Testing, Antibodies & Convalescent Plasma as Treatment Option?

Posted by jdlogan65 @jdlogan65, Sat, Mar 28 4:50pm

We all know that COVID-19 testing has lagged far behind the spread of this pandemic. You can extrapolate the reported cases, mortality rate etc. and assume that hundreds of thousands of people have already survived this virus and are carrying potential life-saving antibodies. Now that we will soon have rapid testing available why not reach out to those people, test them and ask for the only treatment currently available? A public service announcement would be a good start. We must protect our health care workers first and treat others according to what the experts determine. It is a bit scary being a transplant recipient and having a suppressed immune system. I have been taking precautions for 3 months and have self quarantined. I have seen so much good in people during this crisis. My neighbors are wonderful. It is good to see people coming together and helping each other.

@jdlogan65 There are already tests being done on how to harvest and use the antibodies at several facilities in the US and elsewhere….many of us who are at risk are anxiously waiting, on the theory that this may be a quicker path for high-risk patients than vaccine development. But like any new treatment, there is a huge curve to climb – isolation, testing for efficacy, then for safety, then approval. I don't think there are any safe shortcuts, and anyone promising that should be suspect.
Also, as of yesterday, there was not a publicly available approved post-test for the antibodies in the US – right now most energy is focused on getting everything geared up for high volume initial testing and developing an accurate rapid test. Once there is an antibody test available, expect to see the first use to be concentrated on medical personnel and other first responders, so employers know they can get back to work without intense fear of reinfection.
I won't throw numbers around because we don't know how accurate they are, but in a lot of the country, there are so few tests available compared to the numbers of people with symptoms and/or known exposure, that many people are being told no to a test and being sent into quarantine on the assumption they are infected. Tests are being reserved for testing where there is very high risk of infecting vulnerable populations, like in nursing homes. So we are some time away from a wide focus on antibody testing, I think.
In the mean time, our best defense is to take precautions – isolation, handwashing, surface sanitizing, and eating well to stay as strong as possible.
Sue

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@jdlogan65 and @sueinmn, I think you both might appreciate these 2 articles:

– The Science Behind the Test for the COVID-19 Virus https://discoverysedge.mayo.edu/2020/03/27/the-science-behind-the-test-for-the-covid-19-virus/
– Research After COVID-19? Hold That Thought Says Infectious Diseases Expert https://discoverysedge.mayo.edu/2020/03/24/research-after-covid-19-hold-that-thought-says-infectious-diseases-expert/

This quote from Dr. Poland is particularly poignant.
""Each piece of research adds a pixel to the canvas, but it takes time," says Dr. Poland. "Whether we're talking about developing knowledge or a vaccine, the process is designed to be slow, evidence-based and reflective to help the most and harm the least."

It is really hard to patient during a crisis, but this rigor of research and evidence is necessary. I am, however, encouraged by some of ingenuity being applied to delivery of care, for example virtual visits. See this discussion:

– Telemedicine: How to make the most of a virtual doctor visit https://connect.mayoclinic.org/discussion/covid-19-telemedicine-its-a-brave-new-world/

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@colleenyoung

@jdlogan65 and @sueinmn, I think you both might appreciate these 2 articles:

– The Science Behind the Test for the COVID-19 Virus https://discoverysedge.mayo.edu/2020/03/27/the-science-behind-the-test-for-the-covid-19-virus/
– Research After COVID-19? Hold That Thought Says Infectious Diseases Expert https://discoverysedge.mayo.edu/2020/03/24/research-after-covid-19-hold-that-thought-says-infectious-diseases-expert/

This quote from Dr. Poland is particularly poignant.
""Each piece of research adds a pixel to the canvas, but it takes time," says Dr. Poland. "Whether we're talking about developing knowledge or a vaccine, the process is designed to be slow, evidence-based and reflective to help the most and harm the least."

It is really hard to patient during a crisis, but this rigor of research and evidence is necessary. I am, however, encouraged by some of ingenuity being applied to delivery of care, for example virtual visits. See this discussion:

– Telemedicine: How to make the most of a virtual doctor visit https://connect.mayoclinic.org/discussion/covid-19-telemedicine-its-a-brave-new-world/

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No sooner did I post my message above did I listen to Mayo Clinic Dr. Farrugia's interview on CBS Face the Nation. Here are excerpts from the interview about antibody serum.

"MARGARET BRENNAN: One of the therapies that's gotten a lot of attention is these antibody serums. Tell me what your thoughts are on how effective that can be.

FARRUGIA: So we know that in order to really handle this crisis, we have to take many different approaches. The best antivirus still remains washing your hands, and we have to remind people of that. Then there are the antivirals themselves that attack the virus themselves. Then there are agents that are effective at blocking the molecules that the virus causes our own cells to release. And that can prevent some of the damage we're seeing in the lungs and other organs, including the kidneys. And then there are these convalescent ser- or convalescent plasma. Where you take plasma from a person who has had the virus and has recovered and has now an antibody response to it. And take that and in general, you can treat four people from one person. And doing so, you can provoke a artificial- a given response that allows them to recover more quickly. This is based on other diseases. It is now being tried for the coronavirus, for COVID-19. And Mayo Clinic and other institutions are working very hard, collaborating with industry to make sure that we can have adequate supply to test if this is going to make a difference. And I'm hopeful that it will."

Watch or read the entire interview here: https://www.cbsnews.com/news/transcript-gianrico-farrugia-on-face-the-nation-march-29-2020/

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@colleenyoung

@jdlogan65 and @sueinmn, I think you both might appreciate these 2 articles:

– The Science Behind the Test for the COVID-19 Virus https://discoverysedge.mayo.edu/2020/03/27/the-science-behind-the-test-for-the-covid-19-virus/
– Research After COVID-19? Hold That Thought Says Infectious Diseases Expert https://discoverysedge.mayo.edu/2020/03/24/research-after-covid-19-hold-that-thought-says-infectious-diseases-expert/

This quote from Dr. Poland is particularly poignant.
""Each piece of research adds a pixel to the canvas, but it takes time," says Dr. Poland. "Whether we're talking about developing knowledge or a vaccine, the process is designed to be slow, evidence-based and reflective to help the most and harm the least."

It is really hard to patient during a crisis, but this rigor of research and evidence is necessary. I am, however, encouraged by some of ingenuity being applied to delivery of care, for example virtual visits. See this discussion:

– Telemedicine: How to make the most of a virtual doctor visit https://connect.mayoclinic.org/discussion/covid-19-telemedicine-its-a-brave-new-world/

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@colleenyoung Thank you for these – I shared them with friends and family – including some who think those urging us to pause & wait are "scaremongers" or worse. Dr Poland's numbers are stark.

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does anyone know if there is a study of convalescent plasma therapy in healthy adults if there is not a vaccine available

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@bvh176

does anyone know if there is a study of convalescent plasma therapy in healthy adults if there is not a vaccine available

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Hello @bvh176, Welcome to Mayo Clinic Connect. We moved your post to this discussion that is on the same topic so that you can meet other members discussing convalescent plasma therapy. The Mayo Clinic Newsfeed just released a new podcast today on the topic.

COVID-19 convalescent plasma program:
https://connect.mayoclinic.org/page/podcasts/newsfeed-post/covid-19-convalescent-plasma-program/

I also saw another article that might be of interest to you and other members.
Convalescent Plasma Trial in COVID -19 Patients:
https://clinicaltrials.gov/ct2/show/NCT04356534

Have you been tested for COVID-19?

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@johnbishop

Hello @bvh176, Welcome to Mayo Clinic Connect. We moved your post to this discussion that is on the same topic so that you can meet other members discussing convalescent plasma therapy. The Mayo Clinic Newsfeed just released a new podcast today on the topic.

COVID-19 convalescent plasma program:
https://connect.mayoclinic.org/page/podcasts/newsfeed-post/covid-19-convalescent-plasma-program/

I also saw another article that might be of interest to you and other members.
Convalescent Plasma Trial in COVID -19 Patients:
https://clinicaltrials.gov/ct2/show/NCT04356534

Have you been tested for COVID-19?

Jump to this post

I have been tested and it came back negative. I am 69 years old with an underlying lung condition. my daughter has tested positive for antibodies and I was wondering if convalescent plasma therapy can be used in covid negative people so they can interact with family members until a vaccine becomes available (if ever)

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@bvh176 I love the questions we get here – it sends me to find the most up-to-date information in the fast-changing illness!
At this point, the plasma is being reserved for treating those who are very ill and in respiratory distress. It is still considered experimental, and results are being closely tracked.
A study using anti-body rich plasma as a preventative is planned "soon", but will be limited to at-risk individuals with prolonged close contact to an infected person – https://www.uab.edu/news/health/item/11314-convalescent-plasma-therapy-is-treating-coronavirus-patients-in-uab-research.
At this point, I would say they are some time from trying this as a general preventative therapy, because the needed plasma is not very abundant. One study I read said one person's plasma is only sufficient to treat 1-2 other individuals.
Stay tuned for further developments.
Sue

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Sue, thanks for that information, good to know. I wonder if you happen to have any idea which antibody tests are considered to be most accurate? I believe I have read that the Abbott Labs ones are considered fairly unreliable. A bloodwork lab I had done yesterday included a covid antibody test; I plan to find out which one it was. Any info will be most appreciated.

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@zep.. my daughter said the Roche one is more accurate. She is not in the medical profession but she is a very good researcher.

Liked by zep

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@mayofeb2020 Thanks very much for that info. I know I can't depend on the actual negative or positive result to be guaranteed, but knowing whether or not I had a somewhat reputable test will make a little difference. In the meantime, it's quarantine city, and raw paws….

Liked by lioness

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@zep and everyone else – as I said above "Stay tuned for further developments" – the tests are being tested and reviewed by multiple organizations as I write this. I keep checking for results. Keep in mind – these were all released under emergency authority without the usual independent testing and review by any government agency or any independent testing laboratory. Preliminary testing done by the manufacturers or their chosen labs were not up to the same rigorous standards as usual. Even the early verification tests by a couple of universities didn't hit all the benchmarks – for example, testing against other non-covid Corona viruses, testing of two or more manufacturers lots of the same product, and testing under multiple conditions (e.g. number of days since infection, number of days symptom-free, varying ages of patients, other known health conditions…).
My daughter is checking weekly with contacts at two test developers to learn when they will feel their tests are "ready for prime time" and when there will be a reliable supply available.
I will certainly post here as soon as I see definitive writing on the matter.
Sue

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@mayofeb2020

@zep.. my daughter said the Roche one is more accurate. She is not in the medical profession but she is a very good researcher.

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@mayofeb2020– More accurate means nothing really in relation to what needs to be an accurate test result. This is an almost, but not there yet. Unless there is a true standard with proven results tests just aren't "there" yet.

Liked by lioness

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@sueinmn

@bvh176 I love the questions we get here – it sends me to find the most up-to-date information in the fast-changing illness!
At this point, the plasma is being reserved for treating those who are very ill and in respiratory distress. It is still considered experimental, and results are being closely tracked.
A study using anti-body rich plasma as a preventative is planned "soon", but will be limited to at-risk individuals with prolonged close contact to an infected person – https://www.uab.edu/news/health/item/11314-convalescent-plasma-therapy-is-treating-coronavirus-patients-in-uab-research.
At this point, I would say they are some time from trying this as a general preventative therapy, because the needed plasma is not very abundant. One study I read said one person's plasma is only sufficient to treat 1-2 other individuals.
Stay tuned for further developments.
Sue

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@sueinmn– It's so frustrating to have "almost" reliable testing. It's like almost pregnant.

Liked by lioness, zep

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@merpreb

@sueinmn– It's so frustrating to have "almost" reliable testing. It's like almost pregnant.

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@merpreb Ha Ha!

@mayofeb2020 @zep @bvh176 We need to remember that development of such tests is usually measured in many months, if not years, not in days or weeks. Rushing products to market may work for the latest fad or gadget, but not for a critical medical test. There are many, many steps in proper validation for medical tests, and they take a long time. Before release, the test results generally undergo peer review as well. All of this was bypassed under emergency orders, and tests were allowed to be released with the assurance of validity by the developer alone.

In any other time, the current Covid-19 antibody tests would not see the light of day, much less be promoted, until tested by an independent laboratory and having the results peer-reviewed. Shortcuts can have serious, even deadly consequences. If a vulnerable person were to get a "false positive" result and stop taking precautions, then get Covid-19 … I don't even want to think about it.

We also need a few more answers about what being positive for antibodies really means. Can one be reinfected, or do the antibodies confer immunity? If immune, for how long? If you can get reinfected, would it be more or less severe? And on and on… Again, these answers are beginning to emerge as scientists do their research, both for a vaccine and studying immunity. So far, what is coming out looks positive – that is, in primates and mice, antibodies seem to prevent reinfection by the virus, but until we know for sure, the test, at least for those of us at high risk, is immaterial.

As always, stay tuned for further developments

Sue

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