The COVID-19 pandemic has disrupted planetary health and put the existing political fault lines on steroids. We don’t know how long the current impasse will last or whether the contagion will abate in the summer. We are living in a dangerous interregnum. There is no better way to describe the current reality and mood than recalling Antonio Gramsci: “the crisis consists precisely in the fact that the old is dying and the new cannot be born; in this interregnum a great variety of morbid symptoms appear.”
A new vaccine may be 12 to 18 months away. New or repurposed drugs are in development but require testing in diverse populations prior to worldwide use. At least an interim solution is required much sooner, before a vaccine is available. Otherwise, we might run a collision course in planetary mental health and face a contagion of social conflicts, too.
What would an ideal cure for COVID-19 look like, medically and sociologically?
I suggest it should be a ‘two-in-one’ cure, (1) restoring human biology, and (2) reinstating trust in society, thus enabling collective action to stem the pandemic.
Such a solution might be available sooner than what the current dark clouds on the planet suggest. There are now growing numbers of COVID-19 survivors anticipated to have coronavirus-neutralizing antibodies in their blood. Administration of plasma obtained from consenting survivors’ blood can, potentially, make the recipients immune to coronavirus immediately, for a period that may last weeks or months. It can prevent healthy persons from getting the virus or help treat patients with COVID-19. This is particularly valuable to protect older people; nurses, physicians and laboratory technicians and thus help prevent the collapse of health systems; and those who care for friends and family sick with COVID-19 at home.
On March 19, an Investigational New Drug Application was filed with the United States Food and Drug Administration (FDA) by a team led by Arturo Casadevall at Johns Hopkins University in Baltimore for clinical testing of the human convalescent plasma. Results may be available as early as summer 2020.
Will it work? Is it safe?
There are over 100 years of science history and experience in using convalescent plasma or serum from recovered patients, for prevention and treatment of the same disease in others. Before the development of antimicrobial therapy in the 1940s, convalescent sera was one of the ways in which physicians could effectively fight infectious pathogens such as polio, measles, mumps and the 1918 influenza virus.
In the 21st century, convalescent plasma continues to play an important role in medicine, especially when there is no established intervention available. For example, convalescent serum treatment reduced mortality in the 2009-2010 H1N1 influenza virus pandemic. In the 2013 Ebola virus epidemic in West Africa, convalescent whole blood treatment prolonged patients’ survival. In SARS, convalescent plasma improved the health outcomes in Hong Kong, if administered early in the course of the illness. Moreover, anecdotal data from China in a sample of 245 patients with COVID-19 suggest convalescent serum improves clinical symptoms.
A nice feature of the convalescent plasma therapy approach is that it can synergistically build on existing blood bank services in a country. Modern blood banks can safely screen for blood-borne pathogens and prevent transfusion reactions by matching the blood type of donors and recipients.
When used for treatment of patients with COVID-19, there may be a risk for plasma transfusion-related acute lung injury. Survivors donating their plasma should be confirmed to be clear of COVID-19, by clinical examination as well by molecular testing for the coronavirus in their respiratory system and blood.
After recovery from an infection, people differ from each other in the extent to which they produce virus-neutralizing antibodies. Hence, COVID-19 survivors should be tested for antibody titers in their blood, before they donate plasma. Using the plasma samples with high antibody titters would boost our chances to prevent or treat COVID-19.
In an article published on March 13 in the Journal of Clinical Investigation, Arturo Casadevall and co-author Liise-anne Pirofski note that the benefits of convalescent plasma therapy in those at high risk for or with early COVID-19 disease outweigh the risks.
The researchers anticipate one COVID-19 survivor’s plasma could help treat two sick patients. When it is used for prevention, the plasma from one survivor might protect more than two persons. Current research will answer these questions in the coming weeks.
Opening up space for new solidarities
A wonder drug for COVID-19 should restore not only biology but also the broken trust and social contract in society. This was my premise at the beginning. Insofar as restoring biology is concerned, the human convalescent plasma, if proven safe and effective, is of broad interest to Turkey and the world for COVID-19 prevention and treatment until vaccines and drugs become available.
As far as trust and social contract are concerned, they are the ingredients of a healthy democracy and the collective action sorely required to stem the pandemic. We have witnessed over the past few weeks the devastating consequences when the politics and power-laden nature of COVID-19 testing were ignored around the world, pouring gasoline on the fire of the pandemic.
The convalescent plasma approach, if brought to life by early summer, will also have sociological effects. It will bring convalescent serum donors and recipients from diverse politics and walks of life together, potentially creating new solidarities and social dynamics. One can think of many examples in Turkey and elsewhere.
Of course, it is also conceivable that individuals, institutions and countries may attempt to sell the COVID-19 convalescent plasma as a neoliberal commodity and at prohibitive prices, rather than seeing it as a public good to be shared by consenting persons for solidarity and mutual aid.
Still, on balance, the prospect of helping others through plasma donation might surely open up constructive spaces for new forms and formats of solidarity in historically entrenched and divided political landscapes.
All hands on deck for science and society
Hot development: The Food and Drug Administration will reportedly allow doctors across the United States to begin using plasma donated by COVID-19 survivors to treat patients who are critically ill with the virus, under new emergency protocols approved on March 24.
The public blood banking sector in Turkey should prepare –now- as the numbers of COVID-19 survivors willing to donate convalescent plasma will likely increase by early summer.
In my personal view, the convalescent plasma might be our best option at the moment, testable in a matter of few months, until vaccines and drugs are broadly available.
Diplomat of the American Board of Clinical Pharmacology and Editor-in-Chief, OMICS: A Journal of Integrative Biology, New York.