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miércoles, 28 de octubre 2020
28/10/2020
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Can plasma from recovered patients help treat COVID-19?

Laura María Ayala
El Colombiano Newspaper
Translation by José López


Why a century-old treatment is being explored for possible treatment and prevention of COVID-19?

The slight flutter of the wings of a butterfly can be felt on the other side of the world", says a Chinese proverb known as the Chaos Theory. In Wuhan, China, a bat apparently transmitted coronavirus to another animal - perhaps a pangolin - and it in turn transmitted the virus to people. On December 31, 2019, China reported 27 cases of severe pneumonia of unknown cause. Almost five months later, a virus known as SARS-CoV-2 has infected nearly three million people worldwide, and more than 200,000 have died (Johns Hopkins University).

The mutation of a coronavirus, an infectious agent that measures less than one-thousandth of the width of a human hair, was enough for the "butterfly effect" to hit every continent except Antarctica. Thus, the "bug" continues to shake everything that crosses its path, from governments, health systems and economies, to the scientific community, businessmen and ordinary citizens around the world.

From his laboratory at the Center for the Study of Autoimmune Diseases – CREA - at Universidad del Rosario in Bogotá, Dr. Juan Manuel Anaya, Immunologist, PhD, member of Misión de Sabios (a government-run program for the development of science, technology and innovation) talks about the impact of the COVID-19 pandemic.

Dr. Anaya looks for clues in a treatment used 100 years ago to ward off the Spanish Flu. Perhaps plasma from recovered patients could help treat COVID-19 until a vaccine is found.

The treatment was widely deployed during the Spanish flu pandemic in 1918. It was also used later to fight against the Ebola virus and SARS, which is caused by another type of coronavirus. This is something that can be done very quickly, it basically involves donating and transfusing plasma - the liquid element of the blood that contains antibodies and proteins - from recovered patients to those who have developed COVID-19.

People who have survived a virus (convalescent) develop antibodies in the blood that can quickly detect and destroy the virus if it re-emerges. This therapy could be of great help to individuals with active COVID-19 whose immune response is insufficient. Currently, in the absence of drugs with proven efficacy to eradicate SARS-CoV-2 and without the certainty that a vaccine will be found soon, researchers from all over the world are looking to revive a century-old therapy known as "convalescent plasma".

Clinical trials are being conducted in China, the United States, Italy, Iran, Mexico and Colombia. In Colombia, the trials are being led by Dr. Juan Anaya. On the other hand, an interdisciplinary team of researchers from several institutions including the Center for the Study of Autoimmune Diseases (CREA) at Universidad del Rosario; Universidad CES; the Institute of Science, Biotechnology and Health Innovation (IDCBIS); and Fundación Universitaria de Ciencias de la Salud, launched the PC-Covid-19 project, which is responsible for the transfusion of plasma to COVID-19 patients whose condition is not yet critical, that is, individuals who are hospitalized but don't need to be referred to an intensive care unit.

It is important to clarify that this therapy is not a cure for COVID-19. In this regard, Dr. Anaya states that about 80 percent of patients may not have any symptoms and have mild disease. Convalescent plasma therapy is aimed at helping symptomatic patients respond effectively against infection. Dr. Anaya explains that in the case of Colombia, this therapy is aimed at patients who are not severely ill and, therefore, could recover without sequelae, as well as prevent the disease from progressing towards more severe phases and eventually to death.

"The PC-Covid-19 project will become the first randomized, controlled study, that is, it is intended to determine whether, in addition to conventional therapy, the plasma from recently recovered patients is more effective than conventional therapy alone". If proven effective (using rigorous, validated clinical criteria) and its effect on viral load are demonstrated, a great advance in the fight against the disease would be achieved.

"It could be implemented as initial treatment for hospitalized patients with mild COVID-19 and thus reduce the morbidity and mortality rates of the new coronavirus. It would also help promote social cohesion, flatten the epidemic curve, shorten the hospital stay and reduce the use of medical personnel as well as the need for ventilators, intensive care units and, last but not least, facilitate the gradual return to everyday life," says Dr. Anaya.


Dr. Juan Manuel Anaya, Immunologist, PhD, member of Misión de Sabios, director of the Center for the Study of Autoimmune Diseases at the School of Medicine, Universidad del Rosario. Photo: Universidad del Rosario  

Here is the interview with Dr. Anaya

Do you feel threatened by the new coronavirus?
Of course. However, it is important to note that 80 percent of cases are mild or asymptomatic.  If I get infected I hope to be part of those who will not be seriously affected by the virus.

When will we know that the pandemic has already been overcome? Do you think it is possible that in the coming months it will be announced that a cure has been found?

It is estimated that more than half of the Colombian population will become infected by the virus (some predict that this number will be lower, but others estimate that it can reach up to 80 percent). Similarly, some countries have not taken the same measures at the same time, which means that many will have to spend Christmas at home. Therefore, the news that the pandemic has been overcome, will occur first in those countries where people have quarantined responsibly.

Will we learn to cope with the novel coronavirus?
The novel coronavirus is here to stay; therefore, it is safe to say that we will have to learn to deal with this low-level endemic disease (one that emerges in a given region, either permanently or periodically). What we should ask ourselves is when will we get infected, instead of when. We must not forget that we have not yet overcome other communicable diseases such as malaria and dengue, among others.

If mass contagion is imminent, could the so-called "herd immunity" help to stop the pandemic?
With regard to SARS-CoV-2, it has been estimated that herd immunity will be achieved when more than 70 percent of the population has been infected and, therefore, becomes immune to the virus (providing that reinfection will not occur). The purpose of vaccination is to increase the level of herd immunity; however, in the absence of a vaccine against COVID-19, the only option available so far is that many patients overcome the disease so that the virus does not easily find someone susceptible to infect, thereby slowing transmission.

Could an eventual flattening of the curve lead to the relaxation of isolation measures?
The relaxation of measures could result in dire consequences, especially for the healthcare system, which in fact is already insufficient. Trying to flatten the curve is the best possible option at the moment.

John Ioannidis, a renowned epidemiologist and professor at Stanford University School of Medicine claims that the lack of accurate data has led authorities in 130 countries to take "draconian measures" that could be quite detrimental to public health. How has the national government dealt with this pandemic?
Several governments in the world, including the Colombian government, are not doing what they should but what they can do. The behavior of some leaders in the face of the pandemic has been somewhat erratic, and although in general they have had good intentions and have taken valuable actions they have also made some mistakes. In the case of Colombia, for example, it is worth mentioning the delay of more than two months in the appointment of the Minister of Health while the outbreak began to move forward. Likewise, the late closure of El Dorado airport; the lack of effective coordination between the national government, mayors and governors; the rush to make certain decisions; as well as disregarding the importance of the Ministry of Science, Technology and Innovation. Today the Government recognizes that the calculations may vary from one day to the next, and therefore, policies must be adjusted accordingly. This is because we are learning to know both the behavior of the virus and the evolution of the pandemic.

President Trump insists that hydroxychloroquine, an antimalarial medicine, could be a breakthrough drug to treat COVID-19.
If mass contagion is imminent, could the so-called "herd immunity" help to stop the pandemic?
With regard to SARS-CoV-2, it has been estimated that herd immunity will be achieved when more than 70 percent of the population has been infected and, therefore, becomes immune to the virus (providing that reinfection will not occur). The purpose of vaccination is to increase the level of herd immunity; however, in the absence of a vaccine against COVID-19, the only option available so far is that many patients overcome the disease so that the virus does not easily find someone susceptible to infect, thereby slowing transmission.

If you were the President of Colombia, what measures would you implement immediately and in the medium term?
It is essential to guarantee the safety and quality of the work of the healthcare personnel. They must be provided with quality, timely training as well as being permanently equipped with biosafety elements. As essential workers they should be paid fairly and in a timely manner. It is also important to guarantee the delivery of supplies for the diagnosis and treatment of COVID-19 patients and continue to provide medical care to other patients, mainly the chronically ill, and those with serious health conditions not related to COVID-19. It is expected that at the end of the pandemic the country will go through a great recession, but on the other hand, we will not end with many deaths. Similarly, issues such as the release of monopolies of products of public interest must be addressed. After the pandemic, we will have to work and take actions to solve the recession that has already started”.

WHO urges countries to perform mass-testing for COVID-19. Is Colombia conducting enough tests, especially in asymptomatic people?
Unfortunately, not.

Why? Does this have to do with financial issues?
It is a public policy problem rather than a financial problem since the government did not choose to carry out massive tests, but also, and above all, it is a problem related to human resources, installed capacity and supplies”.

Regarding COVID-19, what are the most important facts that remain to be known?
The most important thing now is to find a vaccine. Second, the finding of effective treatments. The pandemic has put science to the test as never before, the same is happening with the performance of governments around the world.

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