Many Gurugram patients seeking plasma therapy, but it is no magic bullet: Doctors

At present, India’s premier biomedical research body, the Indian Council of Medical Research (ICMR), has authorised at least 30 hospitals across the country to conduct clinical trials of the treatment.

Doctors at privately-run dedicated Covid-19 hospitals in Gurugram say that many patients were interested in seeking convalescent plasma therapy, a promising yet unproven treatment, to treat the disease.

Doctors say the treatment has come to be perceived as a ‘silver bullet’, particularly among relatives of critically ill patients, which is not the case. (Reuters file photo. Representative image)

At present, India’s premier biomedical research body, the Indian Council of Medical Research (ICMR), has authorised at least 30 hospitals across the country to conduct clinical trials of the treatment. In Gurugram, it is the Medanta Hospital in sector-38. Here too, doctors say, it is a challenge to finding donors.

Convalescent plasma therapy, in which antibody-rich plasma from recovered patients is injected into recovering individuals to help them stave off infection, has previously been used during the Sars and Mers outbreaks (which were also caused by viruses in the same family as the coronavirus Sars-CoV-2 that causes Covid-19).

Plasma is a major component of a person’s blood, making up almost 55% of it. A plasmapheresis machine separates it from the blood and returns the rest -- the red blood cells, white blood cells and platelets -- back into to the donor who typically supplies 300-500 ml of plasma, and the transfusion process takes between 60-90 minutes.

With the rising interest, many citizens have organised themselves on WhatsApp, Twitter and even on web portals designed to meet the demand.

Rajat Toor, a Delhi-resident who has been involved in connecting donors with patients, said, “A relative of mine required a plasma for treatment at a hospital in Saket. I posted about it online, and since then many inquiries have been coming in, from recovered patients who wished to donate but also from people seeking plasma. Now I am currently seeking donors for two patients under treatment, one in Delhi and the other in Gurugram.”

Doctors say the treatment has come to be perceived as a ‘silver bullet’, particularly among relatives of critically ill patients, which is not the case.

A pulmonologist at a prominent private hospital in Gurugram, who is directly overseeing the treatment of Covid-19 patients, said, “Recent stories in the media, celebrating isolated success cases from across the country, seems to have stoked people’s interest in plasma therapy. While it holds a lot of promise, the evidence to widely administer is still being pursued. We are having to turn down multiple inquiries every day.”

Dr. Rajesh Kumar, epidemiologist and former professor of community medicine at PGIMS, Chandigarh, who is assisting the Punjab government in its response to the pandemic, pointed to recent examples of plasma therapy-led recoveries of patients in Punjab, Kerala, and more recently at PGIMER, Chandigarh, where a 60-year-old man from Kurukshetra recovered. “These examples are promising, but patients and their relatives should be careful to not grasp at straws. Physicians should be trusted to find the best course of treatment, depending on the patient’s need,” Kumar said, adding that more widespread use of convalescent plasma is still some time away.

Another doctor at a private hospital said, “We have one 84-year-old man whose son has been pleading with us to start plasma therapy. He even managed to find a donor from Delhi. When we told him it was not possible, as we do not yet have permission to administer it, he tried to shift his father to another private hospital in the city where it is available. But the patient is already on the ventilator so that would endanger his life even more.”

Dr. Sushila Kataria, an internist at Medanta Hospital, said, “Patients and their relatives are seeking this treatment, but we cannot administer it to everyone. The criteria for ICMR’s clinical trial is very strict in terms of the patient’s age, and at which stage of the disease they are at, and so on. Not all patients meet this criteria. In certain cases, and only where required, we are administering ‘off-label’ use of plasma therapy.” Off-label application of the therapy for treating patients in moderate stage of criticality was recently approved by the union health ministry.

Then there is the other challenge of finding donors.

“It is not possible to harvest plasma from (cured) patients while they are (still) under treatment. It has to be done about two weeks after recovery, at which stage people are reluctant to come back to hospitals,” Kataria said. She added that, at Medanta, it was initially recovered health workers who were donating plasma.

Mohit Tandon, whose 74-year-old mother, Sudha Tandon, died due to the virus at Medanta Hospital last week, said, “We were offered the option of plasma therapy when she was critically ill, and were told to find donors. This turned out to be quite hard. You have to find someone of the same blood group, scrutinise their health history, and appeal to their goodwill. I eventually approached an NGO in Delhi which is helping connect patients with plasma donors. Most people I contacted myself were simply not willing.”

Immediate relatives of at least four other patients who have received plasma therapy at Medanta said they faced similar issues, and were compelled to rely on the help of NGOs and volunteers to find suitable donors.

Manish, who went by only his first name whose sexagenarian father is currently under treatment at Medanta, said, “It was much harder for us because my father has a rare blood type, and it took us three days to find the right person.”

Manish, who is a resident of Dwarka in East Delhi, said, “I chose to admit my father in Gurugram precisely because the option of plasma therapy was available there, and government hospitals in Delhi had no beds available. I know at least two other Delhi residents who chose treatment in Gurugram because of these reasons.”