The Who, What, Why (And How You Can Help) of Convalescent Plasma

(*For contact skip to “Leadership.” For links to recent news, skip to the “News Links” section. UPDATE: A lot of messages from wonderful people looking to donate plasma came in, so please forgive me if I can’t respond to every one. More importantly: you can register to donate directly at this link. Or, use this link to find the donor location nearest to you.)

“It only takes a few minutes of conversation to gather that Arturo Casadevall is a beaker-half-full kind of guy.”

That is how I start a section in the last chapter of Range, in which I profile Casadevall, the chair of microbiology and immunology at the Johns Hopkins Bloomberg School of Public Health. He’s a fascinating guy–a Cuban immigrant who has a degree in pest control (his father thought he should have something to fall back on), and insists on discussing his years at McDonald’s in job interviews. In February, as it became increasingly clear that the coronavirus in the U.S. would not be contained, rather than joining the torrent of voices haggling over precisely what level of doom we might face, Casadevall went beaker-half-full. With a group of intrepid colleagues (see “Leadership Team” below), he started a now 40-institution collaboration that includes academic medical centers, two pharmaceutical companies, and logistical help from Amazon to conduct clinical trials on an innovative treatment for COVID-19. That team, which self-organized in days, comprises the National COVID-19 Convalescent Plasma Project. This page is a temporary site for information (below) about the project, and for anyone who might be interested in donating either blood plasma (here) or emergency funding (contact me and I’ll connect you to a team leader) to this unprecedented grassroots collaboration.

**(UPDATE: The collaboration now involves more than ~~1,400~~ 2,000 institutions, from large academic medical centers to community hospitals. One of the project leaders recently shared a map of participating sites. In 10 weeks, the project went from non-existent to having treated 11,000 patients.)

BACKGROUND

With respect to the new coronavirus, humanity is in the age of pre-vaccine medicine. In February, in a Wall St. Journal op-ed and a subsequent journal article, Casadevall proposed using “convalescent plasma” to treat COVID-19. That is, recovering patients have produced antibodies (that is why people get immunity after recovering), which can be transferred to others who are sick or who might become sick. It is, essentially, sharing immunity, and stemmed pandemics in pre-vaccine days, including of measles, which is far more contagious than the new coronavirus.

No other treatment can be mobilized as widely and quickly, which is why the National Academies of Sciences, Engineering, and Medicine called convalescent serum “especially promising” among emerging COVID therapies. The FDA, meanwhile, has authorized emergency “expanded access” use of the therapy on a case-by-case basis, effective immediately, to be coordinated by the Mayo Clinic.

PROJECT STATUS

What began as a grassroots collaboration among colleagues is now the National COVID-19 Convalescent Plasma Project. Under the FDA’s emergency compassionate use authorization, the first patients were treated in Houston and New York City in early April, and several clinical trials are ~~in preparation~~ now underway. Those trials will test convalescent plasma at different stages of illness, and for prophylactic use to protect healthcare workers before they become sick. So far, two small studies (1, 2) out of China suggest that convalescent plasma helped patients and produced no adverse side effects. However, those are not randomized trials and–just like the initial studies of hydrochloroquine–cannot prove that convalescent plasma works.

Of course, everyone hopes for a vaccine as soon as possible. But the first vaccine in trials would not be widely available until 2021 at the earliest, even if it works perfectly. (And, unfortunately, there is no guarantee that researchers will create an effective vaccine at all. Malaria is thought to have killed several percent of all humans who have ever lived, and there is still no effective vaccine.) Convalescent plasma can be tested and widely deployed to patients and front-line healthcare workers around the country within weeks.

THE NEEDS

Plasma from people who have recovered from COVID-19. If you would be willing to donate, please register here, and the team will match you with a collection location.
Emergency funding for trials at five different centers. Most traditional funding mechanisms aren’t built to work quite so quickly, never mind that places like NIH are being bombarded with requests as staff work remotely. Those funding mechanisms may catch up, but an infusion of emergency funding would mean that convalescent plasma can be tested and deployed more rapidly. Needless to say, time is of the essence. And proper clinical trials are both expensive and critically important. If convalescent plasma is proven to work, then it will be a breakthrough that goes beyond COVID-19; it will become a frontline therapy to treat outbreaks of new infectious diseases in the future. Bloomberg Philanthropies and the State of Maryland already combined to donate $4 million, and the NBA pledged $100,000 and sent a message to all 30 teams encouraging players who have recovered to donate plasma. Additional funding is needed to pay for five registered-nurse study coordinators; ten certified research coordinators; three senior program coordinators; fifteen research technologists, and more supplies involved in donor screening, and plasma collection and transfusion. (**UPDATE: UnitedHealth Group and The Moriah Fund have added to the funding for treatment and trials.)

LEADERSHIP

(*If you need to reach a member of the leadership group and haven’t been able to, please tweet at me @davidepstein and we’ll figure it out, or email me at rangewidely@gmail.com. Please include “CONVALESCENT PLASMA” in the subject, as that address is regularly overwhelmed. Thank you!)

The National COVID-19 Convalescent Plasma Project is a collaboration of 40 (UPDATE: now more than 1,400) institutions around the country, two pharmaceutical companies, and logistical support from Amazon. The eight-person leadership group includes:

Arturo Casadevall MD, PhD (Chair), Johns Hopkins University
Benjamin Chen MD, Mount Sinai School of Medicine
Brenda J. Grossman, MD, MPH, Washington University School of Medicine
Michael J Joyner, MD, Mayo Clinic School of Medicine
Jeffrey P Henderson MD, PhD, Washington University School of Medicine
Nigel Paneth MD, MPH, Michigan State University
Liise-anne Pirofski, MD, Albert Einstein College of Medicine
Shmuel Shoham MD, Johns Hopkins University

NEWS LINKS

**(UPDATE: The first studies of convalescent plasma are now being published, and are linked below. They document use cases of plasma in Asia. These early papers are encouraging case studies, but not the kind of causal proof that can only come from a larger trial.)

JOURNAL ARTICLES:

First Peer-Reviewed Paper of Convalescent Plasma Use in the US (tl;dr: safe, promising, but we need to see results of the randomized controlled trials that are underway)
Data From 5,000 Patients Demonstrates Safety of Convalescent Plasma (note: this article is a preprint, and has not yet been peer-reviewed
Treatment With Convalescent Plasma in Wuhan, China
Use of Convalescent Plasma on Two Patients in Korea
Convalescent Plasma in Severe COVID-19 Patients in China
Treatment of Four Critically Ill Patients in China

NEWS ARTICLES: