Preventing Disease Spread, Investigating Plasma Therapy: A Check-In With Health Experts
As the Scott administration gradually eases restrictions in Vermont, we talk to Deputy Health Commissioner Tracy Dolan about precautions to prevent further spread of COVID-19. We also learn about a Dartmouth-Hitchcock Medical Center program, which is investigating convalescent blood plasma -- the plasma of recovered COVID-19 patents -- as a possible treatment for the disease.
Our guests are:
- Tracy Dolan, deputy commissioner for the Vermont Department of Health
- Jami Wilson, director of the Clinical Research Unit and Clinical Research Nursing at Dartmouth-Hitchcock Medical Center
Broadcast live after Gov. Phil Scott's press conference on Monday, May 11, 2020; rebroadcast at 7 p.m.
The following has been edited and paraphrased for brevity and clarity.
Q & A With Jami Wilson, director of the Clinical Research Unit and Clinical Research Nursing at Dartmouth-Hitchcock Medical Center
Jane Lindholm: So I understand that Dartmouth-Hitchcock Medical Center (DHMC) is participating in a program that will evaluate the use of this antibody-rich plasma to treat COVID-19. And you're taking the plasma from people who are either confirmed to have had or are assumed to have had COVID-19. So can you start at the beginning of the process? Who are you testing and what is it that you're taking from people?
Jami Wilson: Yes. Plasma is the liquid portion of blood, and it's donated by COVID-positive patients or, as you said, patients who were deemed by their physicians to likely have COVID-19 based on symptoms or their having had another positive family member in the household. This liquid portion of the blood is extracted from the patient. They take about one pint, and that pint is divided into two units, which can treat two critically ill patients who are hospitalized with COVID-19.
So in terms of the confirmed cases, that's clear from a test. And for the assumed cases, that's when the physician has said, "We assume this person has it," whether or not they've been tested or perhaps tested negative?
Jami Wilson: Yep. If they've tested negative, then they would not qualify as a patient who likely had COVID. But if they are in a household or exposed to somebody who did test positive and are exhibiting symptoms, such that the physician is confident that they can deem that they likely are positive with COVID, then they would qualify.
"The use of convalescent plasma actually dates back to the early 1900s. It was used in the Spanish Flu in 1918, which coincidentally also affected the Upper Valley, and the SARS outbreak in 2003." - Jami Wilson, Dartmouth-Hitchcock Medical Center
Are you testing for antibodies or just taking plasma?
Jami Wilson: There is another protocol that is in the works right now, looking into testing for antibodies. But this study is currently just taking plasma. That plasma is then tested as any other blood product would be for any other disease to make sure that it's able to be transfused into a patient. And then the plasma is given to a patient in-house.
Why is plasma so important or so good?
Jami Wilson: So the plasma likely contains bodies to the COVID-19 virus, which may be a safe treatment option for critically ill patients.
The use of convalescent plasma actually dates back to the early 1900s. It was used in the Spanish Flu in 1918, which coincidentally also affected the Upper Valley, and the SARS outbreak in 2003. In both of those instances, the use was promising in treatment for patients.
So, I’m hearing that it’s promising, but hasn’t been studied enough to really have a great sense of whether it works? This seems like a moment in time where a lot of places – not just DHMC – are working on this question.
Jami Wilson: Yes, you're correct. So we're actually tapping into an expanded access program through the Mayo Clinic, and multiple sites in the United States are able to do this. Through patients participating in this study, they're collecting some observational safety data, which will be informative as to whether this treatment is feasible to continue using in the future. Other sites that have a higher population of COVID-positive patients are doing randomized clinical trials to further that research.
So you're actually transferring this plasma into COVID-positive patients now?
Jami Wilson: Yes. The patients who receive this plasma are critically ill, so they are being treated inpatient. They could be at Dartmouth, but we've also been able to supply plasma to other facilities in New Hampshire.
First, the plasma is extracted from the recovered patient. It's a couple-day process to go through all of the testing and process the plasma to make sure it's safe for transfusion. Then, the plasma is delivered to the [hospital] floor and transfused into the sick patient, just as any other blood product would be.
Yeah, I was going to say: you might not have enough patients at Dartmouth Hitchcock or even in the Upper Valley to be able to just contain this study to this specific region, right?
Jami Wilson: Yep. We've been fortunate enough to be able to supply a lot of the southern hospitals in the state as well.
And what are you observing so far?
Jami Wilson: Unfortunately, we can't share individual patient responses due to the size of our community and patient privacy. But overall, nationally, there are some promising results. But, as we spoke about previously, more research is definitely needed to have that solid answer.
So understanding that caveat, what do those promising results you're seeing nationally look like? What is the hope and what do people think might happen?
Jami Wilson: The hope is that the antibodies in the plasma, once the patient receives that, is going to help them fight the infection and be able to reverse the effects of COVID and that patients who are admitted critically ill with a poor prognosis will actually be discharged home. In some cases, we have been seeing that that is the case. But as with anything, you can't really come to a conclusion off of a variable of a small sample size of patients.
And Jami, just to back up to the science, the idea is that if you are given antibodies that somebody else made through this plasma transfusion and you're a very sick person, and your body is working overtime to combat this virus, getting those passive antibodies may help build your response to the virus without your body having to do it because your body is really struggling already. That's not a super scientific way of putting it, but is that right?
Jami Wilson: That is right. It helps strengthen your own immunity to fight against the virus.
If you are someone who is receiving the plasma, who is a critically ill COVID-19 patient, do you have to consent to this, or is this something that's just part of standard treatment?
Jami Wilson: You do have to consent for this. So if you are doing well enough that you can consent yourself then that is how that process goes. Elsewise, the research team would work to consult a legally authorized representative or next of kin.
"Overall, nationally, there are some promising results. But, as we spoke about previously, more research is definitely needed to have that solid answer." - Jami Wilson, Dartmouth-Hitchcock Medical Center
What are the risks associated with this treatment as a patient who's getting this plasma?
Jami Wilson: Whenever you're receiving a drug like this, you can have an immune response, side effects, just like any other medication. So once a patient is infused with the plasma, they're monitored closely by the floor stuff to ensure that they're not having any type of negative reaction.
What is the protocol for people donating? Can Vermonters and New Hampshire residents who have had or who are assumed to have had COVID-19 get involved in this?
Yes, certainly. The community response around us has actually been pretty amazing. Those who have recovered from COVID, including Dartmouth-Hitchcock employees, have been really eager to contribute to this as a potential solution for the global pandemic.
If you're 28 days out after the resolution of your symptoms, you can call the DHMC blood donor program or email them I have those contact numbers, it would be 603.653.3775 or email email@example.com.
So you are looking for more volunteers?
Yes! When you call the blood donor program, you go through a screening process to ensure that you're eligible, and then they'll set an appointment for the patient to come in.
What are we hoping to understand better from this study that could streamline things in the future, either for a secondary surge of this illness, or for other illnesses like this? As you mentioned, this was something that was used as far back as the 1918 flu pandemic.
Jami Wilson: Yeah, so if we see positive outcomes, then it just highlights the need to have this process in place as soon as possible – should we see further surges.
We also have other treatment studies here at Dartmouth for COVID-19 and interdepartmental collaboration has been integral to quickly operationalizing these trials in response to COVID. We're working very closely with med transfusion, research ops. All of the clinicians, especially in infectious disease, have really allowed us to respond and provide treatments to patients as quickly as possible, so we'll be prepared, should there be a surge or a second rise in what we're seeing in our area.