Posted on : May 6, 2020 by Clinic One on COVID-19
Amid the chaos and turmoil caused by Coronavirus throughout the world resulting in a global lockdown, it’s reasonable to explore the avenues of possible treatment for COVID-19 namely Plasma therapy and Antivirals.
Convalescent Plasma Therapy (CPT) which has been on the news recently as a possible cure is simply the administration of blood plasma of patients who have recovered from infection in question. The basic science behind plasma therapy concerning COVID-19 is that a person infected with COVID-19 naturally generates antibodies against the virus in their blood, which makes their blood equivalent to drugs against the same infection.
Moreover, antibodies are produced and present only in plasma (the colorless fluid part of the blood), hence separation of plasma from the blood cells such as RBCs and WBCs is required as a first step. Basically, after the blood of an infected but recovered patient with COVID-19 has been tested for other diseases such as HIV, Hepatitis B, and C, and if found negative, plasma can be extracted and administered to patients with severe COVID-19 infection.
According to Akriti Anand in an article published in 2020, this can be immensely beneficial for high-risk peoples such as family members of an infected patient or health care workers who are at the forefront of infection as it can boost their immunity required to fight the virus by borrowing antibodies from a plasma donor.
What can history teach us?
History suggests that it is not the first time this therapy has been used. Health care workers throughout many generations have been experimenting with the use of convalescent plasma (plasma from the recovered patient) to treat measles, mumps, polio, and influenza.
In addition to the deadly pandemic “Spanish Flu” that spread through 1918 which killed more peoples than World War I had also seen the use of (CPT) as a treatment. It was noted to be effective to reduce the death rate to half when infected people with measles were treated with blood plasma at the initial stage of infection.
Furthermore, pandemics of the 21st century such as MERS, SARS, and Ebola has also been tested with the use of (CPT) but with little success. Dave Roos from History.com states that nevertheless, it yielded in isolation and consequently lab cloning of pair of antibodies now used in the treatment of Ebola but firstly isolated from Convalescent plasma.
Although it’s a ray of hope in the current crisis, it is too early to speculate it as a permanent solution. This is primarily because it is a passive immunization which means it does not last lifelong as compared to vaccines which on the contrary are active immunization.
It has also been compounded by the fact that there have not been enough clinical trials performed to elucidate the efficiency of this treatment. As a result, it has so far been an experimental study for most nations such as the U.S.A, U.K, China, and India that have approved the test for Plasma therapy.
In addition to that, some authentic questions about the optimum volume of plasma to be used and the stage of infection at which plasma should be administered must be answered before we can proceed any further. Moreover, the sample size of the trials conducted has been too small to arrive at any definitive conclusions.
Ray of hope
But not all is gloom with the use of (CPT) in contemporary crisis. Initial reports on the use of (CPT) in China with severely ill patients infected with COVID-19 showed some encouraging results prompting the state of New York to use this century-old treatment procedure into fashion again.
Ashley Collman, in an article in Business Insider, writes that at the very least (CPT) can be used on a severely ill patient to recover faster and curbing the fatality rates while the whole world waits for a vaccine to be developed.
Other Potential Antivirals
SARS-CoV- 2 (a novel coronavirus that causes COVID-19) has yet to be fully understood by the scientific community. Hence, we are unlikely to have a specific drug tailored to suppress it. But since this virus shares 80% homology to Acute Respiratory Syndrome-Associated Coronavirus (SARS-CoV) that originated in 2002 in China, and some structural similarity with Middle East Respiratory Syndrome (MERS-CoV), drugs that showed some positive results in suppressing (SARS-CoV) or (MERS-CoV) can be seen as a potential drug to rescue us in this pandemic.
This leads us with some choices such as “Remdesivir” and “Hydroxychloroquine”, as some potential candidate antivirals that are discussed in this article.
Remdesivir is a broad range of antiviral medication developed by Gilead Sciences; California based Biotechnology Company, first manufactured to treat the “Ebola” outbreak in Africa in 2014. In an article written by Yu-chen Cao, et. al in Elsevier Journal, Remdesivir is a nucleotide analog that can attack and thereby stop the multiplication of this virus by blocking RNA replication and hence its spread.
In other words, since RNA is the core fundamental genetic element of this virus, any drug that can restrict its amplification can be effective in restricting the spread of this virus.
What do the results suggest?
Although “Remdesivir” has only managed to gain “Orphan drug” status until now but the preliminary results makes one optimistic about its use. Results obtained so far carried on a small sample size by National Institutes of Allergy and Infectious Diseases, U.S.A, reveals a 31 percent faster recovery rate of the patients receiving this medication compared to those who did not and in shorter time frame i.e. 11 days compared to 15 days.
Moreover, the mortality rate was also noted to be lowered to 8 percent compared to 11 percent for patients who did not receive this treatment.
Experts seem to be confident in the experience and expertise of Gilead Science to upscale the manufacturing capacity for the drug along with getting the regulators’ approval. This is based on the intellectual property that Gilead has over other contemporary manufacturing companies along with the situational and political superiority that this drug has gained so far. This leaves for the only constraint to be worked at, which is the pricing of the drug so that all peoples from all socio-economic backgrounds could have access to it in these dire times.
Hydroxychloroquine is an antimalarial drug that has gained popularity due to its political billing from the president of the United States, Donald Trump. Although the use of this as a candidate drug against Covid-19 follows the model Conventional drug in new use, it is too early to vouch for its success. This is because scientists are not sure about the antiviral mechanism of this drug on Covid-19 leaving them to speculate over its anti-inflammatory property or its aid on the immune system to fight the virus.
One thing is for sure is that it does not act to prevent the replication of the virus-like Remdesivir does consequently leading to an opinion that the promotion of this drug may just be desperation to find a way out of this pandemic (The Financial Times Limited, 2020).
Nevertheless, a large sample size on clinical trials, definitive statistical results, and a study about its mechanism of action needs to be ascertained for any conclusions to be reached upon.
To conclude, while we are engrossed with an appalling situation with this virus, an intellectual opinion would be to use Plasma therapy with the severely ill COVID-19 patient so that we can improve the chances of their survival and use Remdesivir as medication at an early stage of infection to reduce the chances of the severity of this disease.
By Mohit Thapa
(Masters in Plant and Forest Biotechnology)
Keywords: Plasma therapy COVID-19, Antiviral Drugs for COVID-19
Akriti Anand, (April 20, 2020), what is Plasma Therapy: A possible treatment for COVID-19, India Today
Dave Roos, (2020), Before Vaccines, Doctors Burrowed Antibodies from Recovered Patients to Save Lives, History.com
Yu-Chen Caoa, Qi-xin Denga, Shi-xue Daib (2020) “Remdesivir for severe acute respiratory syndrome coronavirus 2 causing COVID-19: An evaluation of the evidence”, Elsevier Journal, Travel Medicine and Infectious Disease, pp (1-6)
The Financial Times Limited, (2020), Remdesivir: Five things to know about the antiviral drug, Coronavirus Business Update.
The Financial Times Limited, (2020), Trump’s malaria drug hope: ‘game-changer’ or dangerous gamble? Coronavirus Business Update.
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