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Published on: Apr 13, 2020
3 minute read
By: Dr Rajan Choudhary

Plasma Treatment For COVID-19?

TREATING COVID WITH BLOOD

We have previously covered proposed treatments for COVID-19, in particular hydroxychloroquine, and explained why we shouldn’t look for a magic cure for this disease. Viruses are difficult to treat, and ultimately supportive treatment appears to be best we can achieve. But an editorial published in BioMedicine Central appears to show a novel treatment for the most ill patients, one that may have flown under most people’s radar.

“A novel treatment approach to the novel coronavirus: an argument for the use of therapeutic plasma exchange for fulminant COVID-19”

An interesting title. Lets dissect it.

SUMMARY

- Blood is made up of many different components

- The immune system recognises the virus and produces antibodies against it to neutralise it

- These antibodies float in the blood plasma, a watery solution

- The plasma can be extracted from donated blood, and given to patients suffering from COVID-19

- So far evidence suggests it can help treat the most seriously affected patients.

WHAT IS IN OUR BLOOD

To understand this we must first understand what our blood is made of. Most people know that blood functions to transport oxygen from our lungs. But this is an oversimplification. Blood has many different functions:

- Transport: along with oxygen it transports sugars, fats, protein subunits throughout the body. This is done with the watery PLASMA of the blood.

- Clot: cells and protein structures act to plug any holes that form from cuts and damage. This is done by the PLATELETS in the blood

- Immunity: Immune cells respond to bacteria, viruses, parasites in the blood and body. They target these pathogens, identify and tag them with antibodies, and ultimately destroy them. This is done by the WHITE BLOOD CELLS.

And many more functions that we won’t bore you with.

IMMUNITY

It is this last point that is of interest to us. Our immune system consists of white blood cells that can recognise invading organisms in the blood, around cells and even invaders hiding within our own cells. All cells have protein markers on their surface, no matter if its human cells, bacterial, viral, fungal etc. These markers can be highlighted and targeted by specialised white blood cells, who in turn produce antibodies against these markers. Think of antibodies as handcuffs with flares attached: once attached other white blood cells use this information to find and destroy the invaders.

What is amazing about antibodies is how complex they are. The proteins in our body are incredibly complex. They are long chains that fold into unique shapes depending on hundreds of different types of chemical interactions. These are so complex that supercomputers can take literal years to figure out the shape of a single protein and how it folds depending on the subunits in its chain. This means that our immune system has to recognise these markers and figure out a complementary tag out of hundreds of billions of potential sequences. Antibodies have to be specific to their tag. If an antibody is produced that can target more than one tag, it can cause problems. If it targets a bacterial tag, but accidentally highlights the person’s cells as well, the immune system will start targeting and destroying the person’s organs. These auto-immune disorders can be devastating.

But when they work, antibodies are miraculous. They persist in the blood after an infection, and if a second infection occurs, memory cells in the blood can rapidly produce these antibodies before the infection can even produce symptoms. This is known as immunity, and is why we usually don’t get the same illness twice. Antibody based treatment is see as the future of medical therapy, and is something we will cover in future blogs.

PLASMA EXCHANGE

From population testing we can see that the majority of patients with COVID-19 recover, experiencing either mild symptoms, moderate symptoms requiring some form of treatment and hospitalisation, or no symptoms whatsoever. In these patients their immune system will have successfully recognised the virus and produced antibodies against it to neutralise the virus. It is the patients with severe symptoms, those in which the virus is running rampant in the body, that the production of antibodies happens too late.

Plasma exchange involves obtaining blood from patients who have beaten the virus, spinning the blood to separate out the red cells, white cells, platelets and watery plasma. The plasma contains all the glucose, small proteins and importantly for us, the antibodies. This plasma can be transfused into patients with COVID-19 that cannot cope, in order to help their immune system. These transfused antibodies will neutralise some of the viruses in the patient, reducing the viral load, amount of replication and cell destruction that causes such devastating symptoms in COVID-19.

The published editorial showed that in the most critical pneumonia patients, requiring mechanical ventilators and drugs to support the heart, mortality in plasma exchange patients resulted in a 47.8% mortality instead of 81.3%. Of course it is a single study with a limited number of patients, but the results are encouraging. It is further helped by the fact plasma exchange is a well established therapy, with established protocols known to intensivists and haematologists.

THE FUTURE

We may see the use of Plasma exchange for critically ill patients increase as the pandemic continues. It is not a treatment option available for everyone, as it requires intravenous access and careful monitoring in a controlled setting. But it also needs donation from people who have recovered from COVID and have suitable antibodies. So whilst it might not be a magic pill that everyone expects to cure COVID, it might be the difference between life and death for those that need it most.

Dr Rajan Choudhary, UK, Chief Product Officer, Second Medic Inc

www.secondmedic.com

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The Rise of Telemedicine: Revolutionizing Healthcare

In today’s fast-paced world, convenience is key. From online shopping to digital banking, everything is just a click away. The healthcare industry is no exception to this digital revolution, with telemedicine emerging as a game-changer. This new wave of healthcare delivery has not only made medical consultations more accessible but also provided timely care to patients, especially in remote areas. In this blog, we will explore the rise of telemedicine, its benefits, challenges, and the role it plays in shaping the future of healthcare.

What is Telemedicine?

Telemedicine refers to the use of digital technology, such as video calls, phone calls, or messaging apps, to provide healthcare services remotely. Through telemedicine platforms, patients can consult with doctors, discuss symptoms, receive medical advice, and even get prescriptions – all without stepping out of their homes. While the concept of remote healthcare isn’t entirely new, it has gained significant traction in recent years due to advancements in technology and the widespread use of smartphones and internet connectivity.

The Growth of Telemedicine

The COVID-19 pandemic served as a major catalyst for the widespread adoption of telemedicine. With lockdowns and social distancing measures in place, many people were unable or reluctant to visit hospitals or clinics. As a result, healthcare providers turned to telemedicine as a safe and effective way to continue offering care to their patients.

However, even before the pandemic, telemedicine was growing. Factors such as a shortage of healthcare professionals, long waiting times, and the rising cost of healthcare made remote consultations an attractive option. According to a report by McKinsey, telehealth usage in the U.S. increased by 38 times from pre-pandemic levels. Globally, the telemedicine market is expected to grow at a compound annual growth rate (CAGR) of 25.8% from 2020 to 2027.

Benefits of Telemedicine

The rise of telemedicine has brought numerous benefits for both patients and healthcare providers:

1. Increased Access to Care

Telemedicine has made healthcare more accessible, especially for those living in rural or remote areas where access to healthcare facilities is limited. With just a smartphone and an internet connection, patients can connect with healthcare professionals from anywhere, breaking down geographical barriers.

2. Convenience and Time-Saving

For many people, visiting a doctor’s office involves time-consuming travel and long waits. Telemedicine eliminates the need for physical travel, allowing patients to schedule consultations at a time that suits them. This is particularly useful for those with busy schedules, elderly patients, or individuals with mobility issues.

3. Cost-Effective Healthcare

Telemedicine can be a more affordable option for both patients and healthcare providers. Remote consultations typically cost less than in-person visits, and patients save on transportation and other associated expenses. For healthcare providers, telemedicine can help reduce overhead costs by minimizing the need for physical office space and staffing.

4. Continuity of Care

Telemedicine helps patients stay connected with their healthcare providers even when face-to-face visits are not possible. This is particularly important for patients with chronic conditions who require regular monitoring and follow-ups. Remote consultations allow doctors to track their progress and adjust treatment plans without the need for frequent clinic visits.

5. Reduced Risk of Infections

During outbreaks of contagious diseases, such as COVID-19, visiting a hospital or clinic can increase the risk of infection. Telemedicine provides a safer alternative by allowing patients to receive care from the comfort of their homes, thus reducing the spread of diseases.

Challenges Facing Telemedicine

While telemedicine offers many benefits, it also comes with its fair share of challenges:

1. Technology Barriers

Not everyone has access to the internet or the necessary devices for telemedicine consultations. In rural or underserved communities, limited internet connectivity can hinder access to remote healthcare services. Additionally, older adults or those who are not tech-savvy may struggle to navigate telemedicine platforms.

2. Lack of Physical Examination

Telemedicine works well for consultations, but it cannot replace the need for physical examinations in certain cases. While doctors can provide advice based on a patient’s symptoms, there are limitations when it comes to diagnosing conditions that require hands-on assessments or lab tests.

3. Privacy and Security Concerns

Telemedicine relies on the transmission of personal health information over digital platforms. This raises concerns about data privacy and security. Patients need to be assured that their sensitive medical information is protected, and healthcare providers must comply with regulations like the Health Insurance Portability and Accountability Act (HIPAA) to safeguard patient data.

4. Reimbursement and Insurance Issues

In some regions, the reimbursement policies for telemedicine services are not well established. Patients may face difficulties in getting their telemedicine consultations covered by insurance, which can deter them from opting for remote healthcare. On the other hand, healthcare providers may also face challenges in billing for telemedicine services.

The Future of Telemedicine

As technology continues to advance, the future of telemedicine looks promising. With the development of artificial intelligence (AI), wearable health devices, and remote monitoring tools, telemedicine will become more sophisticated and capable of providing personalized care to patients. AI-powered chatbots, for example, could assist doctors in diagnosing conditions by analyzing symptoms and medical history.

Additionally, wearable devices like fitness trackers or smartwatches can monitor a patient’s vital signs in real-time and share the data with their healthcare provider. This continuous flow of information allows for more accurate diagnoses and timely interventions, reducing the need for emergency hospital visits.

Telemedicine in Specialized Care

Telemedicine is also expanding its reach into specialized fields of medicine. For example, telepsychiatry allows mental health professionals to provide counseling and therapy to patients remotely, making mental health services more accessible. Similarly, teledermatology enables dermatologists to diagnose and treat skin conditions by reviewing images sent by patients.

Another emerging trend is the use of telemedicine for post-operative care. Patients recovering from surgery can have follow-up consultations with their doctors without the need for an in-person visit, reducing the burden on both the patient and the healthcare system.

Conclusion

The rise of telemedicine is revolutionizing the way healthcare is delivered. By providing increased access to care, improving convenience, and offering cost-effective solutions, telemedicine is making healthcare more patient-centered and accessible. While challenges such as technology barriers and privacy concerns remain, the continued growth and innovation in telemedicine point towards a future where healthcare is more personalized, efficient, and readily available to all.

As we move forward, telemedicine will continue to play a vital role in bridging the gap between patients and healthcare providers, ensuring that quality care is just a click away.