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Call off plasma therapy for patients of covid-19

A nurse points to a PentraSorb CRP adsorber, which is connected to a device that pumps the blood plasma through the adsorber in specific cycles, which is the main part of the new CRP-Apherese treatment for a patient suffering from the coronavirus disease (COVID-19) in the Intensive Care Unit (ICU). (REUTERS)Premium
A nurse points to a PentraSorb CRP adsorber, which is connected to a device that pumps the blood plasma through the adsorber in specific cycles, which is the main part of the new CRP-Apherese treatment for a patient suffering from the coronavirus disease (COVID-19) in the Intensive Care Unit (ICU). (REUTERS)

As an open letter from health experts argues, its efficacy is unproven, its burden is heavy, and it might possibly worsen the pandemic. India needs uniformly updated treatment protocols

In times of stress, various forms of quackery thrive, as we often see in a country that isn’t short of credulity, but it should duly alarm us if a dubious line of covid treatment is seen to have state sanction. In the spotlight of controversy now is convalescent plasma therapy, by which an extract of the blood of a patient who has recovered from covid is given to someone who is ill, in the hope that antibodies generated by the donor’s body will fight the virus in the recipient’s. Before vaccines came along, this ‘logic’ may have seemed sufficiently plausible for the idea to be given a chance, and it has been employed widely by doctors across India. The scientific method, however, demands proof of efficacy. To persist with it without clinical validation would not just be folly, but scandalous. This is why an open letter by 18 healthcare experts addressed to the government’s principal scientific advisor K. VijayRaghavan, with copies marked to the Indian Council of Medical Research (ICMR) and All India Institute of Medical Sciences (AIIMS), deserves top-level attention. With signatories that include Dr Gagandeep Kang of Christian Medical College, Vellore, Dr Soumyadeep Bhaumik of the Sydney-based George Institute for Global Health and Dr Shahid Jameel of the Trivedi School of Biosciences at Ashoka University, the letter urges the Centre to call an instant halt to the practice of plasma therapy in the absence of evidence that it does any good.

Terming the use of convalescent plasma against covid “irrational and non-scientific", the letter traces its wide adoption to guidelines issued by the ICMR and AIIMS, and cites the results of scientific trials in support of the contention that it offers “no benefit" in treating the disease. Even an ICMR randomized control study, it contends, found no correlation of plasma use with “a reduction in progression to severe covid-19 or all-cause mortality". Another trial among 11,588 patients, it argues, saw no difference made by it in either saving lives or aiding recovery. Even the ICMR-AIIMS nod for this therapy, it says, is for ‘off label’ use, which amounts to an admission that it lacks medical authorization. What’s worse, it adds, indications have arisen of the possibility that its use in some cases could foster the emergence of more virulent strains of Sars-CoV-2. Even if this danger is in the realm of conjecture, or turns out to bear a very low likelihood, it should suffice to stop plasma infusions.

In any case, we must relieve the families of covid patients from the desperation of finding plasma donors, not to speak of the rigmarole of this hospital procedure, its associated risks and the resources taken up. Covid survivors also need relief from the obligation of trying to heal others. Yet, pleas for plasma abound. Even a small sample of social media posts would reveal both anguish and energy devoted to it—usually at the behest of well-meaning doctors. Granted, this pandemic has not given us much space to catch our breath, and our grasp of its pathology remains a work-in-progress. But India’s healthcare establishment must keep itself updated on scientific knowledge and use properly verified findings to nudge our therapeutic practices up a common learning curve. Which medicines help and which don’t, sadly, are another source of confusion. At this juncture, it is crucial for the ICMR to examine all data and issue fresh protocols for covid treatment. These should be up-to-date, open to peer review and responsive to valid research outcomes. Let laxity not cause any further needless suffering.

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