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Covid confusions

Covid confusions
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While we are fighting the deadly virus Covid-19 various suggestions and theories to help the infected persons recover have been making headlines. One such remedy that made quite a roar was the use of convalescent plasma (CP) therapy for treating coronavirus-infected patients in moderate stage of the illness.

The move was initiated under the Clinical Management Protocols for COVID-19 issued by the Union Health Ministry on June 27 under investigational therapies as a National Task Force for COVID-19, a committee formed by the ICMR to respond to the pandemic, had reviewed and approved it.

This authorisation by the ICMR has been paralleled by questionable practices such as calls for donors on social media, and the sale of CP in the black market with exorbitant price tags in various states of India. Though we did not experience any such issue in Kashmir as people still consider helping those in need, especially while fighting an illness a social responsibility which they wish to fulfill.

Additionally, although CP is a safe therapeutic modality, plasmapheresis, plasma storage and NAb measurement are all resource-intensive processes, with a limited number of institutes in the country having the capacity to undertake these activities in a quality-assured manner.

However, what has come as a rude shock is that another multi-centric study funded by the ICMR has found that the use of convalescent plasma therapy in coronavirus-infected patients does not help in reducing mortality or progression to severe COVID-19.

The ‘open-label parallel-arm phase II multicentre randomized controlled trial’ (PLACID Trial) was conducted across 39 public and private hospitals across India between April 22 and July 14 to find effectiveness of CP for the treatment of COVID-19.

The PLACID trial results indicate that there was no difference in 28-day mortality or progression to severe disease among moderately ill COVID-19 patients treated with CP along with BSC compared to BSC alone.

CP as a passive source of neutralising antibodies and immunomodulators is a century-old therapeutic option used for the management of viral diseases. But has it achieved the desired results as far as the war against the deadly coronavisrus is concerned is debatable as results and studies have not established this theory.

According to the study, only two randomised controlled trials on CP use in COVID-19 have been published, one from China and the other from the Netherlands.

Both were halted prematurely, the China study due to inadequate patient enrolment and the one from the Netherlands due to a need to redesign the trial based on interim findings.

In both studies, no mortality benefit was noted, and the Dutch study raised uncertainties regarding pre-transfusion antibody-status of patients as a potential factor in identifying appropriate candidates for CP therapy.

This uncertainty in the published evidence is reflected in a recent systematic review, which remained undecided on both the safety and effectiveness of CP as a therapeutic option in hospitalized patients of COVID-19.

What is ironic is that the medico bodies in Jammu and Kashmir also endorsed the CP therapy without even bothering to wait for the studies which would have proven its efficacy against the diseases spread by the deadly pandemic.


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