A Johns Hopkins public health researcher is urging that a serum be developed that they think could potentially become a powerful weapon in the battle against the global coronavirus pandemic.
In an article published Friday in the Journal of Clinical Investigation, researcher Arturo Casadevall, of Johns Hopkins Bloomberg School of Public Health, writing with Liise-anne Pirofski, of the Albert Einstein College of Medicine, argue that blood injections from patients who have recovered from COVID-19 might help protect at-risk people — including health care workers and family members caring for sick relatives — from falling prey to the disease.
The serum could also be used to treat people who are already ill, though the researchers anticipate that in these cases the serum might be less effective.
“Time is of the essence,” they wrote in the opinion piece titled “The convalescent sera option for containing COVID-19.”
“As we are in the midst of a worldwide pandemic, we recommend that institutions consider the emergency use of convalescent sera and begin preparations as soon as possible."
Casadevall and Pirofski could not be reached immediately for comment.
The traditional treatment for viruses is with a vaccine frequently made from a weakened or dead form of the microbe that causes the disease, which stimulates the patient’s immune system to attack the intruder. According to published reports, health officials have estimated that it will take 12 to 18 months to develop a COVID-19 vaccine.
In contrast, a serum would use antibodies, or Y-shaped proteins designed to bombard a particular virus or bacteria.
“Currently there are no vaccines, monoclonal antibodies, or drugs available for SARS-CoV-2,” Casadevall and Pirofski wrote.
“Human convalescent serum is an option for prevention and treatment of COVID-19 disease that could be rapidly available when there are sufficient numbers of people who have recovered and can donate immunoglobulin-containing serum.”
Though serums were once widely used, they fell out of favor when new forms of treatment were developed.
“Passive antibody therapy has a storied history going back to the 1890s,” the researchers wrote, “and was the only means of treating certain infectious diseases prior to the development of antimicrobial therapy in the 1940s.”
The article argues that serums have been helpful in fighting recent international epidemics, including the 2003 SARS1 (severe acute respiratory syndrome) epidemic, the 2009 Swine Flu epidemic, the 2012 MERS (Middle East respiratory syndrome) epidemic and the 2013 West African Ebola epidemic.
“Although every viral disease and epidemic is different, these experiences provide important historical precedents that are both reassuring and useful as humanity now confronts COVID-19," they wrote.
For example, when a serum was used to treat 80 SARS patients in Hong Kong in 2003, people who received the treatment before their illness reached the two-week mark were released from the hospital by the 22nd day.
That result is “consistent with the notion that earlier administration is more likely to be effective,” the article said. “Historical experience suggests that convalescent sera may be more effective in preventing disease than in the treatment of established disease."
Nonetheless, they argued that the sera could perform a crucial role in preventing the nation’s health care system from collapsing.
Some physicians, nurses, and first responders have developed COIVD-19 after caring for patients who are ill with the disease — including an unnamed provider at Hopkins. As a result, these medical professionals are being quarantined at the time their expertise is needed the most.
If the serum proves effective, “individuals who receive convalescent sera may be able to avoid a period of quarantine,” the article said. “This could allow them to continue their critical function as health care providers.
"Convalescent sera could also be used to prevent disease among family members caring for COVID-19 patients at home.”
The researchers acknowledges that a sera would be at best “clearly a stop-gap measure” and wouldn’t be risk-free.
Among other things, there’s a danger that some patients could receive the wrong kind of blood. But Casadevall and Pirofski wrote that possibility has diminished in recent years as screening practices at blood banks have improved.
The article listed several conditions that would have to be met for the use of the serum to have its maximum impact:
- There would have to be widespread testing to determine who has been infected and who has not.
- Patients who have recovered from the coronavirus would have to agree to donate blood.
- Widespread coordination would be required between medical researchers, physicians, hospitals and blood banks nationwide.
“The high mortality of COVID-19 particularly in elderly and vulnerable persons,” the researchers wrote, “suggests that the benefits of [the serum’s use] use ... outweigh the risks.”
CORRECTION: An earlier version of this article misstated a co-author’s affiliation with the Johns Hopkins Bloomberg School of Public Health.