Coronavirus Disease 2019 (COVID-19) is a global pandemic that shook the world and shut it down in a manner none of us had ever imagined. As of September 2020, more than 28.6 million people have been infected by the virus, ‘Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)’ that causes COVID-19, and nearly a million people have lost their lives. In Nepal too, around 52,000 have been infected and around 300 people have lost their life. Until the moment that we are writing this article, there is no proven cure for this disease, however, some therapies have been beneficial in reducing hospital stay and the seriousness of the disease and one of such therapies is convalescent plasma therapy. Convalescent plasma therapy means that blood plasma of a recovered COVID-19 patient in the convalescent period is donated to moderate, severe or critically ill individuals which might help in reducing hospital stay and complications. Our blood is made up of blood cells and plasma. Blood cells constitute red blood cells, white blood cells and cellular fragments called platelets while the remaining liquid form of blood is called plasma. All these cells have their own function like red blood cells help in the transportation of oxygen, white blood cells help in fighting infections and platelets help in preventing excessive blood loss when the skin is injured. Whenever there is an infection, our body makes antibodies against antigens (foreign particles) of offending infective agents which helps in destroying these infective agents. This antibody is present and circulated by plasma to different parts of the body.
Antibodies In the case of patients infected with COVID-19 too, our body makes antibodies that are present in the plasma of recovered patients for some time. Any person whose PCR was tested positive and has since recovered from COVID-19 with negative PCR for at least two weeks and is above 18 years of age and below 55 years, non-diabetic, has blood pressure in the normal range and has never been pregnant (in females) can donate plasma if s/he has sufficient antibody titre in his/her plasma. If the donor meets the above criteria, then the whole blood is withdrawn from the donor according to the standard protocol. The plasma is then separated from the whole blood and is stored/ transported to the hospital for a transfusion. The plasma thus obtained can only be transfused to the patient after checking the compatibility and taking consent. Similarly, the respiratory rate and oxygen saturation are also measured before the transfusion. After every criterion is met, the plasma is transfused according to the standard protocol and the patient is kept under observation for at least 7 weeks. Since whole blood is extracted in this process, a person can donate plasma only once in three months and s/he may be eligible to donate plasma only once because in three months the antibody titre in the blood may not be sufficient. However, there is a process called apheresis being used in most of the developed countries where only plasma is extracted from the blood. Until the time that we are writing this article, only Tribhuvan University Teaching Hospital has this facility. If plasma is donated by this process, a person is eligible to donate every two weeks and the collected blood can be donated to three people. However, if whole blood is withdrawn, the collected plasma can be donated to a single person which shows the importance of extending the apheresis technique in other hospitals and blood banks of Nepal. The immunity generated in patients after this process is called passive immunity. This immunity doesn’t last long and hence, the same patient may require multiple transfusion of convalescent plasma. There is a common misconception that donating plasma when the patient is in the recovery phase may weaken their immune system or may make them prone to COVID-19 reinfection. Donating plasma doesn’t affect the donor but may benefit the recipient by decreasing the severity of disease or by shortening the length of their disease. To facilitate and aware of the people on donating plasma, many organizations have started such initiatives in Nepal. Being medical students, we also felt the need to help in such a noble task. Since both of us are volunteering for the Nepal Health Corps, we formed a central committee of 10 people and started the “Donate Plasma, Help Defeat COVID-19” campaign. We officially began our campaign by conducting a virtual webinar on convalescent plasma therapy on September 6, 2020. The chief guest of the webinar was Khagaraj Adhikari (Former Health Minister) and the guest speakers were Dr. Bhoj Raj Adhikari (President, Bharatpur Hospital) and Dr. Prabhat Adhikari (Infectious Disease and Critical Care expert). Since then, we have been encouraging potential donors to donate their plasma. We have also begun a public service announcement via Nepal Health Corps which is solely aimed to give people evidence-based information on convalescent plasma therapy.
Saving Lives Our only hope for writing this article and sharing information is that we can encourage potential donors to donate their plasma. Convalescent plasma therapy is not a proven definite treatment for COVID-19 and no treatment except Dexamethasone has shown to reduce mortality in COVID-19 patients, but several studies in coronavirus patients and experiences from the use of convalescent plasma in other infective diseases have shown that it may benefit moderate, severe and critically ill patients and reduce hospital stay and complications. Hence, we highly encourage and request the recovered patients to donate their plasma as this might help some people and save lives while also facilitating more research in this aspect and maybe even beneficial in future pandemics.
(Joshi is a third-year and Basnet is a fourth-year medical student)