With few other options, clinicians back plasma though efficacy not proven

Experts feel that ICMR guidelines may not be binding upon hospitals unless DCGI gives a direction against use of the investigational therapy

With the Indian Council of Medical Research (ICMR) likely to delete convalescent plasma therapy from its national guidelines for Covid-19 treatment, medical experts are batting in its favour given that there is no definitive remedy available against the virus till now and some patients have benefitted from the plasma. 

According to a senior government doctor with the Delhi government, “If there was any targeted therapy working for covid then it was okay to shut down plasma banks. Plasma therapy might not be showing any benefits but it is also not showing any negative effects in the patients. It has in fact, helped some.” 

Many states had set up plasma banks even though its efficacy was still a subject of study.  Mumbai alone has 15 such banks. Recovered patients have also started coming forward in bigger numbers to donate plasma. 

Experts feel that ICMR guidelines may not be binding upon hospitals unless the drug controller general of India (DCGI) gives a direction against the use of the investigational therapy. 

The DCGI has so far been proactive in fast-tracking the licenses for new blood banks that would be allowed to collect and process convalescent plasma from recovered Covid-19 patients.

ICMR’s study on plasma therapy has not shown any benefit in mortality in moderate to severe patients nor has it stopped the progression of the disease. 

However, another study on plasma therapy on 35,000 conducted by the US based Mayo Clinic found it to be an effective treatment depending upon the stage at which a patient was administered plasma and the amount of antibodies in the plasma itself. “Timing is the key for the treatment. We have given it early to patients, at times within 24-hours of admission, along with steroids and antivirals like remdesivir. We have seen good response,” Dr Behram Pardiwala, principal investigator of plasma trial at Wockhardt Hospital said. 

Is there a commercial loss if convalescent plasma therapy is disallowed  by the government? “ There was no profit in this process. The cost of collecting plasma from one donor (usually two units of plasma) is around Rs 14,600...With a price cap of Rs 5,500 for each plasma unit, there is no profit at all for blood banks here,” Abhijit Bopardikar, joint secretary of the Federation of Bombay Blood Banks said.

A flourishing grey market had emerged in dealing with convalescent Covid-19 plasma. But blood banks say that that is an illegal channel and cannot be counted as loss of business.

The Delhi plasma bank is still getting a lot of demand from patients. A senior official said that closing the bank if ICMR directs it to is not difficult at all. “It was set up just for Covid and if the government feels it has to stop operations we can do that as well.”

The world health organisation's solidarity trial that evaluated four treatments--remdesivir, hydroxychloroquine, lopinavir/ritonavir and interferon also showed little or no effect on overall mortality, initiation of ventilation and duration of hospital stay in hospitalised patients. This has further reduced the treatment options for Covid patients. 

Clinicians, however, feel that the use of these drugs and plasma therapy has led to shorter ICU stays and faster recovery. 

Plasma therapy, though not entirely new, is also not an established standard of care, according to medical experts. The body tries to counteract an infection by forming antibodies and white blood cells. Someone who has had this infection would have antibodies and may also have the white blood cells in the plasma. If that plasma is transfused into another sick person, those antibodies may help fight the infection. 

In convalescent plasma therapy, these Sars-CoV-2 neutralising antibodies containing plasma are administered to a patient. The problem with this approach is that the amount of antibodies differs from one donor to another and plasma has to be stored at very low temperatures. An elaborate infrastructure is needed to get and process plasma.