As Covid-19 cases increase, Delhi hospitals see an increase in plasma therapy
Doctors have warned against plasma therapy being considered a miracle cure, especially in light of an ICMR study which found that the treatment was not associated with any reduction in mortality or progression to severe symptoms of Covid-19Updated: Sep 30, 2020, 10:56 IST
Delhi’s doctors said that they have seen an increase in the number of convalescent plasma transfusions corresponding to the increase in the number of cases over the last two weeks. “We have seen an increase in the number of Covid-19 patients over the last 10 days, even from neighbouring states. Many of them qualify for convalescent plasma therapy and hence there has been an increase,” said Dr Suranjit Chatterjee, senior consultant for internal medicine at Indraprastha Apollo Hospital.
He, however, warned people against thinking that it was a miracle cure. “There are several experimental therapies being administered to patients, so we don’t really know what is working and what is not. In our clinical experience, we have seen some improvements in patients after plasma therapy if administered at the right time,” he said.
When Anand’s 62-year-old father-in-law needed convalescent plasma therapy for coronavirus disease (Covid-19), his friends came to the rescue. “I contacted several NGOs and political party workers whose numbers were being shared online. But I did not find a donor for two days. It was my friends who had recovered from the infection about two months ago who donate plasma,” said Anand, a west Delhi resident who wanted to be identified by his first name only. Doctors have already administered the therapy but his father-in-law’s condition continues to be unstable.
Recently, a study by the Indian Council of Medical Research (ICMR) found that the treatment was not associated with any reduction in mortality or progression to severe disease.
The trial was conducted across the country at 39 public and private hospitals between April and July to determine the effectiveness of the therapy for Covid-19. Convalescent plasma therapy uses an antibody-rich blood component called plasma from a person who has recovered from the infection to aid the immune response of someone still fighting Covid-19.
The study actually supports what Delhi’s phase 1 trial had shown, said Dr SK Sarin, director of Institute of Liver and Biliary Sciences (ILBS) which conducted the study in coordination with Lok Nayak Hospital. ILBS also houses Delhi’s first plasma bank.
“The ICMR study actually reconfirms the findings of our small study—it shows that the oxygen requirement of the patients who received plasma therapy reduced, the duration for which they remained breathless reduced, and the group that received plasma tested negative for the virus quicker than others. What needs to be factored in is that the therapy was administered late, after two days of symptoms in most trial participant; it works best when given early. Also, many of the donors in the study did not have a high titre (concentration) of the neutralising antibodies,” said Dr Sarin.
“For the study, I think a shorter duration (than the original 28 days) has to be chosen because mortality could be because of other complications as well,” he said.
The trial by ILBS and Lok Nayak Hospital—called COPLA 1—where 29 people received either convalescent plasma or fresh frozen plasma without its therapeutic benefits showed that plasma therapy helped stabilise the respiratory rate, improve oxygen saturation, and improve the organ failure score that predicts multi-organ failure.
A large scale study of 400 participants is currently underway at Lok Nayak Hospital and Rajiv Gandhi Super Speciality Hospital in collaboration with ILBS.
At Lok Nayak Hospital, the therapy continues; the hospital has its own plasma bank now. “The ICMR study says that there is a mortality benefit, but other drugs that are being used has also not shown mortality benefits so far. Nowhere does the study recommend that the therapy should be stopped. Our own study has shown encouraging results and what we need to remember from the ICMR trial is that the plasma needs to be given at an earlier stage and not when the patient is on ventilator,” said Dr Suresh Kumar, medical director, Lok Nayak Hospital.
The hospital has so far administered the therapy to 85 people under the trial—meaning half would have received a placebo, not convalescent plasma—and to 59 patients outside of the trial. At Rajiv Gandhi Super Speciality Hospital, 100 people have already received the therapy under trial and a couple received it outside of it. At Guru Teg Bahadur Hospital, the third Delhi government hospital to have a plasma bank, 34 people have received the therapy so far. All three hospitals have plasma banks.