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One of the most successful laboratories during the pandemic is in an old nightclub in Buenos Aires.
"When we first entered, about 20 years ago, we had to remove John Travolta's ball," recalls the Argentine doctor Fernando Polack, who from there has coordinated the trial of the Pfizer vaccine against covid, with 44,000 volunteers.
The Buenos Aires nightclub is today the headquarters of the Infant Foundation, a small non-profit organization dedicated to researching childhood respiratory diseases and, since last year, covid.
The foundation, led by Polack, is now writing a new page in the fight against the pandemic.
After months of speculation and a multitude of confusing studies from which it was impossible to draw conclusions, a robust experiment carried out in Argentina shows the possible benefits, as a treatment against covid, of blood plasma transfusions from donors who have overcome the disease.
The authors, led by Polack himself, argue that "it is the first evidence in the world of a universal, accessible and safe treatment that can save lives."
The clinical trial has included 160 elderly people from the Buenos Aires region, all suffering from covid and with an average age of 77 years.
The authors administered a quarter of a liter of convalescent blood plasma to half the participants and saline water to the other half.
Only nine of the plasma-treated patients ended up needing oxygen, compared to 23 in the other group.
It's a 60% reduction in the risk of serious illness.
The results were published this Wednesday in the specialized journal
The New England Journal of Medicine
.
Polack recalls that survivor blood plasma transfusions were already used against the influenza pandemic of 1918. “It is the oldest medicine there is, it is more than a century old, but it offers us a bridge until the real solution to this - that It is not plasma, it is vaccines - it is finally accessible to all, ”he reflects.
In the last week, four million cases of covid have been diagnosed, with 76,000 deaths, according to data from the World Health Organization.
The scientific community has not yet found effective specific treatments against covid, after a year of pandemic.
People who have overcome the disease, however, retain in their blood the natural defenses against the coronavirus: antibodies.
The strategy of fighting covid with blood plasma transfusions has been tried since the first cases appeared in the Chinese city of Wuhan, but with confusing conclusions, because most of the published studies did not use reliable methods to measure their results.
"It is not known whether convalescent plasma benefits people admitted to hospital with covid," concluded the Cochrane collaboration, an international organization that evaluates the effectiveness of health interventions, on October 12.
Previous studies administered the blood plasma too late, with the disease already advanced, and the donated antibodies were not able to stop the virus.
In other previous trials, such as one conducted in the United States with 35,000 patients, scientists did not include a control group - no plasma treatment - in order to compare the results.
The key to the new study from Argentina is that it administers plasma with very high levels of antibodies and also very early, in the first three days after the onset of covid symptoms.
The doctor Fernando Polack proposes that the vaccinated also donate their blood plasma
“This is as if you want a thief not to enter your house.
If the thief enters, goes through the hall, gets into the living room, breaks everything, opens the patio door, the dogs get into your house, they start eating your furniture, they break the electrical installation and you it starts flooding the kitchen, because the thief is already the least of your problems, ”explains Polack.
“And that's the scenario where plasma was normally used.
He would grab the thief when the damage was done.
We bet on catching the thief in the hallway, at the entrance.
And the one that catches it outside the home is the vaccine ”, he adds.
Plasma is the liquid part of the blood and includes antibodies.
A more sophisticated option than direct transfusion is the development of an industrial preparation with a higher concentration of specific antibodies, hyperimmune immunoglobulins.
The third, much more complex way is the identification of very powerful antibodies for multiplication in the laboratory: the so-called monoclonal antibodies, at a cost of tens of thousands of euros per person.
Polack's team estimates that his treatment costs a total of about $ 186 (151 euros).
"The biggest challenge is to have a sufficient plasma bank," says the Argentine doctor, who proposes another source of donations aside from people who have already overcome the covid.
“The vaccinated are privileged.
They are people who access an immunity of up to 95% efficiency.
They have received something that most of us have not received.
An act of solidarity on his part would be to provide plasma for people who may become seriously ill in the future.
A vaccinated person who donates 750 milliliters a day allows three treatments for three elderly people, ”says Polack.
"The results seem to confirm that convalescent plasma is useful to prevent negative evolution of patients at risk," says doctor Cristina Arbona
The doctor Lise Estcourt, director of the unit of hematological clinical trials of the National Health Service of the United Kingdom, applauds the new work, "very encouraging", in her opinion.
“It suggests that early treatment with convalescent plasma reduces the risk of a severe form of covid.
I hope that the results of this small trial will be confirmed in other larger ones that are underway [in Spain, the Netherlands and the United States], ”says Estcourt, lead author of Cochrane's analyzes of this experimental therapy.
Preliminary results from another Spanish study already showed an improvement in prognosis in September in patients treated early with plasma with high levels of antibodies.
The new results are "encouraging", agrees the doctor Cristina Arbona, director of the Transfusion Center of the Valencian Community.
"They seem to confirm that convalescent plasma is useful to prevent the negative evolution of patients at risk", celebrates Arbona, also a member of the board of directors of the Spanish Society of Hematology and Hemotherapy.
“This strategy is interesting because it is available relatively easily.
It is a blood product obtained from convalescents.
This can facilitate accessibility in the National Health System.
Monoclonal antibodies could have an excessive cost ”, says Jesús Sierra, a pharmacist at the University Hospital of Jerez de la Frontera (Cádiz) who coordinates the registry of the Spanish Society of Hospital Pharmacy (SEFH), a database of 16,000 patients for identify drugs associated with lower covid mortality.
"[This strategy] will require good coordination with primary care, so that detected cases can be treated early, within 48 hours," he warns.
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