Blood-plasma transfusions could soon be used to treat critically ill COVID-19 patients, doctors at Health City Cayman Islands believe.
The method, which has been used effectively in limited trials, is thought could provide an emergency treatment option for the coronavirus until a vaccine is found.
The process involves transferring antibodies from an individual who has recovered from the virus to someone suffering serious symptoms.
Doctors at the East End hospital have the equipment and the capacity to perform the procedure and are hopeful that blood-plasma transfusions can be made available for COVID-19 patients in the Cayman Islands once further research is completed and the process is approved globally.
The hospital now has an antibody test, which will be used to help determine how many people in the territory have had the virus.
Doctors believe these people will have developed a degree of immunity and would be candidates to be blood-plasma donors.
“The basic principle is that if you get an infection, antibodies develop in the body,” said Dr. Dhruva Kumar, medical director at the hospital.
“Those antibodies will fight with the virus and prevent complications and symptoms.”
Patients fighting a virus develop two types of antibodies.
The most effective antibodies are typically only found in the blood post-recovery, but they stay in the body for months, even years, after and provide some immunity against reinfection.
Preliminary research positive
Kumar said preliminary research, including a joint study by, among others, Johns Hopkins and the Mayo Clinic in the US, had demonstrated that transfusing these antibodies into critically ill patients could work. Initial results from that study, involving 5,000 patients, suggest it is safe in treating severely ill patients.
Research into its effectiveness is ongoing.
“For COVID-19 it has been tested with some promising results,” Kumar said.
“If we take the plasma from the blood and give it to the patient with advanced disease, those antibodies in the plasma can fight with the virus.”
The transfusion effectively “buys time” for the patient to develop immunity naturally. he said.
“They will generate their own antibodies eventually.”
Kumar said the process – known as convalescent plasma therapy – has worked in previous outbreaks, from the 1918 Spanish flu pandemic to the SARS outbreak in 2003.
He said recovered patients effectively “shared their immunity” with people who were sick.
Antibody testing crucial
Knowledge of the coronavirus is still developing and it is not yet clear that someone who gets the virus once can’t be infected a second time. Health City’s Roche analyser machine can only indicate if antibodies are present in the blood.
The samples would have to be sent to Miami to determine the amount of the relevant antibodies, before transfusion.
“This is a must for potential plasma donors because we should know whether the antibody is there in their blood and in what quantity,” said Dr. Binoy Chattuparambil, the hospital’s clinical director.
Research suggests enough antibodies can be drawn from one patient to treat two others.
“You are giving to a patient with severe disease the ready-made plasma full of antibodies that will start fighting with this virus,” he said. “The research on this from other parts of the world is encouraging, especially from patients that are very critical.”
Dr. Jadiyappagoudar Jyoti, pathology specialist at the hospital, said further study was needed to determine the guidelines for using transfusions for the coronavirus.
“Many studies have been conducted, but still more studies have to come and details and guidelines established,” she said. “Once the guidelines are in, we should be able to do in-house convalescent plasma therapy.”
Antibody testing could begin next week
Health City hopes to begin testing patients in Cayman for COVID-19 antibodies within the next week.
Shomari Scott, director of business development at the East End hospital, said the new tests could be used to establish how many people had contracted the virus without even knowing it.
“A lot of times you hear people saying, ‘I had the worst flu ever in December, I think I had it’ or ‘January I couldn’t breathe, I know I had it’,” he said.
Establishing if that is the case is not just a matter of curiosity.
Scott said identifying past infections of COVID-19 could help inform decisions about how and when different sectors of the economy open up and may even allow for a controlled resumption of tourism.