Lack of oversight leaves COVID-19 patients scrambling for plasma

17 August 2020
Donors give plasma at the Delhi Plasma Bank, for Covid-19 patients who will receive the trial antibody treatment, at the Institute of Liver and Biliary Sciences (ILBS) hospital in New Delhi. India's coronavirus epidemic became the third biggest in the world as infections surged after the nation eased containment measures to reverse an economic collapse that has left millions destitute.
<strong>T. Narayan / Bloomberg / Getty Images</strong>
Donors give plasma at the Delhi Plasma Bank, for Covid-19 patients who will receive the trial antibody treatment, at the Institute of Liver and Biliary Sciences (ILBS) hospital in New Delhi. India's coronavirus epidemic became the third biggest in the world as infections surged after the nation eased containment measures to reverse an economic collapse that has left millions destitute.
<strong>T. Narayan / Bloomberg / Getty Images</strong>

In mid-July, the family of a 74-year-old male COVID-19 patient at Patna’s All India Institute of Medical Sciences was in a bind. The patient was already critically ill and had been put on ventilator support. With his condition starting to further deteriorate, his doctors said that he needed convalescent plasma therapy urgently. The family first assumed that the hospital would organise this medically prescribed plasma. The patient’s son-in-law said in a phone call from Mumbai, “We first thought the blood bank will organise plasma themselves and we will have to pay for it.” They were in for a rude shock—the hospital expected them to find plasma themselves.

More and more, doctors across India have started to prescribe convalescent plasma therapy, commonly known as simply plasma therapy, for severely ill COVID-19 patients. Plasma is taken from a person who has recovered from a disease—a convalescent—because it contains antibodies to fight the disease. It is then injected into a patient still ill with the same disease whose own immune system may not be producing antibodies. Theoretically, it should jumpstart an antibody response in the patient. Even though it has been used as a medical intervention to treat other infectious diseases in the past, there is little scientific evidence to show that it helps COVID-19 patients. Results of most clinical trials for plasma therapy, including in India, have not yet been released, but a major trial in China showed plasma therapy had no significant effect on patients. 

But since the world has had just eight months of experience with this disease, doctors are deploying plasma and several other drugs as experimental tools to keep their patients alive. 

Dr RS Mishra, the director and senior consultant for internal medicine at Max Super Speciality Hospital in Delhi, said, “Our experience is that plasma therapy works if it is used at the right time. If it is used late when there are already antibodies in the system, the therapy will not work. If you give plasma after 15 to 16 days, the patient is already producing antibodies. Timing is very important.”

With only vague guidelines and little regulation, patients and their families are facing the added undue burden in the middle of a pandemic of trying to procure plasma. All patients who need plasma therapy have specific requirements. The Patna patient needed plasma from a donor who had recovered from COVID-19 at least 14 days earlier, and had his blood type, O positive. Neither his wife nor his daughter-in-law, who lived with the couple, could figure out where to source plasma. The family turned to relatives and friends in Mumbai to find plasma donors. This network of relatives and friends, the son-in-law said, called more than a hundred people. 

Menaka Rao is a freelance journalist from Mumbai. She writes on law and health.

Keywords: COVID-19 blood donation Delhi government public health AIIMS
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