If given during the first few days, it can block the coronavirus and turn the disease "into a bad cold". These trials, unique in the world, could reduce the mortality of covid and decompress the health system.
"Plasma, when administered during the first three days of mild symptoms, was 60% effective in slowing the progression of patients to severe disease. We can say that the plasma interrupted the disease. Our goal is to prevent people from progressing to severe stages, requiring intubation, respirator and intensive care," he said. Fernando Polacka pediatrician, infectious disease specialist and director of the Infant Foundation, in charge of coordinating the study. From the SUM of the Antonio Vespucio Liberti Stadium (River Plate), representatives of the institution gave a press conference to disseminate the results of their project related to the early use of convalescent plasma in older adults with Covid-19.
Accompanied by other specialists such as doctors Diego Wappner, Romina Libster and Perez Marc, Polack affirmed: "Plasma works for mild patients.Plasma works for mild patientsif the donor has sufficient antibodies and when it is administered within when it is administered within 72 hours.. It works in those over 65 years of age with comorbidities and in those over 75 years of age in general, who are also the population that needs it most. It transforms covid into a bad cold and prevents it from turning into pneumonia that requires oxygen". And then he continued his speech with emphasis on solidarity. "A donor with a high level of antibodies can serve for about 12 treatments. Plasma is cheap, it is universal, it has no patents and it is accessible to everyone, but it depends on our will to generate a bank. If the management strategy is good, we can have adequate results before a vaccine even arrives. This works if we are able as a society to help each other.".
In this regard, Pérez Marc, another of the experts in charge and present at the conference, reflected: "Plasma is a tool that can be very useful. Based on these results, strategies will have to be operationalized. I think that I think that donation is very important; a campaign could be carried out for massive donation. We provide the evidence so that those who manage can do it in the best way. Plasma is safe, we have not found any adverse effects of any kind.". From here, scalability (i.e. that every health institution has access to plasma) will depend on management, as well as on a strong information and scientific dissemination campaign. "We need a very targeted campaign. Every recovered patient is a probable and potential plasma donor and can save another person's life. We need to be vigilant and consult with early symptoms, and our study serves that purpose as well. In fact, we have had volunteers who have donated on a large number of occasions, because they have a very high antibody titer," said Libster, one of the leading national figures in the field.
What is plasma and how did they do the study
Plasma is the liquid portion of the blood in which red blood cells, white blood cells and platelets are suspended. It contains a number of very important proteins: some are food proteins, such as albumin; others carry fats, such as lipoproteins; and finally, there are the antibodies. When the infusion takes place, the defenses used for covid-19 carry the active immunity of the cured individual and are passively transferred to the patient presenting an acute infection. To sum it up: the one who is cured gives some of his defenses to the one who is infected.
Polack has been focusing on viral diseases for more than three decades, and at the beginning of the year he had a premise and at the beginning of the year he had one premise: in general, pathologies of this type can only be interrupted when they are treated very early, because time starts to run from the very moment the virus enters the body.The time starts to run from the very moment the virus enters the body. "We started in March. We discussed again and again how to develop it to agree on a working protocol. We invited people with higher antibody levels and asked them to donate. Simultaneously, those people who called with symptoms and were over 65 years old were invited to participate in the study. Those who had the disease, after proving it by PCR testing, we took them to the hospital and gave them placebo or plasma," Polack described. These individuals were then monitored by members of Infant to track the evolution of the disease. Monitoring continued for 15 days, until they were discharged.
The universe of patients in which the study was performed was 160 people. The average age was 77 and the majority were women. Half received plasma and half placebo. People participated on a voluntary basis in a randomized (so the researchers and the doctors in charge do not decide who gets plasma and who gets a placebo), "double-blind" (no one knows who got the real treatment and who got the control), placebo-controlled study. "We had 479 plasma donors, of whom almost one in three (28%), had blood antibody titers that allowed them to donate for this project. Nearly one in three or one in four people among those who have had coronavirus are individuals who can donate to improve the situation for older adults who are symptom-onset"Polack explained.
The study brought together a large number of institutions. The Instituto de Efectividad Clínica y Sanitaria (IECS) and the Fundación Hematológica Sarmiento at the Hospital Dr. Carlos Bocalandro participated. Also the hospitals San Juan de Dios, Simplemente Evita, Central de San Isidro Dr. Melchor Ángel Posse, Clínica Olivos. The network of geriatric care units linked to PAMI in the Province of Buenos Aires and the Hospital Militar Central, Centro Gallego, Sanatorio de los Arcos, Hospital Universitario CEMIC, Sanatorio Sagrado Corazón, Sanatorio Anchorena and Sanatorio Finochietto in CABA were also key.
Divergent results on efficacy
The project carried out by Polack and company is original worldwide because it tests plasma infusion in an early stage.. There is only one similar study conducted by an Italian team. "In the world, plasma is delivered later. We always think of it as a very early intervention, otherwise it doesn't work.". He then continued with a metaphor as an example: "We thought that we did not have to stop a thief (virus) once it had already ransacked the house, but that we should prevent entry, slowing down the course of the disease when it is mild and not more than 72 hours since it started. The objective is to prevent you from being given oxygen, to prevent you from being in intensive care; to attack the problem when it is not yet so serious. The results were promising," he pointed out.
In addition to the Infant Foundation's work, there were other clinical trials linked to plasma infusion with there were other clinical trials linked to plasma infusion that yielded divergent results.. One of the most important was conducted by the Hospital Italiano of Buenos Aires. Called Plasm-Ar, it was the first study to evaluate its efficacy in patients with severe evaluate its efficacy in patients with severe covid-19 pneumonia.. A total of 334 individuals participated, with an average age of 62 years and a higher proportion of men (69.2%). For every two volunteers who received plasma, one received a saline solution (placebo). As a result, the Italian team came to the following conclusion: "In hospitalized patients with severe covid-19 pneumonia with severity criteria, the use of convalescent plasma did not produce a significant clinical benefit at 7-, 14-, or 30-day follow-up compared with the use of placebo".
The other background information came from the Buenos Aires Ministry of Health. In mid-October, the provincial health ministry released a study which revealed that "its use in patients with coronavirus pneumonia reduces mortality by 24.4%".". The trial included 3529 adult patients diagnosed with covid-19 pneumonia, admitted to hospitals in the province of Buenos Aires. Of this total, only 868 received plasma infusion therapy. In this case, it is worth noting that the clinical data of those transfused were obtained from four provincial and national databases: the National Health Surveillance System, the Bed Management System, the Provincial Registry of Persons and the registry of the Hemotherapy Institute.
The latest local trial was conducted at the "Norberto Quirno" Medical Education and Clinical Research Center (CEMIC). In this line, 87 patients participated in a multicenter study, although it was not compared against a placebo branch. As a result, the experts concluded that "convalescent plasma infusions are not a substitute for a placebo.convalescent plasma infusions are feasible, safe and potentially effective, especially before requiring mechanical ventilation, and are an attractive clinical option to treat severe forms of Covid-19 until other effective therapies are available".
The results are different because the approaches are divergent and the objectives are different. Some, as we have seen, use a placebo branch as a control group and others do not; and what is even more significant, while some provide plasma in severe cases by Covid, others administer it in mild cases, that is, when the picture has not yet become more complex. All works are essential because new evidence is added to the past and problematizes them from different angles. This is the only way to advance science. Only in this way will the country be closer to curbing the pandemic until there is a vaccine.
By Pablo Esteban-Page 12
Link to the complete article:
https://www.pagina12.com.ar/305438-fernando-polack-el-plasma-funciona-con-una-eficacia-del-60-p
