Survivors of COVID-19 seek a way to help those suffering, often feeling a sense of obligation. Blood plasma from rehabilitated COVID-19 patients has emerged as a promising treatment option to aid COVID-19 patients fighting for their lives. Those who have recovered from COVID-19 have built up antibodies in their bloodstream that can now follow its path and subsequently neutralize the virus in others. On March 24, the FDA released guidelines as an investigational new therapy whereby a recovered patient would donate his or her blood plasma in a process typical of an ordinary blood donation. “With few treatments available for COVID-19 patients, Agudath Israel of America was eager to explore options and see what could be done to help the many suffering,” says Avrohom Weinstock, Chief of Staff and Associate Director of Education for Agudath Israel. “After speaking with infectious disease experts, we were advised that the downsides of plasma donations are minimal and, with drugs and vaccines far from development, plasma therapy seemed logical to pursue. With that, we began encouraging our eligible constituents to donate plasma on [Wednesday,] April 1.”
This approach dates to the 1890s, most notably to the 1,700 patients who received the blood serum from survivors of the 1918 H1N1 “Spanish flu” influenza virus contagion. Recent successful applications, albeit on a much smaller scale, reflect on the late 2002 outbreak of SARS, H1N1’s resurgence in 2008, MERS in 2012, and the 2014 African Ebola spate. Finally, plasma was used – to positive results in small studies – in this very COVID-19 outbreak in China and later in the ravaged country of Italy. The plasma is filtered by a machine that returns both the red and white blood cells to the donor, and what remains is a golden fluid known as plasma. It can then be transfused into two or even three people suffering from the infection.
As of Monday, April 20, the Mayo Clinic reports that there are 1,663 registered sites with 2,246 registered investigational new drug physicians and 2,300 enrolled patients having 750 who have completed infusions associated with the National COVID-19 Convalescent Plasma Project. These programs have sprouted across the nation with plasma donation centers for those who have tested positive for coronavirus and are now upwards of three weeks from the arrival of symptoms. America was stricken with an endless list of COVID-19 patients, and many are eager to help mitigate its harm, but the task of logistics stood as an obstacle. In his quest to find a cure for his ailing father-in-law, Mordechai Serle, a lawyer by profession, happened upon an April 1 Wall Street Journal article by Amy Dockser Marcus that mentioned the efforts of Chaim Lebovits, the owner of a men’s and boy’s shoe warehouse outlet, at a Montefiore Medical Center plasma collection drive in the hard-hit area of New Rochelle. Serle and Lebovits soon connected and were also joined by Abba Switzky, a real estate investor, seeking the COVID-19 cure for his languishing father. Avrohom Weinstock of Agudath Israel became the fourth and final piece to the puzzle, forming a team that knew the extent of the outbreak in the Orthodox frum communities. “The combined efforts of Agudah, with Lebovits, Serle, and Switzky’s painstaking work, were a recipe for amazing opportunities for the Jewish world,” related Weinstock. Within just a few short days, the newly formed remote team released the website covidplasmasavealife.com with a slew of media blasts to rally the Jewish world to become prospective plasma donors. “Our team coordinated around 25 volunteers to man the phones and field inquiries, leaving no impediments in their sight. Only 2,300 prospective donors submitted information, suggesting they were eligible to donate. We now work to help ensure that each prospective donor fulfills his or her wish to help others. Over 600 plasma transfusions have so far been completed,” noted Serle. Said Weinstock, “Based on experience, we were confident that the Orthodox community would respond and jump in if there was an opportunity to help others, but this response exceeded our expectations.” Based on current cases, it appears most beneficial to run the therapy in the first few days of hospitalization and before things take a turn for the worse. In the days that followed, more neighborhoods from Monsey to Lakewood and Crown Heights created their own plasma extraction drives, further expanding the cause.
On Thursday, April 2, the FDA awarded the famed Mayo Clinic in Rochester, Minnesota, the opportunity to direct a national convalescent plasma study; Dr. Michael Joyner, an anesthesiologist and physiologist by trade, was chosen to lead this project, entitled the Mayo Clinic Extended Access Program. Joyner publicly explained, “We intend to harvest those antibodies from recovered patients and then give these antibodies in the form of plasma to people to either prevent disease in people that have been exposed but are not yet sick, to treat people who are in the hospital and try to keep them from going to the intensive care unit, or to try to shorten the stay in the intensive care unit.”
Mount Sinai Hospital in Manhattan began testing specifically to aid critically ill patients and has conducted research on hundreds upon hundreds of patients to date, but the Mayo Clinic study allows for any hospital to link up if it appoints a “principal investigator.” Dr. David Reich, president of Mt. Sinai, explained in a CBS News interview, “In theory, if you give a large enough dose and early enough in the disease process, the antibodies in the convalescent plasma will neutralize the viral particles in the bloodstream of that individual, possibly leading to a milder course of disease with potentially fewer complications.”
Agudah then reached out to NYS Assemblyman Simcha Eichenstein, who worked with the grassroots group to methodically apprise area hospital administrators and board members of convalescent plasma rehabilitation, and how the Orthodox community could assist hospitals with donors and pre-screening to take this to reality.
Such research was previously started by Dr. Arturo Casadavell, a professor in Baltimore at Johns Hopkins Bloomberg School of Public Health and School of Medicine. Casadavell might be credited as the first to bring national light to the potentials of plasma therapy, as he published an op-ed on the topic in the Wall Street Journal at the close of February, when the virus was starting to pick up pace in the US. “Dr. Shmuel Shoham, Associate Professor of Medicine at Johns Hopkins School of Medicine, was instrumental in advocating the convalescent plasma therapy with fellow Hopkins associates,” explained Serle.
On Tuesday, April 21, FDA Commissioner Dr. Stephen Hahn announced the emergency authorization of mail-in, doctor-ordered, at-home testing kits. “We have been facilitating test development to ensure patients’ access to accurate diagnostics,” reported Hahn. The broadcast noted that in due time, “reliable and accurate at-home sample-collection options” will be made available. Plasma donor blood is also checked for HIV and hepatitis traces. With countless donors at its fingertips, clinics seek those with the highest levels of antibodies, as medical personnel are unsure how long antibodies stay in the bloodstream. It is suspected that these elevated levels occur between three and four weeks after one falls ill. To that end, the Mayo Clinic has produced 1,000 antibody tests a day and is able to manufacture upwards of 20,000 a day in the coming weeks. Aspirations are high for a synthetic version of the antibody to be created targeting SARS-CoV-2, the virus that causes COVID-19. Testing remains to figure how much of the antibodies are required and how long protection continues. A point of care test, essentially just a finger prick, requires just ten minutes for one to learn if he or she has an immune response to COVID-19.
With the American government’s stamp of approval, the frum team quickly realized the need to address collection capacity issue. “The Brooklyn-based Maimonides Medical Center had just one machine with the plasma-drawing technology and could only successfully process five to ten patients a day,” explains Serle.
The New York Blood Center, widely known as one of the largest blood collection facilities in the region, was contacted by the team to become a partner. Serle described, “Dr. Beth Shaz, the Chief Medical and Scientific Officer and Senior Vice President of NYBC, explained that they have the capability to collect at least 1,000 donations a month, making them a much-needed collaborator.” Serle continued: “In the beginning of April, overburdened hospitals, even if they were aware of plasma’s capabilities, were simply too overwhelmed to begin incorporating it into their routines, and there was a lot of red tape to cut through. NYBC soon accumulated over 400 samples, but no willing hospitals to accept them.” Outside of New York, donations were abysmal. Serle reported, “NYBC had an affiliate in the State of Delaware capable of receiving 120 donors a day but only took in three. A lot of education remained.” To date, the Red Cross has agreed to donate several plasma collection machines, and the initiative has taken upon itself to fill every working machine with donors.
Between the Albert Einstein College of Medicine and the Montefiore Medical Center, Brooklyn Hospital Center, Mount Sinai Hospital in New York, and the Mayo Clinic, thousands of inquiries were fielded, and plasma donation centers were soon announced. Due to the efforts of the program, convalescent plasma therapy has been activated at Good Samaritan Hospital, Jersey Shore University Medical Center, Kimball Medical Center, Lenox Hill Hospital-Northwell Health, Long Island Jewish Medical Center-Northwell Health, Maimonides Medical Center, Monmouth Medical Center, Mount Sinai, North Shore University Hospital-Northwell Health, Rutgers Robert Wood Johnson Medical School-Rutgers University, and Westchester Medical Center.
Weinstock elaborated, “Hospitals did not medically disagree with the potential efficacy of plasma therapy, nor did they find safety concerns; they were simply struggling to keep patients in their ICUs alive in the here and now.”
“NewYork-Presbyterian-Weill Cornell Medical Center is one of our next hospitals to tackle,” added Serle. The hope remains to replicate these efforts across America. Agudath Israel is exploring a united national plasma effort and is conferring with its regional offices of how to replicate the efforts of the New York grassroots team. “Plasma infusions are not a COVID-19 cure. But, results from the ongoing therapy have been encouraging. There is more that needs to be done. There needs to be sufficient donors and sufficient machinery to process the plasma donations, so that any hospital that requests it should have what it needs to treat any patient who needs it,” said Weinstock. “All available plasma collection machinery throughout the country must be put in operation,” concluded Serle.
Different hospitals have different testing protocols for accepting plasma. Some require a prior positive COVID-19 test, and others require a current negative test. The bottom line is that if you had, or believe you had COVID-19, and have been symptom-free, fill out the survey at covidplasmasavealife.com, so volunteers can connect you with the right hospital.