New blood plasma Covid-19 treatment set to be trialled at London hospital

Hundreds of NHS coronavirus patients will be given the blood of virus survivors as part of a new treatment being trialled at London’s Guy’s and St Thomas’ hospital.

The hope from the trial, which has now started, is that antibodies in recovered patients’ blood can bolster the struggling immune system of infected people.

The treatment – used for around a century for other infections – works using the liquid part of the blood, known as convalescent plasma.

This antibody-rich plasma is injected into critically unwell COVID-19 patients who are struggling to produce their own antibodies, with hopes it can help clear the virus.

Last week, NHS Blood and Transplant began collecting blood from survivors – including Health Secretary Matt Hancock, who fell ill with the virus in March.

There is currently enough plasma to treat 143 patients and transfusions will begin in weeks, according to hospital bosses.

If effective, the treatment would be scaled-up nationally to provide up to 10,000 units per week, enough for 5,000 patients.

Hundreds of NHS coronavirus patients will be given the blood of virus survivors as part of a new treatment being trialled at London’s Guy’s and St Thomas’ hospital. Health Secretary Matt Hancock posted the image on Twitter as he donated last Saturday

NHS Blood and Transplant (NHSBT) photos show former patients making the donation in a process known as plasmapheresis. Pictured: Laura Martin at Tooting Blood Donor Centre, south west London on Monday

Guy’s and St Thomas’ Hospital in London said it has enough plasma donations to treat 143 patients – but if the trial is effective this will be scaled up nationally

More than 6,500 people have registered their interest to take part in the trial in London.

Donating takes around 45 minutes and medics filter the blood through a machine to remove the plasma, in a process known as plasmapheresis.

Donors must have tested positive for the illness either at home or in hospital, but should now be three to four weeks into their recovery, ideally 29 days.

The promising therapy, which was first used a century ago in the 1918 Spanish flu pandemic, has been used already in China and the US.

What happens during plasmapheresis

Plasma exchange is carried out by a specially trained nurse. A person’s vital signs (temperature, blood pressure, pulse and oxygen levels) are checked before, during and after the exchange and any changes will be recorded.

During the procedure, a patient is monitored for any side effects and the appropriate treatment is administered if needed. An Optia machine automatically takes the blood, spins it, collects the plasma into a bag and returns fresh plasma or albumin to the person, along with their blood cells.

The patient is asked to remain on a bed throughout the procedure and to stay fairly still. This is to ensure a smooth flow of blood being removed from the veins and replacement fluid being returned.

But the person should be able to sit up on the bed to read, eat or drink while they are connected to the exchange machine. Once the main part of the exchange is complete, the remaining fluids are returned and the person is disconnected from the machine.

Source: NHS

When someone contracts coronavirus, their immune system produces antibodies which attack the virus.

The antibodies build up over a month and are stored in the plasma, ready to be released if the virus enters their body again.

There is no cure for the killer coronavirus and thousands of patients worldwide are involved in trials of promising medicines.

A key advantage to the blood based therapy is that it’s available immediately and relies only drawing blood from a former patient.

It is also significantly cheaper than developing a new drug, which costs millions to take through trials and regulation before mass production.

Infusing patients with blood plasma has also been used to tackle SARS and MERS, two similar coronaviruses, as well as the deadly infection Ebola.

Plasma makes up around 55 per cent of all blood volume and provides the liquid for red and white blood cells to be carried around the body in.

By injecting this into patients it can provide their bodies with a vital dose of crucial substances called antibodies.

Antibodies can only be created by people who have already been infected and learnt how to fight off an infection, such as SARS-CoV-2.

It may be the best hope for COVID-19 patients while scientists work to develop new, specific treatments for the disease.

The first donations of the plasma in the UK have been collected and transfusions will begin in ‘the coming weeks’, Guy’s and St Thomas’ Biomedical Research Centre said.

The treatment – used for around a century for other infections – works using the liquid part of the blood, known as convalescent plasma. The yellowy liquid is removed from former patients’ blood. Pictured, Dr Zhou Min shows his plasma after donating in Wuhan, China

The process uses a machine similar to those used in regular blood platelet donation to collect the sample. Pictured: Rebecca Mascarenhas donating her plasma in Tooting last week

Left: Recovered coronavirus patient Douglas James making his donation in Tooting. Right: Plasma that has been extracted

The hospital says if the trials prove the treatment to be effective, NHS Blood and Transplant will begin a national programme to deliver up to 10,000 units of convalescent plasma per week to the NHS, enough to treat 5,000 patients each week.

The trial is co-led by Dr Manu Shankar-Hari, a consultant in intensive care medicine at the hospital, along with experts from NHS Blood and Transplant and the University of Cambridge.

Dr Shankar-Hari said: ‘As a new disease, there are no proven drugs to treat critically ill patients with COVID-19. Providing critically ill patients with plasma from patients who have recovered… could improve their chances of recovery.’

Health Secretary Matt Hancock said: ‘This global pandemic is the biggest public health emergency this generation has faced and we are doing absolutely everything we can to beat it.

‘The UK has world-leading life sciences and research sectors and I have every hope this treatment will be a major milestone in our fight against this disease.

‘Hundreds of people are participating in national trials already for potential treatments and the scaling up of convalescent plasma collection means thousands could potentially benefit from it in the future.’

Previous research has suggested that antibodies drawn from the blood of COVID-19 survivors improves the symptoms of patients severely ill with the disease.

Scientists in China who carried out the preliminary study said no serious adverse reactions were observed after convalescent plasma transfusion.

Ten patients received a 200ml dose of plasma, and researchers said all clinical symptoms, which also included fever and cough, subsided within three days.

WHAT IS CONVALESCENT PLASMA AND WHERE HAS IT BEEN USED?

Convalescent plasma has been used to treat infections for at least a century, dating back to the 1918 Spanish flu pandemic.

It was also trialed during the 2009-2010 H1N1 influenza virus pandemic, 2003 SARS epidemic, and the 2012 MERS epidemic.

Convalescent plasma was used as a last resort to improve the survival rate of patients with SARS whose condition continued to deteriorate.

It has been proven ‘effective and life-saving’ against other infections, such as rabies and diphtheria, said Dr Mike Ryan, of the World Health Organization.

‘It is a very important area to pursue,’ Dr Ryan said.

Although promising, convalescent plasma has not been shown to be effective in every disease studied, the FDA say.

Is it already being used for COVID-19 patients?

Before it can be routinely given to patients with COVID-19, it is important to determine whether it is safe and effective through clinical trials.

The FDA said it was ‘facilitating access’ for the treatment to be used on patients with serious or immediately life-threatening COVID-19 infections’.

It came after New York Governor Andrew Cuomo said that plasma would be tested there to treat the sickest of the state’s coronavirus patients.

COVID-19 patients in Beijing, Wuhan and Shanghai are being treated with this method, authorities report.

Lu Hongzhou, professor and co-director of the Shanghai Public Health Clinical Centre, said in February the hospital had set up a special clinic to administer plasma therapy and was selecting patients who were willing to donate.

‘We are positive that this method can be very effective in our patients,’ he said.

Meanwhile, the head of a Wuhan hospital said plasma infusions from recovered patients had shown some encouraging preliminary results.

The MHRA has approved the use of the therapy in the UK, but it has not been revealed which hospitals have already tried it.

How does it work?

Blood banks take plasma donations much like they take donations of whole blood; regular plasma is used in hospitals and emergency rooms every day.

If someone’s donating only plasma, their blood is drawn through a tube, the plasma is separated and the rest infused back into the donor’s body.

Then that plasma is tested and purified to be sure it doesn’t harbor any blood-borne viruses and is safe to use.

For COVID-19 research, people who have recovered from the coronavirus would be donating.

Scientists would measure how many antibodies are in a unit of donated plasma – tests just now being developed that aren’t available to the general public – as they figure out what’s a good dose, and how often a survivor could donate.

There is also the possibility that asymptomatic patients – those who never showed symptoms or became unwell – would be able to donate. But these ‘silent carriers’ would need to be found via testing first.

Japanese pharmaceutical company Takeda is working on a drug that contains recovered patients antibodies in a pill form, Stat News reported.

Could it work as a vaccine?

While scientists race to develop a COVID-19 vaccine, blood plasma therapy could provide temporary protection for the most vulnerable in a similar fashion.

A vaccine trains people’s immune systems to make their own antibodies against a target germ. The plasma infusion approach would give people a temporary shot of someone else’s antibodies that are short-lived and require repeated doses.

If US regulator the FDA agrees, a second study would give antibody-rich plasma infusions to certain people at high risk from repeated exposures to COVID-19, such as hospital workers or first responders, said Dr Liise-anne Pirofski of New York’s Montefiore Health System and Albert Einstein College of Medicine.

That also might include nursing homes when a resident becomes ill, in hopes of giving the other people in the home some protection, she said.

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