ICMR's Head Of Plasma Therapy Research Answers Questions On COVID

Earlier in May, a few days after Delhi chief minister Arvind Kejriwal announced that five critically ill patients suffering from COVID-19 had recovered after being administered plasma therapy, the Indian Council for Medical Research (ICMR) and the Centre issued a strong warning against using plasma from recovered patient as a treatment procedure indiscriminately.

In response Kejriwal said that the Delhi government will not stop clinical trials of plasma therapy. “We are not going to stop clinical trials of plasma therapy. We are getting good results of the therapy. However, it is on trial basis,” he said.

However, several patients have succumbed to the disease despite being administered convalescent plasma.

He went on to add that the government is contacting 1100 people who have recovered from COVID-19 to donate their plasma ‘to save lives’. On social media, families of patients being treated for COVID-19 have been seen seeking donation of plasma, some of who were convinced that would immediately cure their kin.

Aparna Mukherjee, the ICMR scientist leading research on plasma therapy to treat the novel coronavirus, however, wants governments and medical institutions to exercise caution.

In an interview to HuffPost India, Mukherjee explained the process, the challenges involved and warned against overestimating its effects.

Here are excerpts from the interview:

If you had to explain it to a layman, what exactly does plasma therapy for COVID-19 involve?

When a person gets infection by a virus or a bacteria, then the body tries to fight off the bacteria or the virus. While fighting, the body makes a tool to fight the virus or bacteria, which is called antibody. So, when a virus or bacteria attacks us for the first time, there are no antibodies. But during subsequent infections, we have antibodies. These antibodies protect us for a long time from these viruses and bacteria.

This is the way vaccines work. In vaccines, we give a part of the virus or bacteria in an injection. The part is not strong enough to cause the disease, but it enough to make the body produce antibodies, and then, these anti-bodies protect our bodies during future infections.

Currently, there are no vaccines for SARS-CoV-2. But people who are recovering from the disease, will have antibodies against the virus. So, what we are doing is, we will take some of the part of blood which will have these antibodies and give it to patients who are sick and hope that these anti-bodies will protect them. Now, this sounds good in theory, but we do not know, how much it will work in reality.

At what point of the novel coronavirus outbreak in India did you start considering plasma therapy?

Plasma therapy is a known concept which has existed for more than 100 years. We started the discussion for a trial on Convalescent Plasma on 25th March.

At which stage of the disease does administering plasma therapy to a COVID-19 is likely to yield the most result?

We do not know this yet. There are any trials being done across the world. Theoretically, this is a good paper that you could refer to, but again, this is a theoretical paper and we do not have the answer to your question in regards to COVID-19.

When the Delhi government announced that 5 critically ill patients had recovered after being administered plasma therapy, ICMR announced that the treatment was still in experimental phase and should not be used indiscriminately. Could you explain what that means?

We cannot comment on what Delhi government wanted to say. We have not heard exactly what they said, so, will not comment on that. But, at this moment, there is no evidence to support the fact that convalescent plasma works with certainty in COVID 19. We need to do clinical trials to examine whether it works or not. And we need to examine it in the Indian context specifically.

It should not be used outside of clinical trials because we do not know whether it works or not and it definitely has risks associated with it. So, once we know whether it works on not, we can comment on it.

A lot of articles claim that plasma therapy is one of the few treatments that has shown promise in India... countries like US had been trying this for a while, yet their mortality rates kept spiralling out of control, is there any explanation for that?

There are no scientific evidence that it works. Only randomised controlled trials can ascertain whether a particular drug works in a particular disease or not. There are no randomised controlled trials on Convalescent Plasma. ICMR is doing a randomised controlled trial to find out whether it works in the Indian context or not. 

What are the top risks of administering plasma therapy at the moment in India?

There are multiple risks -
1. Plasma itself has certain risks which range from mild allergies to life threatening infections and drop in blood pressure.

2. Plasma can become a legal and ethical issue.

 Are there certain kinds of patients who shouldn’t be administered plasma?

This is to be determined the treating doctor.

I understand you are heading the research on plasma therapy, would you like to share your most promising findings if any? And disappointments?

Not yet.

Is there any evidence still that plasma therapy has worked on patients with severe co-morbidities?

Not yet.

How do you suggest doctors should decide on administering plasma therapy?

They should do it only as part of clinical trial.

Do you think people who are discharged from hospitals after recovering from COVID should be encouraged to donate plasma is that necessary at the moment?

We should not force people to donate plasma. If someone wants to donate plasma for the benefit of clinical trial with a pro-social altruistic attitude, they should donate.

Blood plasma from one recovered person can help how many patients at a time?

First of all it is not known whether or not it will be helpful. Second, usually at a time, around 500ml of plasma can be taken, as plasma unlike blood, is 92% water, and can be donated every 15 days. It is very safe to donate plasma. So, one donation of plasma, can help one patient.