MANILA, Philippines — Being afflicted with the coronavirus disease (COVID-19) does not mean the end, as those who have received convalescent plasma from recovered patients have started showing improvement in their conditions.
Dr. Francisco Lopez, a hematologist at St. Luke’s Medical Center, said that in the nearly two weeks since they started with convalescent plasma transfusion—or the process of transferring convalescent plasma from a recovered COVID-19 patient to a person still infected by the disease—some of the recipients have shown encouraging improvements.
In an interview with INQUIRER.net, Lopez said that since April 11, convalescent plasma transfusions were done on 13 COVID-19 patients. Of this number, 12 were considered to be “critically ill” while one was “progressing to illness.”
Following the transfusions, five of the 12 critically ill patients have been detached from ventilators. Meanwhile, the one patient whose condition was just progressing to being critically ill no longer had to be attached to a ventilator.
“Our results seem to be encouraging and I think also the PGH (Philippine General Hospital) group presented their own data and I think they were also encouraged that they saw some improvement in their patients,” Lopez said.
“I think it’s an option for the recipient to receive this. Other treatments may be quite expensive when they use other medicines,” he added.
According to Lopez, some of their patients showed improvements in just two days after receiving convalescent plasma from recovered patients, while the condition of one patient improved after six days.
But are these cases enough to validate the efficacy of convalescent plasma?
“Thirteen is still a small number when you review literature. Again these are just case series,” Lopez said.
Order of priority
With a limited number of convalescent plasma donations, specific criteria are also being followed as to which patient would receive them first.
Lopez explained that the criteria mainly lie on the degree or stage of the illness.
“The criteria—are they critically ill? Is their condition progressing o severe illness? We have our own Viber group and they will just post it, we need x number of donors for x number of recipients and then we start looking for the donors in our donor pool,” Lopez explained.
“Who will get the plasma first? We have to see who is more critical than the other if we have to choose between two patients or among three patients we have to decide who is more critical then we’ll give the plasma right away,” he added.
There are also several indicators being considered to see if a patient’s condition is improving after the transfusion.
Those whose conditions are improving require less oxygen and are extubated (removed from a ventilator). Improvements in their X-ray results are also seen.
“We have other biomarkers that we check regularly, and we see that these levels start to decrease after we give the convalescent plasma,” Lopez said.
In terms of cost, those admitted to St. Luke’s Medical Center need not pay for the transfusion, said Lopez. The entire transfusion process is free of charge.
Faster release of test results
Lopez said their analysis of COVID-19 data showed that there is a 14-day preferred timeframe where the transfusion of convalescent plasma should be done.
This begins from the day a patient starts showing symptoms of COVID-19.
“When we were analyzing the data there seems to be a period of within 14 days where we see the response of the treatment. Six out of these 13 patients, the plasma was given within 14 days,” Lopez said.
“We see that the recovery seems to be faster. We can get them off the ventilator right away. All of these will translate in fewer ventilator days, less ICU (intensive care unit) stay, and eventually, what we want is lessen the hospital cost and hospital days of the recipient,” he added.
But the confirmation of the results of COVID-19 tests could last for up to 10 days. Thus, Lopez expressed hope that this could be hastened, especially now that there are more testing centers in the country.
“If it takes ten days to get the results, one, the doctor might be hesitant to give the plasma until there’s confirmation. Number two, the recipient might also be hesitant to receive that plasma,” Lopez said.
“If you have to wait that long and hopefully it will get shorter this time that more centers are providing this service, then we can immediately decide whether we should give the plasma or not to the recipient. That is also crucial to get the results right away and not have to wait ten days or even longer to get the results,” he added.
As of April 23, there are 7,192 COVID-19 cases in the country, with the death toll at 477.