
Promising Covid-19 treatment using convalescent serum therapy fast-tracked - jamessun
https://hub.jhu.edu/2020/04/08/arturo-casadevall-blood-sera-profile
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callumprentice
I read this last night:
[https://www.scmp.com/news/china/science/article/3078840/coro...](https://www.scmp.com/news/china/science/article/3078840/coronavirus-
low-antibody-levels-raise-questions-about) It's not peer reviewed so might not
be valid or entirely accurate but worrying nevertheless.

~~~
jacquesm
Yes, it was already mentioned today in the update to parliament here.
Apparently - as with other respiratory viral infections - if you don't get it
really bad then you may not be immune. That's a pretty fine line there. This
would explain some of the more puzzling positive / negative / positive test
sequences.

~~~
BurningFrog
Half-informed layman questions:

If this 30% recovered don't have antibodies, how _did_ they beat the
infection?

Does the immune system have some other mechanism to defat a virus?

Or does the antibody production taper off very fast for some people?

Or can the virus just die out by itself somehow?

~~~
somewhereoutth
There is the innate immune system, and the adaptive immune system. If I
understand correctly pathogen specific antibodies are created by the adaptive
immune system, so maybe if the innate deals with the virus quickly the
adaptive is not triggered.

There was a good TWIV podcast talking about this.

~~~
nsxwolf
If your innate immune system beats it, does that mean you're effectively
already "immune" and are unlikely to develop serious COVID-19 disease when you
catch the virus again, or was it just luck?

~~~
LeoNatan25
Probably luck. Given a much more potent viral load, it is more than likely the
same patient can be infected again.

~~~
nsxwolf
There just doesn't seem to be any good news anywhere.

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samizdis
The New York Blood Center continues to appeal for plasma donors via a form on
this page, "Convalescent Plasma COVID-19 Donor Request Form":

[https://www.nybloodcenter.org/donate-blood/convalescent-
plas...](https://www.nybloodcenter.org/donate-blood/convalescent-plasma-
covid-19-donor-request-form/)

~~~
cowmoo728
Many in NYC were unable to get a test. I was extremely sick mid-march and was
unable to get a test because it was before New York started ramping up
capacity. NY blood center requires a positive test result before they'll
consider you for plasma donation.

Mt Sinai's study also accepts people that did not get tested for covid-19 at
the time of infection. They will accept plasma and then test it for
antibodies, which has the handy side effect of telling you if you already had
covid-19. I'm scheduled to donate there next week.

[https://redcap.mountsinai.org/redcap/surveys/?s=RCC7FNHK3Y](https://redcap.mountsinai.org/redcap/surveys/?s=RCC7FNHK3Y)

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raudaschl
I work at a publishing company and I have been seeing more researcher interest
in this paper recently from 2010 - Zn2+ inhibits coronavirus and arterivirus
RNA polymerase activity in vitro and zinc ionophores block the replication of
these viruses in cell culture -
[https://journals.plos.org/plospathogens/article?id=10.1371/j...](https://journals.plos.org/plospathogens/article?id=10.1371/journal.ppat.1001176)

————
[https://www.mendeley.com/catalogue/a048aadd-e0c3-3870-bf5d-6...](https://www.mendeley.com/catalogue/a048aadd-e0c3-3870-bf5d-668abab26cf7/)

~~~
selimthegrim
Have there been observed correlations with zinc deficient patients?

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korethr
Damn. I was thinking just a couple days ago that serum therapy might be a
potential treatment avenue. For whatever reason, the plot of a Dragonriders of
Pern novel came to mind, and I realized the similarity of the situation to the
COVID-19 pandemic, and found myself wondering if the solution there wouldn't
be workable here in the real world.

<Spoilers>

In Moreta: Dragonlady of Pern, a viral disease (a flu strain IIRC[1]) jumps
from horses to people, and quickly begins spreading. A quarantine is
implemented, but too late, and the illness becomes an epidemic. And this is
Very Bad, because the dragonriders and everyone else find themselves with
people falling ill and dying just in time for Thread to return.[2]

One of the master healers is infected in the line of treating others. Once he
recovers, he realizes that his blood can be used to produce a serum to treat
others. And so begins the work of producing the serum and logistical problems
of getting it everywhere needed fast enough.

One thing we have over the fictional Pernese peoples is that we have a more
advanced medical medical establishment that could probably produce a serum
quicker and more precisely, with less secondary infection risk. (Although, a
brief shortage of blood-work needles wouldn't surprise me.) And while Pernese
dragons can teleport, they also tire, whereas our planes and trucks need only
refueling, and each does not require a unique psychically-bonded pilot/driver
to operate at all -- round-the-clock shift work is possible.

</Spoilers>

And I just realized, I recalled almost all of those details from memory
without the aid of Wikipedia. I read that book back in middle school. Damn.

[1] I might be wrong about this detail. I know I am recalling this from an
interview that I read, but I might be mis-remebering. The author might have
been stating she took inspiration from the 1918 flu pandemic.

[2] If you're unfamiliar with the Dragonriders of Pern books, the general
premise is that periodically, "Thread", a hostile organism which eats all
organic matter it can reach, falls from the sky. The dragons and their riders
protect everyone else by burning the Thread from the sky before it makes
landfall.

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throwanem
The Red Cross is soliciting potential plasma donors via a form at
[https://www.redcrossblood.org/donate-blood/dlp/plasma-
donati...](https://www.redcrossblood.org/donate-blood/dlp/plasma-donations-
from-recovered-covid-19-patients.html)

They're currently working to establish antibody testing, and require potential
donors to be at least 14 days from end of symptoms, but they will still accept
your contact information and relevant details for later contact.

~~~
y-c-o-m-b
Assuming this treatment is viable, hospitals should be sending discharged
patients home with the website and number to call for donating after recovery.
I think most people will not see this or even know about it.

~~~
BurningFrog
They really should follow up with the patients 14 days later and badger them
to donate.

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nradov
Dr. Peter Hotez has been proposing clinical trials of convalescent serum
therapy for several weeks now. If it works it could potentially be used both
to treat infected patients, and reduce the risk of infection for healthcare
workers.

[https://twitter.com/peterhotez/status/1239387184681177090?la...](https://twitter.com/peterhotez/status/1239387184681177090?lang=en)

~~~
wswope
I don't know if Dr. Hotez is directly involved, but St. Luke's, which is a
Houston-based hospital heavily affiliated with BCM/TCH (where Dr. Hotez
works), started trialing this in patients a few days ago.

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subsubzero
A few questions on serum therapy:

1\. Do you need the same blood type as the donor?

2\. Can other infectious diseases spread via an infusion from an infected
donor, ie. hiv, hepatitis?

~~~
abhisuri97
bio undergrad so take w/grain of salt 1\. No, because serum does not contain
any cells that have the markers of a bloodtype. You're just transferring the
antibodies pretty much. When you spin down a blood sample in a centrifuge, the
bottom pellet contains blood cells, the supernatant is plasma. From that
supernatant, when you get rid of clotting factors, the remainder is just
soluble molecules and antibodies. 2\. Maybe. Serum can also contain viruses,
but I assume the serum will be treated with chemicals to "clean it up" and
just isolate antibodies.

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shadowprofile77
I really, really wish there could be a clear answer on at least this one basic
thing that one would think (as a layman) to be fairly understood about viruses
and immune response: Having had a SARS COVID 2 infection and assuming the
virus hasn't mutated in the way that influenza does periodically to keep
needing new vaccines, does or does not your body gain bloody immunity for some
time after recovery? From everything I've know to date, the absolute normal,
standard thing is that yes, being sick with something viral that doesn't cause
your death gives you at least a certain period of months or usually years of
immunity to it unless it mutates enough to re-attack without being recognized
immediately. Is this not correct? For smallpox it applied, for chicken pox it
does, for measles it mostly does for many years, likewise for many viruses for
which there are vaccines. We even get immunity from the flu once we've had it
for at least some months to a year or two. So why would Covid 2 be different?

~~~
T-hawk
Short answer: recovering from Covid-19 probably does give immunity, based on
all the precedents you mention, but we can't prove it for sure yet because not
enough time has elapsed and no sufficiently rigorous studies have been done.

Of course viral antibodies persist for some amount of time, they don't
disappear immediately upon clearing the virus. What we don't know is anything
about the shape of that persistence. Is it days or weeks or years? Does it
decline linearly, or exponentially (as a half-life), or on some other
schedule? What kind of variance between people is there? How much does it vary
based on all the other factors, like other health and immunological
conditions, or re-exposure to the virus? This is all what we don't know yet,
but need to before we can make assumptions regarding herd immunity to start
lifting lockdowns.

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pmoriarty
From episode 594 of _This Week in Virology_ [1]:

Vincent Racaniello: _We have a bunch of emails and correspondence about the
use of convalescent sera, and Frank, for example, who 's a professor at
Misericordia University, said "Why aren't we using antisera from recovered
patients to treat infected people?" and we have some email from Ed Niles in a
bit, but I want to just say that yesterday the FDA approved this kind of
treatment for serious infections on an emergency basis. So if you have a very
serious or life-threatening infection you can apply to the FDA for what's
called emergency investigational drug application and you can get convalescent
serum, which means serum from someone who's recovered from the infection, is
checked to make sure there's nothing else -- no other viruses -- in it, and it
can be given to you and we know from previous experience with other infections
that this can work._

Rich Condit: _The idea here is that someone who has recovered from the disease
has antibodies to the virus, in this particular case the SARS-CoV-2, and so if
you give them intravenously this preparation that has these antibodies in it,
presumably that can latch on to virus that 's infecting you and those pathogen
antibody complexes will be disposed of appropriately in your body. This what's
called, comes under the general umbrella of passive immunization, which you're
giving antibodies from some other source which will last you for some period
of time and it can be up to weeks or months, actually (we've been through this
before), as opposed to active immunization where you mount your own._

Racaniello: _Rich, you had some correspondence with Ed Niles. Why don 't
you..._

Condit: _Yeah, he 's obsessed with this. [laughter] Ah.. let me see here, we
haven't highlighted this but I'll clip through it. This came to me, I
forwarded it to everybody. "I listened to the first part of TWiV today,
through the passive transfer comments," passive transfer being what we were
just talking about, passive immunization, "It was claimed that passive
transfer was first used in Lhasa in 1968. Smallpox docs shouldn't be short-
changed in this regard. VIG, which is vaccinia immunoglobilin, was used a
decade earlier. I went to a meeting in 2009 where several smallpox docs talked
about their experiences trying a host of putative anti-pox drugs and the
impact on their patients. One had tears recalling the impact treating sick
patients with untested and unproven drugs. I understand the urge to try
something, but there are limits."_

Condit: _Ok. So Ed, as background, worked for BARDA for a while. I forget what
the acronym stands for, but it 's a government agency that was born out of
the..._

Alan Dove: _I think it was Biodefense Advanced Research and Development
Agency, or something like that._

Condit: _There you go. And, he, so he saw a lot of grants having to do with
smallpox, anti-pox viral drugs and etc, so he 's pretty up on this, and the
vaccinia immunoglobilin would be part of that. He's referring to the 60's and
before when the global smallpox eradication campaign went forward, and one of
the things that was used was the vaccinia immunoglobilin. VIG is, was,
prepared by two companies under contract with the US government from pooled
serum taken from vaccinies, mostly military at this point. We have 100,000
doses in the stockpile. However, 25 doses have been used in some cases to
clear vaccination complications. Provides a link to an article which provides
some background for the practicalities of preparing and using coronavirus
immunoglobilin if we get to that. "It helped remind me of what we were
thinking about 15 years ago. Seems like a lifetime. On another note, pooled
monoclonal antibodies have proven to be effective against pox viruses in
animal models. Unfortunately this is an expensive way to go," and suggest
contacting our friend Mike Bershlinsky (sp?) for looking in more detail. He
attached an article from an old friend of ours, Rico Wittick (sp?), since
deceased. It summarizes the prep and use of vaccinia immunoglobilin over the
decades. Ok. So this is like a review. He correctly refers to a handful of
reported anecdotal applications of vaccinia immunoglobilin against smallpox.
"I don't know that true controlled studies have been done at this point. By
2011 there were none, even with the compassionate uses of vaccinia
immunoglobilin ST-246," which is, was, an experimental anti-pox drug, now
approved, "and Senovavir. It was never clear which, if any of them had a
positive effect. You need controlled trials. In each case the patient cleared
and survived. Controlled studies are hard to come by. So I'm not a big fan of
VIG, vaccinia immunoglobilin, and if anyone wants an antibody approach to
SARS-CoV-2 they may as well go directly to monoclonals and do the right set of
studies. Of course this will take time. Alternatively, if you have other tools
in the toolbox, maybe a convalescent serum study is warranted. Any volunteers?
Keep the faith."_

Racaniello: _Well, that 's exactly what the FDA is doing. They are doing a
convalescent antibody study in case, for prevention. The emergency use is not
for prevention, it's for very sick people._

Dove: _Right._

Racaniello: _Because.. So, Brianne, what could go wrong if you gave someone
anti... SARS-CoV-2 antibodies?_

Brianne Barker: _Well, if we are imagining that there are no other viruses and
nothing else there, there are some situations where antibodies and antigens
can bind together and get sort of stuck in places, like in some cappilaries
and some areas of the skin and kidney and lead to something that in class I
call a type-3 hypersensitivity reaction, but really it 's something called
serum sickness or it's kind of similar to farmer's lung that we see in a few
different people. So sometimes we can see some issues there where people will
make a response to those antibodies that they're getting from other people,
because they are technically foreign proteins that you are injecting in to
someone._

[1] -
[http://www.microbe.tv/twiv/twiv-594/](http://www.microbe.tv/twiv/twiv-594/)
(about 23 minutes in to the program)

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98codes
Post this again when it's not on a university PR site.

