Tag: finds

 

Cardiac MRI contrast agents unlikely to produce adverse reactions, study finds

Oct. 29 (UPI) — Chemicals used to improve images of the heart during MRI scans are unlikely to produce allergic reactions and other side effects in patients who take them, according to a study published Thursday by the journal Radiology: Cardiothoracic Imaging.

In reviewing data from more than 145,000 cardiac MRI scans performed in Europe between 2017 and 2019, well under 1% included reports of side effects or allergic reactions related to the use of contrast agents such as gadolinium, the data showed.

In addition, just 47 of the contrast agent-related adverse reactions included those that were “severe” in nature, such as chest pain, the researchers said.

“Our study demonstrates that the administration of intravenous gadolinium-based contrast agents for cardiac MRI is safe for the overwhelming majority of patients,” study co-author Dr. Johannes Uhlig said in a statement.

Cardiac MRI is used to diagnose a variety of conditions, including aneurysms, blood clots and defects. The imaging method also can help evaluate diseases such as cardiomyopathy and myocarditis, or inflammation of the heart.

The majority of cardiac MRI exams use intravenous gadolinium-based contrast agents to improve visualization of the heart muscle and blood flow, the researchers said.

Contrast agents contain an ion of the heavy metal gadolinium, which is toxic to humans. However, in contrast agents, it is bound in a molecule called a ligand to make it safe, according to Uhlig, a cardiologist at University Medical Center in Goettingen, Germany.

The findings of this study come three years after the European Union enacted new regulations restricting the marketing of linear gadolinium-based contrast agents, he and his colleagues said.

Gadolinium-based contrast agents are classified as either linear — with longer ligands — or macrocyclic — with a cage-shaped ligand that traps the ion inside — based on the type of ligand used, they said.

Studies have shown that trace amounts of the toxic gadolinium ions may remain in the body following repeated gadolinium-based contrast agent use, and linear agents are thought to have a higher likelihood of staying behind compared to macrocyclic ones, according to Uhlig.

The U.S. Food and Drug Administration recommends that physicians consider gadolinium retention when choosing agents to use, he said.

For the new study, Uhlig and his colleagues reviewed data on 154,779 patients who underwent cardiac MRI, with almost 95%, or 145,855, receiving gadolinium-based contrast agents.

Among those who received these agents prior to cardiac MRI, 0.38%, or 556, reported an adverse reaction, with all but 47 being classified as “mild.” Those included allergic reactions such as developing hives and wheezing, the data showed.

The 47 “moderate” or “severe” adverse reactions included chest pain and irregular heartbeat. Adverse events also occurred in cardiac MRIs performed without gadolinium, with 2.6%, or 231, of the 8,924 patients reporting adverse reactions such as anxiety and shortness of breath, the researchers said.

The results underscore the importance of preprocedural assessments to look for contraindications to MRI scanning and use of gadolinium-based contrast agents, as well as the likelihood of adverse

Immunity to coronavirus lingers for months, study finds

Immunity to Covid-19 infection lingers for at least five months, researchers reported — and probably longer than that.



a man and a woman looking at her cell phone: PERTH, AUSTRALIA - APRIL 20: Registered nurse Heather Hoppe receives a flu vaccination in the trial clinic at Sir Charles Gairdner hospital on April 20, 2020 in Perth, Australia. Healthcare workers in Western Australia are participating in a new trial to test whether an existing tuberculosis vaccine can help reduce their chances of contracting COVID-19. 2000 frontline staff from Fiona Stanley, Sir Charles Gairdner and Perth Children's Hospital are taking part in the research trial, which will see half of participants receiving the existing Bacillus Calmette-Guérin (BCG) vaccine in addition to their flu vaccine, while the other half receive the regular flu shot. The BCG vaccine was originally developed to work against tuberculosis, but it is hoped it might help reduce the chance of contracting coronavirus as well as lessen the severity of symptoms and boost immunity in the long term. The BRACE trial is being led by by the Murdoch Children's Research Institute. (Photo by Paul Kane/Getty Images)


© Paul Kane/Getty Images AsiaPac/Getty Images
PERTH, AUSTRALIA – APRIL 20: Registered nurse Heather Hoppe receives a flu vaccination in the trial clinic at Sir Charles Gairdner hospital on April 20, 2020 in Perth, Australia. Healthcare workers in Western Australia are participating in a new trial to test whether an existing tuberculosis vaccine can help reduce their chances of contracting COVID-19. 2000 frontline staff from Fiona Stanley, Sir Charles Gairdner and Perth Children’s Hospital are taking part in the research trial, which will see half of participants receiving the existing Bacillus Calmette-Guérin (BCG) vaccine in addition to their flu vaccine, while the other half receive the regular flu shot. The BCG vaccine was originally developed to work against tuberculosis, but it is hoped it might help reduce the chance of contracting coronavirus as well as lessen the severity of symptoms and boost immunity in the long term. The BRACE trial is being led by by the Murdoch Children’s Research Institute. (Photo by Paul Kane/Getty Images)

While the report may seem confusing and contradictory to a similar report out of Britain this week, it really isn’t. People’s bodies produce an army of immune compounds in response to an infection and some are overwhelming at first, dying off quickly, while others build more slowly.

The new report out Wednesday shows 90% of people who recover from Covid-19 infections keep a stable antibody response.

“While some reports have come out saying antibodies to this virus go away quickly, we have found just the opposite — that more than 90% of people who were mildly or moderately ill produce an antibody response strong enough to neutralize the virus, and the response is maintained for many months,” Florian Krammer, a professor of vaccinology at the Icahn School of Medicine at Mount Sinai, who led the study team, said in a statement.

“This is essential for effective vaccine development.”

The team looked at the antibody responses of more than 30,000 people who tested positive for Covid-19 at Mount Sinai’s Health System between March and October. They characterized their antibody responses as low, moderate or high. More than 90% had moderate to high levels, or titers, of antibodies to the spike protein of the virus — the structure it uses to grapple the cells it infects.

They then closely studied 121 patients who recovered and donated their plasma — once three months after they first developed symptoms, and again five months later.

They did see a drop-off in some antibodies. But others persisted, they reported in the journal Science.

“The serum antibody titer we measured in individuals initially were likely produced by plasmablasts, cells that act as first responders to an invading virus and come together to produce initial bouts of antibodies whose strength soon wanes,” said Dr. Ania Wajnberg, director of Clinical Antibody Testing at the Mount Sinai Hospital.

“The sustained antibody levels that we subsequently observed

U.K study finds sharp drop in COVID-19 antibodies just months after infection

One of the vexing things about coronaviruses like the common cold is that the immune response they induce is often short-lived. You catch a cold, recover and then catch it again six months later.

New research published Tuesday indicates fading immunity might also occur with the much more serious coronavirus, SARS CoV-2. Imperial College London scientists found that in a random sample of 365,000 adults in the United Kingdom, the presence of COVID-19 antibodies declined in all age groups by 26% from June to September.

The subjects in the REACT2 study, which has not been peer-reviewed, were given finger-prick tests in three rounds over the summer. After the first round, which ended in July, about 60 of 1,000 people in the sample, or 6%, had positive antibodies. By the end of September, that number had fallen to 44 per 1,000 (4.4%).

Age appeared to affect antibody duration. Younger people had higher levels than those over 65, and their antibodies lasted longer.


A faster decline in antibodies was observed in asymptomatic or mildly symptomatic cases than in those with full-blown symptoms, said Professor Wendy Barclay, head of the college’s infectious disease department, in a video call with journalists. Health care workers showed no change in antibody levels, possibly due to continuous on-the-job exposure to the virus.

“On the balance of evidence, I would say, with what we know for other coronaviruses, it would look as if immunity declines away at the same rate as antibodies decline away, and that this is an indication of waning immunity at the population level,” Barclay added.

“We don’t yet know what level of antibody is needed in a person’s blood to prevent reinfection,” she added.

Just a handful of cases of people getting COVID-19 twice have been confirmed. But immunity from the first wave of infections in March and April may only now be starting to dissipate, raising the prospect of more repeat cases, according to epidemiologists.

The findings suggest that those expecting increased infections to result in so-called herd immunity over time could be disappointed.

Herd immunity occurs when enough of a population is immune to a disease, making it unlikely to spread and protecting the rest of the community.

If no vaccine is developed, the portion of the population that would have to recover from COVID-19 in order to achieve herd immunity is estimated at about 70%, or more than 200 million people in the United States, according to the Mayo Clinic.

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Nurses Make Up Most Hospitalized Coronavirus Health Care Workers, CDC Finds | Health News

Most of the health care workers hospitalized with the coronavirus are nurses, according to a new Centers for Disease Control and Prevention report.

The report found that nearly 6% of all patients hospitalized with COVID-19 were health care workers, with 36.3% of those patients being nurses. More than two-thirds, 67.4%, had direct patient contact and more than 4% of the health care workers who were hospitalized died.

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TOPSHOT - A passenger in an outfit (R) poses for a picture as a security guard wearing a facemask as a preventive measure against the Covid-19 coronavirus stands nearby on a last century-style boat, featuring a theatrical drama set between the 1920s and 1930s in Wuhan, in Chinas central Hubei province on September 27, 2020. (Photo by Hector RETAMAL / AFP) (Photo by HECTOR RETAMAL/AFP via Getty Images)

The CDC’s report included medical records from nearly 7,000 coronavirus patients who were in the hospital between March 1 and May 31.

Nearly 90% of health care workers who were hospitalized with the virus had at least one underlying medical condition, with the most common, 73%, being obesity.

According to the report, the median age of the hospitalized health care worker was 49, compared to 62 among the general population. Most health care workers in the hospital with COVID-19 were women, with a large proportion being Black.

Additionally, the report found that the median length of hospitalization among the providers with COVID-19 was four days and 27.5% of providers were admitted to the intensive care unit for a median of six days.

The CDC said the findings were comparable to those reported among health care providers with COVID-19 in China.

In the U.S., nursing-related occupations account for a large proportion of the health care workplace, and in 2019 registered nurses represented approximately one-third of health care providers.

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New Landmark Study at UM School of Medicine Finds Aspirin Use Reduces Risk of Death in Hospitalized COVID-19 Patients

BALTIMORE, Oct. 26, 2020 /PRNewswire/ — Hospitalized COVID-19 patients who were taking a daily low-dose aspirin to protect against cardiovascular disease had a significantly lower risk of complications and death compared to those who were not taking aspirin, according to a new study led by researchers at the University of Maryland School of Medicine (UMSOM). Aspirin takers were less likely to be placed in the intensive care unit (ICU) or hooked up to a mechanical ventilator, and they were more likely to survive the infection compared to hospitalized patients who were not taking aspirin, The study, published today in the journal Anesthesia and Analgesia, provides “cautious optimism,” the researchers say, for an inexpensive, accessible medication with a well-known safety profile that could help prevent severe complications.

“This is a critical finding that needs to be confirmed through a randomized clinical trial,” said study leader Jonathan Chow, MD, Assistant Professor of Anesthesiology at UMSOM. “If our finding is confirmed, it would make aspirin the first widely available, over-the-counter medication to reduce mortality in COVID-19 patients.”

To conduct the study, Dr. Chow and his colleagues culled through the medical records of 412 COVID-19 patients, age of 55 on average, who were hospitalized over the past few months due to complications of their infection. They were treated at the University of Maryland Medical Center in Baltimore and three other hospitals along the East Coast. About a quarter of the patients were taking a daily low-dose aspirin (usually 81 milligrams) before they were admitted or right after admission to manage their cardiovascular disease.

The researchers found aspirin use was associated with a 44 percent reduction in the risk of being put on a mechanical ventilator, a 43 percent decrease in the risk of ICU admission and – most importantly – a 47 percent decrease in the risk of dying in the hospital compared to those who were not taking aspirin. The patients in the aspirin group did not experience a significant increase in adverse events such as major bleeding while hospitalized.

The researchers controlled for several factors that may have played a role in a patient’s prognosis including age, gender, body mass index, race, hypertension and diabetes. They also accounted for heart disease, kidney disease, liver disease and the use of beta blockers to control blood pressure.

COVID-19 infections increase the risk of dangerous blood clots that can form in the heart, lungs, blood vessels and other organs. Complications from blood clots can, in rare cases, cause heart attacks, strokes and multiple organ failure as well as death.

Doctors often recommend a daily low-dose aspirin for patients who have previously had a heart attack or stroke caused by a blood clot to prevent future blood clots. Daily use, however, can increase the risk of major bleeding or peptic ulcer disease.

“We believe that the blood thinning effects of aspirin provides benefits for COVID-19 patients by preventing microclot formation,” said study co-author Michael A. Mazzeffi, MD, Associate Professor of Anesthesiology at

Hospitalized coronavirus patients who take daily aspirin have lower death risk, study finds

Hospitalized coronavirus patients who took daily aspirin for cardiovascular health had a lower death risk than those who did not take aspirin, according to the findings of a new study conducted by researchers with the University of Maryland School of Medicine. 

Patients who took aspirin also had a lower risk of complications, while their chances of requiring admission into the hospital’s intensive care unit (ICU) and being ventilated also fell, according to a news release regarding the findings, which were published Wednesday in the journal Anesthesia and Analgesia. 

Those who took aspirin also had a 47% reduced risk of dying in the hospital compared to those who did not take the drug. (iStock)

Those who took aspirin also had a 47% reduced risk of dying in the hospital compared to those who did not take the drug. (iStock)

For the study, the team looked at the medical records of some 412 patients who were hospitalized due to complications with COVID-19. The average age of patients was 55. All patients in the study were treated at the University of Maryland Medical Center in Baltimore or three other hospitals along the East Coast, per the release. Any of the patients’ preexisting conditions, such as hypertension, diabetes, kidney disease, and others, as well as age, gender, body mass index and race, were all accounted for in the study. 

Roughly a quarter of the patients were taking daily, low-dose aspirin before they were admitted or began taking the drug shortly after they were admitted to the hospital.

CAN MOUTHWASH PROTECT AGAINST CORONAVIRUS? EXPERTS DISCUSS RESULTS OF VIRAL STUDY

Following their analysis, the study authors concluded that those who took aspirin had a 44% reduced chance of requiring ventilation, and a 43% less risk of requiring admission into the ICU. Most importantly, the researchers said, those who took aspirin also had a 47% reduced risk of dying in the hospital compared to those who did not take the drug. 

“The patients in the aspirin group did not experience a significant increase in adverse events such as major bleeding while hospitalized,” they added. (Daily use of low-dose aspirin, which is often recommended for those who have previously suffered a heart attack or stroke to prevent future blood clots, can increase the risk “of major bleeding or peptic ulcer disease,” the researchers explained.)

The researchers hypothesize that aspirin’s blood-thinning effects may have played a role in the positive outcomes for hospitalized patients taking the drug, as COVID-19 infections “increase the risk of dangerous blood clots that can form in the heart, lungs, blood vessels and other organs. Complications from blood clots can, in rare cases, cause heart attacks, strokes and multiple organ failure as well as death,” they said. 

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“This is a critical finding that needs to be confirmed through a randomized clinical trial,” said study leader Dr. Jonathan Chow, an assistant professor of anesthesiology at the University of Maryland School of Medicine, in a statement. “If our finding is confirmed, it would make aspirin the first widely available, over-the-counter medication to reduce mortality in COVID-19 patients.”

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U.S. Faces Half a Million COVID-19 Deaths by End-February, Study Finds | Top News

LONDON (Reuters) – More than a half million people in the United States could die from COVID-19 by the end of February, but around 130,000 of those lives could be saved if everybody were to wear masks, according to estimates from a modelling study on Friday.

The estimates by researchers at the University of Washington’s Institute for Health Metrics and Evaluation showed that with few effective COVID-19 treatment options and no vaccines yet available, the United States faces “a continued COVID-19 public health challenge through the winter.”

“We are heading into a very substantial fall/winter surge,” said IHME Director Chris Murray, who co-led the research.

He said the projections, as well as currently rising infection rates and deaths, showed there is no basis to “the idea that the pandemic is going away,” adding: “We do not believe that is true.”

President Donald Trump said in Thursday’s election debate of the pandemic: “It’s going away.”

The Friday update was the first time the IHME has projected deaths beyond Feb. 1. Its current forecast on its website is for 386,000 deaths as of Feb 1.

Trump’s handling of the coronavirus pandemic, which has killed more than 221,000 Americans so far, has become the top issue for him and Democratic candidate Joe Biden in the Nov. 3 election. Polls have shown that Americans trust Biden more than Trump to handle the crisis.

The IHME study forecast that large, populous states such as California, Texas and Florida will likely face particularly high levels of illness, deaths and demands on hospital resources.

“We expect the surge to steadily grow across different states and at the national level, and to continue to increase as we head towards high levels of daily deaths in late December and in January,” Murray said.

The modelling study, which mapped out various scenarios and their projected impact on the spread of the COVID-19 epidemic in the United States, found that universal mask-wearing could have a major impact on death rates, potentially saving 130,000 lives.

Current mask use in the United States varies widely. While some states, like New York, set strict rules on when to wear masks, others have no requirements. The issue has become political, in which some supporters have taken their cues from Trump, who is often seen without a mask and has repeatedly questioned their usefulness.

“Expanding mask use is one of the easy wins for the United States … and can save many lives,” Murray said.

He added that, just as parts of Europe and some local U.S. areas of high transmission are doing now, many U.S. states would need to re-introduce social distancing measures to curb the winter surge.

(Reporting by Kate Kelland, additional reporting by Caroline Humer, editing by Steve Orlofsky and Cynthia Osterman)

Copyright 2020 Thomson Reuters.

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A New, Large Study Finds Plasma Does Not Lower Risk of Dying from COVID-19

SPAIN-VIRUS-HEALTH-PLASMA
SPAIN-VIRUS-HEALTH-PLASMA

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Researchers in India report that COVID-10 patients who received convalescent plasma from recovered patients did not see a lower risk of dying from the disease.

The study, published in BMJ, included 464 people with moderate COVID-19 disease, meaning they had oxygen saturation levels of 93% or less when breathing room air, the criterion that most doctors use to determine if they should hospitalize people who are infected with SARS-CoV-2, the virus that causes the illness. Study co-author Aparna Mukherjee, a scientist in epidemiology and communicable diseases at the Indian Council of Medical Research, notes that patients in her study would likely be considered severely ill in other countries, since definitions of illness vary considerably around the world. Once in the hospital, some patients in the study received two doses of convalescent plasma from those who had recovered from the disease and donated their immune cell-rich blood. These patients were compared to those treated with standard of care, who acted as a control group (but did not receive a placebo infusion). Both groups had similar mortality rates after 28 days.

“This study had a large sample size and it showed that when plasma is infused in patients who have moderate COVID-19 (similar to severe in other countries), it did not reduce mortality or progression to more critical COVID-19,” Aparna Mukherjee, a scientist in epidemiology and communicable diseases at the Indian Council of Medical Research and one of the co-authors of the study, said in an email response to questions.

The results add to the continued debate over how useful convalescent plasma might be as a treatment for COVID-19. Convalescent plasma is one of the oldest therapies that doctors have used in treating infectious diseases, based on the idea that people who are naturally infected and recover will have a ready supply of the proper immune cells needed to fight off the virus or bacteria in question. But because people’s immune systems vary widely, their volume of disease-fighting cells is also unpredictable, and may range from barely adequate levels to extremely rich sources of immune cells. That variability has led to conflicting results on the effectiveness of the therapy, including in this study, which used donated plasma from people who were sick for an average of six days with what the authors describe as mild disease.

Two other international studies also failed to find a benefit of convalescent plasma, but those were stopped early because too few eligible patients were enrolled. Other, smaller studies were more encouraging, so in the U.S. the Food and Drug Administration issued an emergency use authorization for the therapy in August that allows doctors to treat patients with plasma. Key public health leaders including Dr. Francis Collins, director of the National Institutes of Health, and Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, however, have noted that researchers are still studying convalescent plasma’s role in COVID-19. Those ongoing studies are comparing people who receive

Report finds coronavirus pandemic leading to ‘unacceptable’ shortage of US drug supplies

A report released this week from the Center for Infectious Disease Research and Policy (CIDRAP) at the University of Minnesota said that COVID-19-related drug shortages in the United States have reached “unacceptable” levels.

“Ensuring a Resilient US Prescription Drug Supply” is the sixth report in the center’s series titled, “COVID-19: The CIDRAP Viewpoint.” 

The newest report, released Wednesday, found that 29 out of 40, or approximately 73 percent, of drug treatments for COVID-19 are experiencing shortages, including propofol, albuterol, midazolam, hydroxychloroquine, fentanyl, azithromycin and morphine, citing data from the American Society of Health-System Pharmacists.

The Food and Drug Administration (FDA) has reported that 45 percent, or 18 out of 40, of the drug treatments are on its official drug shortage list, according to CIDRAP. 

The report added that 67 out of 156 critical acute drugs, including diazepam, phenobarbital, lidocaine and acetaminophen, are also in short supply. 

“Drug shortages can be a matter of life and death, and some shortages mean that a life-saving drug is not available to U.S. patients at any price,” CIDRAP said in a statement announcing the report’s release

“There is an urgent need for new, more effective policy with robust transparency to solve the persistent drug shortage issues plaguing the U.S. healthcare system,” the statement added. 

Michael Osterholm, the director of CIDRAP, said in the news release, “The urgency with the drug shortage supply issue is related directly to the major increase in COVID-19 cases that we will experience in the coming months.” 

“This, in turn, will dramatically increase the need for specific COVID-19 treatment drugs, while at the same, COVID-19 is having a major impact on two of the three key drug manufacturing areas of the world, India and Italy,” he added. 

According to the report, the drug shortages have been fueled by the closure of production factories, shipping delays, shutdowns, limitations on trade and export bans amid the coronavirus pandemic. 

CIDRAP outlined several possible solutions in its report, including a national infrastructure for “analyzing, predicting, managing and preventing shortages of critical medications” and the creation of an in-depth map to measure the U.S. drug supply chain. 

The drug shortages come amid the race to approve a coronavirus vaccine for public use in the U.S. 

While experts have predicted that a vaccine may not be safe and ready for FDA approval until the end of this year or into 2021, the Trump administration has aimed to get one out sooner through its Operation Warp Speed. 

In Thursday’s final presidential debate, President TrumpDonald John TrumpMore than 300 military family members endorse Biden Five takeaways from the final Trump-Biden debate Biden: ‘I would transition from the oil industry’ MORE claimed that new rising cases across the country would soon be “gone” and that a vaccine could be available in a matter of weeks. 

“It will go away, and I say we’re rounding the turn, we are rounding the corner. It is going away,” he said of the coronavirus, a remark that his administration’s own health

Don’t Give up on COVID-19 Plasma, Experts Say, After Study Finds No Benefit | Top News

LONDON (Reuters) – Researchers called on Friday for more research into using blood from recovered COVID-19 patients – or so-called convalescent plasma – as a potential treatment, after a small trial of hospitalised patients in India found it was of no benefit

The Indian results, published in the BMJ British Medical Journal, found that the plasma, which delivers antibodies from COVID-19 survivors to infected people, did not help hospitalised patients fight off the infection, and failed to reduce death rates or halt progression to severe disease.

The findings are a setback for a potential therapy that U.S. President Donald Trump touted in August as a “historic breakthrough”, and one experts say has been used in some 100,000 patients in the United States already, despite limited evidence on its efficacy.

Scientists not directly involved in the India study, which involved around 460 patients, said its results were disappointing but should not mean doctors give up hope altogether on convalescent plasma.

They said further and larger trials are needed, including in COVID-19 patients with milder disease and those newly infected.

“With just a few hundred patients, (the India trial) is still much too small to give clear results,” said Martin Landray, a professor of medicine and epidemiology at Britain’s Oxford University.

“One could well imagine that the treatment might work particularly well in those earlier in the course of the disease or who have not been able to mount a good antibody response to the virus of their own,” he said. “But such speculation needs to be tested – we can’t just rely on an educated guess.”

While the United States and India have authorised convalescent plasma for emergency use, other countries, including Britain, are collecting donated plasma so that the treatment could be widely rolled out if it is shown to be effective.

The Indian researchers enrolled 464 adults with COVID-19 who were admitted to hospitals across India between April and July. They were randomly split into two groups – with one receiving two transfusions of convalescent plasma alongside best standard care, and the other getting best standard care only.

After seven days, use of convalescent plasma seemed to improve some symptoms, such as shortness of breath and fatigue, and led to higher rates of so-called negative conversion – a sign that the virus is being neutralised by antibodies.

But this did not translate into a reduction in deaths or progression to severe disease by 28 days.

Ian Jones, a Reading University professor of virology, agreed with Landray that plasma may be more likely to work very soon after someone contracts COVID-19.

He urged these and other researchers to continue to conduct trials, and to do so in newly diagnosed patients.

“We still do not have enough treatments for the early stage of disease to prevent severe disease and until this becomes an option, avoiding being infected with the virus remains the key message,” he said.

(Reporting by Kate Kelland; Editing by Peter Graff and Frances Kerry)

Copyright 2020 Thomson Reuters