Story at a glance
- The FDA granted emergency use authorization for convalescent plasma as a treatment for COVID-19.
- Health experts are hesitant about it.
- We need clinical trials for convalescent plasma to truly understand whether it’s good or bad for people infected with SARS-CoV-2.
Months ago, Changing America explored how convalescent plasma from recovered COVID-19 patients might be used to help treat patients before their cases get serious. Since then, doctors and researchers have been testing it out in clinical trials to see if it is effective.
Experts warn that convalescent plasma may not work for COVID-19, but the data suggests there may be a benefit.
“The data we gathered suggests that patients who were treated early in their disease course, within three days of being diagnosed, with plasma containing high levels of antibodies, benefited the most from treatment. We saw about a 35% better survival in the patients who benefited most from the treatment,” says U.S. Health and Human Services Secretary Alex Azar, according to CNN.
However, it’s not enough or even appropriate to compare survival rates at this time. More robust randomized clinical trials with placebos are necessary to show that it is effective and not harmful.
“The problem is, we don’t really have enough data to really understand how effective convalescent plasma is,” said Jonathan Reiner, professor of medicine at George Washington University, to CNN.
The Federal Drug Administration (FDA) initially did not give emergency use authorization for convalescent plasma. But after what appears to have been pressure from the White House, the FDA reversed and gave the authorization. The FDA’s commissioner Stephen Hahn recently admitted that he overstated the benefits of using convalescent plasma as a treatment for COVID-19.
Why this matters
Part of why experts may be hesitant to endorse convalescent plasma as a treatment is that it may not be very precise and the effects can be positive or negative. Blood has to be donated by recovered patients then separated from the plasma and tested for antibody levels. The antibody content in blood may vary widely from person to person.
For Ebola, for example, convalescent plasma was actually harmful.
I had Ebola and was treated with convalescent plasma. It was before we had good data on it. And it actually made me worse.
Convalescent plasma has an incredible history & works for many diseases.
But it didn’t for Ebola. And might not for Covid.
Only good science can tell us. https://t.co/5yBuXmD9q6
— Craig Spencer MD MPH (@Craig_A_Spencer) August 23, 2020
In epidemic or pandemic situations, it may seem like doctors should be trying anything that could potentially work. “They engage in what I call ‘panic prescribing,’ leaving the world with no idea if convalescent plasma does anyone any good or not,” writes bioethicist Arthur Caplan of New York University in an opinion for STAT. This suggests that in the rush to do something, we could be bypassing good science and the opportunity to really test ideas.
There’s still a lot we don’t know about convalescent plasma in regards to the coronavirus. “No one knows how much plasma to give, who is a good donor, when is the best time in the disease course to transfuse convalescent plasma, how much, if any it actually improves survival, who are the best candidates for convalescent plasma, and whether it should be tried in combination with other therapies,” writes Caplan.
Slow your roll
It’s very difficult to name any one reason why one person survived COVID-19 and someone else did not. A phrase borrowed from crime investigations that might apply is “circumstantial evidence.” It is evidence that is not derived from direct observation and requires making an inference. Any good mystery does not end with the first collection of circumstantial evidence. It might give you some leads and allow you to dig deeper to find direct evidence, but your work is not done.
People may feel less anguish if some action, any action, is taken, and it’s understandable that they would want the best care for their loved ones. But we can’t rush into something that could potentially harm them. Caplan writes, “Panic is not the way to identify treatments for Covid-19.”
For up-to-date information about COVID-19, check the websites of the Centers for Disease Control and Prevention and the World Health Organization. For updated global case counts, check this page maintained by Johns Hopkins University.
You can follow Chia-Yi Hou on Twitter.
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