- [Daniela] With a vaccine
against the new coronavirus
many months, if not years, away,
scientists and doctors are racing
to treat the disease it causes.
They have identified antibody testing
and blood plasma therapeutics
as promising approaches
to mitigating the health
and economic-related fallout
from the pandemic.
These technologies could
also help us learn more
about how widely the virus has spread.
- It's based on the same principle
of, if you have a protective antibody,
passive transfer of that could provide
not only protection
prophylactically, but also treatment.
- When patients recover
from a viral infection,
they produce virus-fighting
proteins known as antibodies.
These circulate in a person's blood
and help protect against
future infections.
Antibodies are particular
to the invader they're
produced to fight off.
If they're found in the blood,
that means the person was infected
and that they now have
the molecular defenses
to fight that virus off, a
process known as immunity.
In theory, doctors could
transfer these antibodies
to a person who is still sick
so these proteins could help them recover.
This kind of therapy has
been tried in the past
during previous public health crises.
- It was used in the 1918 flu epidemic.
It was used in many
outbreaks of mumps, polio,
and measles in the early 20th century,
and it continues to be used
as recently as the SARS epidemic of 2003.
- [Daniela] The treatment,
known as convalescent plasma therapy,
is gaining traction now
because there aren't other
approved alternatives
for treating COVID-19.
- The word stopgap is
often associated with it,
and the reasons is it is available today.
- [Daniela] The safety and efficacy
haven't been established
yet through clinical trials,
which is the gold standard,
but preliminary tests in China
have shown encouraging
results, and in March,
the FDA started to allow
doctors in the U.S.
to treat some patients with the plasma
of those who have recovered from COVID-19.
- For the recipients,
we're looking for people
who are admitted to a hospital
who are showing increasing
oxygen requirements,
which indicate to us that they're on
potentially a downhill course.
- Mount Sinai in New York
is one of a growing number of
hospitals across the country
administering convalescent plasma
to qualifying COVID-19 patients.
Recovered patients
interested in donating plasma
fill out a survey.
Then, to comply with FDA guidelines,
clinicians have to put
these potential donors
through two tests,
first, a diagnostic test.
They have to make sure
they're not still carrying
the new coronavirus, and
then an antibody test
to ensure they're making enough antibodies
to fight the virus off.
That second test looks for
antibodies in blood plasma.
Scientists at Mount Sinai
developed an antibody test
by starting with the
genetic code for the virus.
That serves as the blueprint for proteins.
Using these instructions,
they mass-produce synthetic
copies of a protein
that the virus has on its surface.
Then they take special plates
with dozens of tiny wells
and coat the bottom of each one
with the synthetic proteins.
After that, they put
some of the donor plasma
into each well.
If there are antibodies,
these recognize the viral
protein and bind to it.
The scientists then add
an additional antibody
which lights up when it binds
to the synthetic viral protein
and coronavirus antibody combo.
Scientists run this test
at different concentrations
until it stops lighting up.
The more they have to do the sample,
the more antibodies the
person's plasma has.
The more antibodies, the better
the plasma is for therapy.
Scientists do this kind of
testing in labs all the time,
but to do it clinically, they
need to notify regulators.
If a potential donor passes the virus
and the antibody tests,
then Mount Sinai clinicians
ask them to go to the
New York Blood Center
where they can give enough plasma
to administer to patients.
Then there are two other hurdles
before that plasma can
be given to patients,
making sure it doesn't
have any other viruses
like hepatitis or HIV, and
the blood types have to match.
One donation can likely treat two people
according to preliminary estimates.
So far, Mount Sinai has
treated more than 30 patients.
Administering the therapy
requires sign-off from the FDA.
How will you tell if
somebody's getting better
because of this treatment?
- Well, in about four or five days,
hopefully they'll be
recovering more quickly
than other people with
similar characteristics.
We have a team of bio
statisticians that are starting
to model what happens for
patients in our experience
in the health system, such as
the length of hospital stay,
the need for ICU days,
the need for a ventilator,
and of course, mortality and survival
are, of course, the ultimate.
- The treatment is not without risks.
Transfusion reactions can include
fever, allergic reactions,
and even lung injury,
and like the swab tests
that tell somebody if they have the virus,
antibody tests are also in short supply.
In the long-term, the hope is
that they could help mitigate
some of the economic
effects of the pandemic.
So right now, I'm talking
to you from my apartment.
You're in your house in
Baltimore, I imagine.
Could this kind of testing
also help policy makers
figure out who is able to
go back to work safely?
- If we knew who has antibody
and they have recovered,
you could imagine that
those could go work safely.
It would require an enormous undertaking
to test almost everyone in the country.
- [Daniela] The antibody tests
also have to be highly
accurate, and recently,
the accuracy of some
tests developed abroad
has been called into question.
Despite the challenges,
scientists are optimistic
that plasma therapy could
help patients recover faster
and give them clues about how
deadly the virus really is.
- We don't know the denominator.
We don't know the number of people
that have been infected
but did not have disease,
and the presence of
antibody in their blood
will identify that subset, and
you need to know that number
to know really how lethal this disease is.
(pleasant bell music)
