Alex Armlovich on blood plasma donors and markets

From my email:

I saw your post about COVID blood brokers–My girlfriend and I had it in March and finally got antibody tests last week when the city opened the free clinics.

I inquired on a national plasma donor site, was directed to CSL Plasma in Clifton NJ, and a donor concierge from LeapCure reached out. They didn’t tell me what the compensation is (the CSL website says it’s usually ~$50 for normal plasma) but they’re calling a roundtrip Uber from my apartment near Ridgewood, Queens all the way to NJ, which is $108 one-way. The concierge said to reach out if there are any concerns with the first trip next week because they’re hoping for up to 2x weekly donations.

What I don’t understand is, why doesn’t the city’s antibody testing program directly link up to plasma donation? I had to go through a bunch of hassle to find out where to donate, and I think the information & coordination friction is a bigger deterrent than anything else. And why isn’t there more collection capacity in the city itself; the long commute seems unnecessary. If this is scientifically important enough to merit real donor spending from biotech, it seems like the city should make even a minimal investment in reducing process friction.

Maybe an integrated, frictionless testing & plasma donation infrastructure should be a permanent strategy for future “zero-day viruses” where convalescent antibodies are the only thing we have to treat first responders…

Here is Alex Armlovich on Twitter.


Related to antibodies and immunity, what do people make of this:


“My husband ended up very sick,” she says. “He was in intensive care for a day, and in hospital for 10 days. But while I was also infected, I had no symptoms at all. I have no idea why we responded so differently.”

It took two months for Raje’s husband to recover. Repeated tests, done every five days, showed that Raje remained infected for the same length of time, all while remaining completely asymptomatic. In some ways it is unsurprising that the virus persisted in her body for so long, given that it appears her body did not even mount a detectable immune response against the infection.

When they both took an antibody test earlier this month, Raje’s husband showed a high level of antibodies to the virus, while Raje appeared to have no response at all, something she found hard to comprehend.

If an asymptomatic carrier expresses no antibodies, what does this imply about the use of seroprevalence testing to estimate population prevalence?

And how did Raje's body clear the virus - native immune system?

I have often wondered if some viruses are actively using the hosts immune system to spread within the host and also spread themselves. The immune system creates inflammation and other trauma to the body perhaps making it more susceptible to the virus. So if you don't have a strong immune response, you don't get sick (or as sick). Since I got older my cold symptoms have significantly decreased, could it be due to my immune system being weaker?

If an asymptomatic presentation implies a *weak* immune system then a) how do the infected ever clear the virus (without antibodies, at that)? and b) why are older person (with weaker immune systems) more at risk of significant symptoms?

About this: *Since I got older my cold symptoms have significantly decreased, could it be due to my immune system being weaker?*

I would guess your lifetime exposure to colds has left you with antibodies and T-cells which are cross-reactive to the moderately-mutated strains of the flu in current circulation.

Let's imagine there is a sweet spot in terms of your immune system, too much response and your body basically attacks itself and makes it more susceptible to the virus, too little and the virus doesn't encounter any opposition. It may be that the "correct response" by the immune system is very much to the end of this spectrum, that is the body can easily clear the virus from the system without a huge immune response. Of course this is just idle speculation by me, I have no proof only a hypothesis.

Inflammation is thought to be the body's defensive response to infection. The human body can cope with higher temperatures than bacteria can. So basically it is chemotherapy - raise the temperature, cook both the host and the disease, the host will cope better and so survive.

The more interesting idea is whether diseases modify behavior. Toxoplasmosis does in cats and in humans. It seems. So do any sexually transmitted diseases? Herpes for instance. What do you think the odds are that infection causes more high risk behavior?

Although cause and effect made be hard to distinguish.

Sure - but a virus isn't a bacteria. Can fever help eliminate viruses?

There are sources indicating that fever makes the bodies immune responses work better also.

We have to remember that both the Covid-19 PCR and antibody tests will have false positives and false negatives.

I'm sure Raje is well-aware of that, being an oncologist and a professor of medicine.

Then she should be saying. Perhaps my result was a false positive and that is not so mysterious.

BTW many of my clinical colleagues do not understand false+/False negative and how to interpret in light of base rates and testing rates/criteria.

Per the quote from the article, she had 10+ positive PCR tests: every 5 days over 2 months. That seems to make a false positive extraordinarily unlikely.

On the other hand, it sounds like she only was tested once for antibodies, so it seems reasonable to wonder about a false negative result from that test.

Re: the OP suggestion of a zero day plasma response, of course lessons should be learned on how this current incident was handled, but I would guess that the next time it will be an entirely different challenge that perhaps all the "hard lessons" we have from this epidemic would be useless against. I think the soft lessons are going to be more difficult. For instance it is clear that we need a different structure of institutions in the West as they are unable to cope with rapid and tough decision making that dealing with a national emergency like this. For instance the various efforts by the FDA to shut down independent testing, the slowness in closing down travel from infected areas, the slowness in isolating infected areas within the country etc etc. It seemed to me that we needed a more War Time response here. The Roman Republic could temporary suspend democracy and elect a Dictator, which has its dangers, but maybe if we start discussing how this could work in a none panic situation rather than waiting until the panic occurs, maybe we can deal better with those issues (sort of like discussing AI risks before there is an AI to deal with).

I think the soft lessons are: (1) don't think a bad thing cannot happen here only because it has not happened for a while and (2) plan looking at the experience of those who had similar problems in recent past. The main difference between countries that responded well and badly is having relatively recent, if smaller, outbreaks of new diseases.

However, as can be seen presently, those lessons are simply beyond the ability of some countries to implement. Quarantining/isolating those who are contagious until they are no longer transmitting an infection is a basic response that has again proven its fundamental worth.

Assuming that a country is able to effectively implement it. The real lesson seems to be that is too hard for some nations to do..

As one commenter suggests, we don't know enough about the coronavirus for a robust market in blood plasma donated by those who have tested positive for antibodies. The development of a vaccine will reveal what we don't know now. In the meantime, should government, should this blog, promote the creation of "an integrated, frictionless testing & plasma donation infrastructure"? I know, let markets be markets.

If one encourages people to act as lab rats in the development of a vaccine, why not encourage people to act as lab rats in the development of "an integrated, frictionless testing & plasma donation infrastructure".

"Donor concierge". That is just brilliant. English is a never ending source of novelty. I wonder if Planned Parenthood is going to use that if, in the extremely unlikely eventuality that the Powers That Be are forced to bring charges, they get their day in court? "We don't sell baby parts, we employ a donor concierge".

It sounds like a great profession. I wonder if they also do kidneys.

From the House Committee on Oversight and Reform
The undercover videos show Planned Parenthood trafficking in fetal tissue for profit in violation of federal law.

Planned Parenthood engages in the “illegal sale of aborted baby parts.”[1]
Planned Parenthood engages in “selling baby parts.”[2]

The videos include no credible evidence that Planned Parenthood profits from its fetal tissue donation program.

Despite Daleiden’s three-year effort to entrap Planned Parenthood, he “failed to succeed in convincing even a single affiliate to enter into a procurement contract with his fake company.”[3]
Daleiden offered one Planned Parenthood affiliate $1,600 for two specimens—more than 25 times the amount of expenses affiliates typically recoup—but the affiliate never agreed.[4]
In another attempt to entrap a Planned Parenthood affiliate, Daleiden sent a proposed “transfer agreement” with a “compensation” clause. The affiliate removed that term and added: “Nothing in the Agreement is intended to provide valuable consideration in return for the transfer of the Samples.” Daleiden was “unresponsive” to these revisions and dropped the effort.

I’d say Project Veritas was spot on: they were sued for recording PP, not for libel

I gave a Power Red donation at the Red Cross on March 16th; those folks are always hitting me up for platelet donations and offering gift cards that I don't take them up on. About a week after giving, I came up with a marketing idea for them that I thought would increase willing donors -- that they could & should give feedback as to whether or not antibodies for the novel coronavirus were present in their donors' blood. I know they're testing the blood anyhow. I emailed their senior leadership and reached out to their social media contacts. They didn't implement the idea. Kind of a headscratcher to me why they didn't like what I was proposing to them.

That was a bit early in the game. I gave blood on 4/27 and I asked them about their campaign to get plasma from those who had been infected. The nurse told me that they had gotten 60 donors, but that antibody tests were not used. I’m going to check with them again.

"reducing process friction" seems to be outside the mindset of anyone in health care. Other people's time and environmental load (traffic congestion, growing queues etc) is regarded of no value whereas their own is of immense importance and value. Also the stress on patients over uncertainty seems to be discounted, such as appointments cancelled without prior notification.
That is probably why things like homoeopathy that have no physical basis appear to work in competition with allopathic medicine - that health damaging stress isn't there.

I am like 99.5% confident I had covid (no PCR test, but I had anosmia which is a pretty distinctive symptom, and I live in NYC). Yet the Abbot IgG test showed me antibody-negative. Is my plasma really worthless?

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