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

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Back to school: Many large districts are opening doors again

Trepidation about the pandemic persists. In many cities, coronavirus infection rates are rising, which could prompt school leaders to reverse plans. Some classrooms and even entire schools have opened and had to close again in response to outbreaks. In some cities, opposition from teachers unions has slowed efforts to open buildings.

But overall, the trend is now toward more in-person school.

Of the 50 largest school districts, 24 have resumed in-person classes for large groups of students, and nine others plan to in the coming weeks, according to a Washington Post survey. An additional four have opened, or plan to open, for small groups of students who need extra attention.

Many are in Florida and Texas, where Republican governors are requiring in-person classes, but schools are also open in New York City, Greenville, S.C., and Alpine, Utah, the state’s largest district. Returns are planned in Charlotte, Baltimore and Denver.

Just 11 of the largest 50 school districts are still fully remote, with no immediate plans to change that.

“I think everybody’s quite worried about what the price is that we’ve paid for having the buildings closed,” said Michael Casserly, executive director of Great City Schools, a lobbying group for urban districts. He said the biggest drivers are concern over substantial “learning loss” and a sense that even though remote education is better than it was in the spring, it still is not working well enough.

Officials also worry because some students are simply not showing up to remote classes, with attendance figures down in many places.

Casserly said many educators worry that “we are going to dig ourselves a hole that is so deep that it takes us years and years to get out of.”

The trend is evident, too, in tracking by the Center on Reinventing Public Education at the University of Washington at Bothell. In the beginning of September, 24 of 106 mostly urban districts were open for at least some in-person school. By the end of October, that will rise to 69 out of 106, assuming districts stick with their announced plans.

“Parents are very, very eager to get their kids back to school. Students are very eager to get back to school,” said Robin Lake, the center’s director.

Assessing infection rates

In many districts, including in suburban Washington and the District of Columbia, students are being phased back into school, often starting with the youngest because online learning is so difficult for them. That’s also the approach in Charlotte-Mecklenburg Schools in North Carolina, which is using a hybrid system in which students are on campus on certain days and online on others.

Superintendent Earnest Winston said it’s the right move because children learn best in person, but he worries as he sees infection rates rising. For the first time since late July, the tally of newly reported coronavirus cases in the United States surpassed 64,000 last week. In 44 states and the District of Columbia, caseloads were higher than they were one month ago.

“This virus

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