for consent from convalescents? Their numbers will remain small relative to ICU patients until the virus has peaked. Maybe it's not 1:1 donor/receipient here, but what's the number of severely ill people any donor can help? How much blood is the maximum one donor could give, with blood loss perhaps made up for on the other side by a blood transfusion?

And what if the donee/donor is a Jehovah's Witness?

Bonus trivia: the FDA actually regulates the amount of quinine in tonic water, making the maximum amount so small (83 mg per liter) that you have to drink six liters of the stuff to get one 500 mg anti-malaria dose. Still, for Covid-19 purposes, I'm buying and drinking a can every day, as a prophylactic.

And breeding quinine tolerant malaria, et al, parasites.

Great job!

The world needs more drug resistant infections.

Quinine-resistant malaria... That ship sailed long ago.

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It's kind of difficult to withdraw plasma from someone without their permission.

Completely untrue. China excels at exactly this kind of volunteerism. We need only ask and they’ll show us how they do it.

And you can replace the plasma with colorful plastic and turn people into amazing exhibitions.

Yeah, the Oregon Museum of Science and Industry was having one of those human body exhibitions, until the epidemic closed their doors. Someone said that their cadavers were coming from certifiably legitimate sources, rather than from prisons in China. But I still find the whole idea creepy. Even with responsibly sourced (instead of farm-to-table, is it deathbed-to-museum?) cadavers.

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Well, while the patient is being treated or after recovery before discharge you could take a blood sample, get the plasma.

One done, you figure out what the antibodies are and engineer bacteria or your own viruses to produce those antibodies. Technically you would need permission to do all that but that is a legal issue, which could easily be resolved by ignoring the law.

That's similar to how vaccines work.

I don't understand why it has to be the same technique used 100 years ago, it could be the same idea but better. We didn't have genetic engineering back then.

What you're describing is very very different from what the article is about. In fact, there are efforts to create antibodies, but that is a completely different process, and does not rely on collecting bags of convalescent plasma.

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Can anyone find my brain? I lost the last one to prior derangement syndrome.

Boomers trying to troll on purpose is cringe. Stick to the unintentional type.

I lost my ballsack too. Nevermind, I found it. It's kind of small to begin with.

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Amazing news! As I predicted the last few days were just a one-time spike in cases! We went from over 11,000 new cases in the US yesterday to just 225 today!

Please delete the above comment. The day is not close to being over.

By this time yesterday, and the day before reported cases were close to 3000. We are way down. Way way down today.

If you re-check your source you will see we are already at 5,000 new cases for today now

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I heard about another innovative virus solution today. Infect all the kids at once. When they have all recovered, let them care for all the elderly. At that time, let the virus run its course for all the others.

Maybe this is a joke. If not a joke then it is insanity.

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I was thinking along similar lines; instead of close the schools, make it a two week sleep away camp, let the infection burn itself out amongst the kids, then let the kids get back to business as usual. Of their parents get sick, now being immune, the kids can be safely cared for by their grandparents.

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The two obvious flaws with that are:

First, we don't know what the long term effects are and this approach nearly guarantees more people will be infected and;

Second, we don't know that getting one strain of Covid19 protects you from all strains. This is true with the plasma sharing also, though it's effects are probably subject to closer medical examination.

This is one of those takes that exposes you as someone getting their takes from Twitter. 99 percent of mutations make the virus less deadly and less virulent. If this is the only objection to a plan then you implement that plan yesterday.

"99 percent of mutations make the virus less deadly and less virulent."

So? Just because a different strain isn't more dangerous doesn't mean you can't become reinfected with it. And unless the doctors can be sure of which strain you have and also the virulency of that new strain, the treatment has to be the same.

Furthermore, your statement is wrong. 99 percent of mutations are completely random. In many (most?) cases they don't effect deadliness one way or the other.

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Anyone venturing to guess the number of infected to recovered patients in New York right now? 1 to 10? 1 to 100? And how would you determine who has recovered among those that recovered without being tested at all, due to having zero interaction with the New York health care system.

How about a guess for next week? Basically, no one infected in the last week will be recovered by next week. Week not being a hard limit, just an interval to point out the delay before this idea can even be implemented, in a health care system with zero spare capacity if Italy or Spain or France are any guide to the course of a still growing pandemic.

Yes, this is a treatment that is difficult to scale. Since the antibody response starts declining as soon as the infection is cleared, the plasma needs to be withdrawn early in the convalescent period. Also, the donors need to be willing, and they need to be reasonably well, and they need to be free of other infectious diseases. You also have to draw the blood, test it, and store it.

It's a very useful piece of the puzzle, but it's a relatively minor piece, at least in the short term.

Which is precisely the problem of talking up such things. The true short term in New York is how to deal with the sort of problems the Spanish are facing - 738 dead yesterday, and an increase in infections of 20% in one day to 47,610. And Spain/Madrid still looks like a best case scenario for the NYC region, not a worst case one.

One hopes that whatever time and effort was spent on approving this did not detract from the sort of planning that Italy and Spain are using to handle hundreds of dead, day after day after day.

You have it backwards. A successful treatment means that an infection doesn't lead to intensive care or death.

Successful treatment at what level? How many people, right now, are suitable to provide such plasma in NY? 10? 100? 1000? Leaving aside all practical questions (let us pretend to be economists), say that 1000 people could provide enough plasma to cure one patient each in NY right now. Other people can likely provide more realistic figures, but let's keep things straightforward.

In NY on Tuesday, more than 4,700 new cases were reported. A number which people are likely to consider hard to imagine being that small in a few days, using Italy or Spain as a guide. One can discuss endlessly which day NY is at compared to Spain, but even using just a week behind, on March 17, Spain had 11,000 cases, with almost 1900 being new on that day. As of March 24, Spain had 42,000 cases, of which almost 7,000 were new cases, according to worldometer info

Covid19 is a tidal wave, one can that anyone can see still rising in Italy, Spain, France, and Germany. New York needs a lot of things immediately, however convalescent blood therapy is not needed in NY now, nor in a week.

There is precisely zero reason, as of today, to think that NY will do better than Spain/Madrid. Where bodies are being placed in an ice rink, since there is absolutely no way to handle that many dead, day after day.

Again, you have it backwards. Cases of the virus become an interesting number if there is an effective treatment.

And don't compare NY to Italy or Spain until you look at the demographics. For younger people it is a nasty flu. For a demographic like Italy, where a few days ago the average age of those losing their life was 81 it is a death sentence.

I am not a doctor, and don't know if this specific treatment would be effective, but if something comes along that can take 10% of the intensive care load away, that changes the situation dramatically.

The problem isn't cases, it is overwhelmed intensive care facilities.

Exactly. I don't understand why people are throwing shade on this. Seems to largely be a critique of mechanics. Creating the therapy protocol now will only give increasing dividends as things get more and more dire.

In the next seven days?

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The problem most certainly is overwhelmed intensive care facilities, with roughly 50% of the beds being filled with people considerably younger than 60. That is what is going to happen to the NYC region in the next 7 days, if the Chinese, Italian, Spanish, or French examples are any guide.

'but if something comes along that can take 10% of the intensive care load away' leads to the reasonable question whether will this happen in the next seven days?

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" say that 1000 people could provide enough plasma to cure one patient each in NY right now."

This sounds completely wrong. I would assume the ratio would be closer to 1:1 not 1000:1. It's been used in China for coronavirus and at other time for other diseases. It's improbably if they needed 1,000 donors per patient.

I read that as 1:1, that is 1000 donors cure 1000 patients, but can certainly see how each could be taken either way from how it is written. Any therapy that requires 1000 donors to cure one patient would be meaningless in a pandemic outside of a dystopian nightmare context.

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If it allows health care workers to stay in the fight than it has a multiplier effect and better outcomes. If you give it to first responders you keep the gears going. It could save the life of some critical patients. For 80-90% of the population, it won't much matter. But for 10% it is a potential game-changer

Finally, a good idea in terms of medical personnel. Won't have the tiniest bit of effect in NYC, if only due to trying to get such a system up and running in the next week is not likely to be a priority for anyone, but maybe it could be helpful in other places.

And if all of the points made below by Sure are successfully addressed.

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Considering that many people equate a pandemic with war, when is it reasonable, by walking right up to the Godwin border, to point out that such proposals seem akin to a desperate hope to achieve victory through the use of miracle weapons, far too late and in far too limited quantities?

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Boomers are just making official what they've always been doing: sucking the blood and life of future generations.

Every generation steals from the children up until the debt rebellion. In forty years millennials will repeat this pattern.

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Pithy.

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We have turned the corner, the numbers for yesterday prove it. This thing is well under control and the market is SURGING! S&P 500 up almost 10 points yesterday - I hope everyone bought on Friday!
The wisdom of crowds - the market knows things are much better than expected.

Thanks to the largest bailout in world history! 2 trillion dollars printed up by Donald Trump and Congress with free money going to many Americans! Who needs Bernie when we have Trump.

Politics is circular! Go to the left of Bernie and you get Trump.

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Not just the bailout though. The indicators for the virus infections are looking good. Investors are realizing that this will be over soon.

Trillions of dollars injected into the economy will force the price of everything up even if 25% of the country perished. That's how the money supply and prices work.

Well the point is few people are going to perish. New cases today up ONLY 84! ONLY 84 new cases in the entire USA. We've turned the corner HARD!

I'm surprised anyone is still responding to you. You need to step up your trolling game, it's much to obvious you're just trying to provoke. Or take a step back and ask yourself why you need to anonymously play the fool.

He is a disinformer. If you challenge him to produce support for his assertions, he runs away to another post.

You can read about him here, and how to deal with him.
https://www.technologyreview.com/s/615368/facebook-twitter-social-media-infodemic-misinformation/

S&P 500 was up strong. I think the markets have spoken. I am correct.

Ban

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The situation is under control in Brazil. Brazil's President Captain Bolsonaro has asked governors to end the lockdowns and asked the people to resume normal living and working (except for old people and people with immunodeficiency). Brazil has started sending humanitarian aid to Italy (while the Czechs are stealing masks). Brazil has prevailed where America, Italy, China, etc. have failed. Even if Brazil and its republic last for a thousand years, men will still say, “This was their finest hour.”

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Who said America or China is losing? They are developing herd immunity. If Brazil didn't have tropical weather they would be the next Italy.

Not at all. Brazil's skilful leadership are to be credit for the success.

No, in Brazil the gangs have taken over the streets and they impose the curfews.

https://imgur.com/LoRQxHF

Those cases are incredibly infrequent. The lockdowns have been ordered by city and state authorities. Sound trucks have been dispatched to order the populace to stay at home. Brazil's leader, President Captain Bolsonaro, however, has determined that further isolation is unnecessary and harmful to the economy. He has denounced the lockdown measures as unjustified scorched earth measures.

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The media is now pushing Cuomo as an alternative to Biden. Perfect illustration of what's wrong with today's "elite" .

Cuomo does not have notable accomplishments or abilities, but he's one of "them" and talks impressively (at least right now) - and that's all that matters to "them.

He can talk? He is better than Biden!

-+1 newyorktimes.com is looking a little panicky about biden while
como can demand ventilators in a theatrical manner!
-uncle paulie is looking a lotta less prescient than the president on china and letting the u.s. midwest collapse

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Cuomo wins automatic points for not being a gimpy septagenerian like Biden or a dotard septagenerian like Trump.

always saw Andrew as a lay up for 2024....especially after 8 yrs of Trump...think Andrew and the Donald r more than aware of this to

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And the GOP should dump Trump for FL Governor DeSantis.

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I would have to double check the rules, but most plasma donations require the donor to be in generally good health and those who have recently had a raging fever are at least discouraged from donating.

Depending on how recently the donor recovered, we may also be looking there being unhealthy levels of cytokines, DAMPs, and other things in the blood. Under normal circumstances these would not be healthy to inject, but these may be beneficial under these circumstances. They definitely, we hope, will have large amounts of antibodies all derived from one clonal expansion population. These may have increased risk of provoking allergic reactions or host damage (e.g. the epitope your donor antibodies focus upon is too close to some variant protein in your patient).

I would need to ask the blood bank, but this may also entail not doing quite as much downstream processing of the plasma in order to better preserve antibodies without chemical changes (e.g. some of the washes might deamidate or oxidize antibody sidechains). We might also be looking at skipping the mandatory screens for things like Hep B and HIV.

Plasma under these circumstances likely should be treated like an experimental drug when getting informed consent. I still think it will fall under the "people are dying so the risk is easily justified" rubric, but I would be very leery of doing this sort of treatment under routine circumstances.

But it's not Trump making the proposal, so the downside is irrelevant.

You are honestly saying that to a person who says they are a practicing doctor?

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Seriously, in NYC? - We might also be looking at skipping the mandatory screens for things like Hep B and HIV.

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Whatever works.

Test an hypothesis.

Ok, what is the burn rate in New York? Social isolation and the rest seems to be a lost cause for most of them. So how long before 75% of New Yorkers have been infected and recovered or dead? And how much will the flight from New York increase infections along the east coast

A key for the country is how effectively the NYC region can be isolated. My guess is not very effectively at this point. But still probably worth trying.

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Blood banks are low because a lot of blood drives have been canceled so it is worthwhile to donate blood even if you can't contribute covid-19 antibodies.

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Once again you can't talk about healthcare without talking about Gilead.

This isn't going to help. Or at least not more than chloroquine. The scientific objection to it is 1) we're unclear if if can get into the lung cells; 2) by the times you're at the ICU the viral loads are minimal and it is your immune system and 3) The issue is reducing ICU usage and this doesn't do that.

Better to infect every health worker in NYC with low loads of the virus. If you're under 50, no conditions, no problems. Remove all health workers over 60 and with conditions until you do an antibody test on them to show exposure.

And then do what the South Koreans did -- any patient who shows up with a fever, don't bother with a test, hit them with chloroquine and zinc.

You don't even need a CT -- just use a match test. Can you blow out a match at 6 inches? If not, you're going to a hospital. Otherwise you're at home.

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Blood banks should ask for a bailout. The government loves to bail out banks.

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"it’s not clear to me that legally they should be involved at all ": very satirical, Mr Tabarrok. A bureaucracy grows to fill the space available.

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meanwhile
in a viral pandemic
cannabis sales are encouraged by the colorado governor despite data
that suggests smoking increases covid 19 morbidity &mortality!

Don't smoke it

tell gov. polis he is the pol who defined smokable cannabis as essential in a viral pandemic

Provinces of a certain completely sanely governanced country have done the same. Partake and it will all make sense.

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Prior to antibiotics, immune globulin prepared in horses was used to combat the most common cause of bacterial pneumonia. This was common in the 1930s. It was felt to be active, but it did cause some toxicity due to being from a different species. In WW II, US troops received gamma globulin injections for hepatitis. There is a immune globulin concentrate made from pooled donors against Herpes zoster used for immunosuppressed people. Donating plasma can be done more frequently than whole blood.
Of course, I have no idea whether donated immune globulin works for this disease. Some pathogens use host immune globulin to coat themselves as a way of eluding the immune system. Viruses do their harm inside cells, and a too vigorous globulin response may prevent the T-cell immunity needed. The ability of some viruses to elude antibodies is reflected in the difficulties in developing a HIV vaccine.

Nice concise summary of the potential problems. I remember reading how injections of gamma globulin used to be a favored treatment in emergencies or urgent situations. But AFAICT fell out of favor? Maybe for the reasons that you describe -- better, more specific treatments were developed. , including modern antibiotics and anti-viral treatments.

But extraordinary times call for extraordinary measures. Such as using techniques from earlier decades (or centuries in the case of quarantines).

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Boomers using Millenials as a juice box to squeeze out another few months of life.

Wonder how long until this is compulsory for public health reasons just like our nationwide lock-downs.

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Thoughts:
1. You can only do transfusions with alike blood types?
2. If the Chinese research showing certain blood types are more or less affected by CoVid-19 (https://medicalxpress.com/news/2020-03-blood-coronavirus-chinese.html) does this limit the extent of the plasma treatment? (IE people with Type A blood are more affected by Coronavirus, therefore there are less recoveries, therefore plasma from recovered Type A patients will be less available or likely to help…conversely: people with Type O are less affected, plenty of recoveries, lots of available plasma, but these people need the treatment less…)

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