Doctors in 2020 found themselves in a similar situation as their colleagues in 1918 : with no proven treatment or vaccine for COVID-19 , they looked to treating patients with the plasma of those who had already survived it .
Knowing when to give patients convalescent plasma ( CP ), and how effective it might be in different phases of the illness , are the key points of the current studies , which are taking place at multiple health centers . Adam C . Levine , MD , MPH , associate professor of emergency medicine and director of Brown ’ s Division of Global Emergency Medicine , is running the trials here .
In one , CP is given to individuals who have had high-risk exposure to COVID-19 , like if they live with someone who has tested positive for the virus or if they ’ re a health care worker . These subjects are enrolled in the study and randomized to CP or standard plasma before they show any signs or symptoms . The goal is to see if giving antibodies to people exposed to COVID-19 can work as prophylactic treatment , to prevent an infection from taking hold .
“ Given that so much transmission happens within a household , and we don ’ t really have a way to prevent that , and frontline workers are putting themselves at risk , this could be a powerful way to prevent those infections ,” says Levine , who also worked in Liberia during the Ebola outbreak in 2014 . If this kind of preventive measure works , he adds , it can also help health care workers feel more confident about continuing to do their jobs . In the second study , participants who recently tested positive for COVID-19 and have mild symptoms are treated with CP in their first week of disease to see if it prevents them from getting severely ill .
“ Based on what we know about convalescent plasma from other diseases and from this disease , it ’ s probably more likely to be effective early in the course of the disease , before the viral load is too high ,” Levine says . “ Then the antibodies have the best shot at neutralizing what is there .”
“ Little Rhode Island has made a big impact ... I ’ m really proud of that .” — Karen Tashima
REDEPLOYING REMDESIVIR
Karen Tashima , MD , a professor of medicine , calls remdesivir a “ drug looking for a disease to treat .” The antiviral was developed in 2009 by Gilead Sciences in hopes of treating RNAbased viruses that could spark global pandemics . It didn ’ t work as well as antibodies for Ebola in a 2014 study , despite showing activity in the lab .
“ Why not try it for COVID-19 ?” asks Tashima , who is the director of clinical trials at the immunology center at Lifespan and clinical research site leader for The Miriam Hospital .
That ’ s exactly what she and her colleagues did as part of a global study . In it , 397 people hospitalized for COVID-19 received remdesivir for five or 10 days . The goal was to determine how long patients should be given the drug . Researchers found that in patients who didn ’ t require ventilators , giving remdesivir for five days was just as effective as 10 days .
“ We can ’ t say how effective it was in this study because it was not compared to a placebo , but we know that after five days , people had very few adverse reactions , and that five days is just as good as 10 days for patients who are not intubated ,” Tashima says . These results can stop patients from getting medication in doses they don ’ t need , especially a medication that at times has been in short supply .
The study was conducted at the height of the spring outbreak , and brought a potential treatment into Rhode Island ’ s hospitals that might not have been available otherwise . “ We really wanted to have a treatment available to patients in Rhode Island because what else could we do ?” she says . “ We wanted to have something to give patients that wasn ’ t just supportive care . We wanted to be able to offer this drug .”
Tashima says researchers made sure to have doctors fluent in Spanish on their team , and consent forms in Spanish , to ensure Spanish speakers could be enrolled in the trial too — key since COVID-19 has disproportionally affected Black and Latinx Americans . Now Tashima is focused on the next frontier : she ’ s heading up a clinical trial of the COVID vaccine at The Miriam . z
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