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| Blood Plasma From Survivors Will Be Given to Coronavirus Patients | Blood Plasma From Survivors Will Be Given to Coronavirus Patients |
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| Can blood from coronavirus survivors help other people fight the illness? | Can blood from coronavirus survivors help other people fight the illness? |
| Doctors in New York will soon be testing the idea in hospitalized patients who are seriously ill. | Doctors in New York will soon be testing the idea in hospitalized patients who are seriously ill. |
| Blood from people who have recovered can be a rich source of antibodies, proteins made by the immune system to attack the virus. The part of the blood that contains antibodies, so-called convalescent plasma, has been used for decades to treat infectious diseases, including Ebola and influenza. | Blood from people who have recovered can be a rich source of antibodies, proteins made by the immune system to attack the virus. The part of the blood that contains antibodies, so-called convalescent plasma, has been used for decades to treat infectious diseases, including Ebola and influenza. |
| “It’s kind of difficult scientifically to know how valuable it is in any disease until you try,” said Dr. David L. Reich, president and chief operating officer of the Mount Sinai Hospital, which will be using the treatment. “It’s not exactly a shot in the dark, but it’s not tried and true.” | “It’s kind of difficult scientifically to know how valuable it is in any disease until you try,” said Dr. David L. Reich, president and chief operating officer of the Mount Sinai Hospital, which will be using the treatment. “It’s not exactly a shot in the dark, but it’s not tried and true.” |
| Dr. Reich said it would be tried as a treatment for hospitalized patients who had a moderate form of the disease and had trouble breathing, but not for those who are in advanced stages of the disease. | Dr. Reich said it would be tried as a treatment for hospitalized patients who had a moderate form of the disease and had trouble breathing, but not for those who are in advanced stages of the disease. |
| “The idea is to get to the right patients at the right time,” he said. “But it’s experimental.” | “The idea is to get to the right patients at the right time,” he said. “But it’s experimental.” |
| Researchers at Mount Sinai were among the first in the United States to develop a test that can detect antibodies in recovering patients, an essential part of this treatment strategy. | Researchers at Mount Sinai were among the first in the United States to develop a test that can detect antibodies in recovering patients, an essential part of this treatment strategy. |
| On Tuesday, the Food and Drug Administration gave permission for the plasma to be used experimentally on an emergency basis to treat coronavirus patients, and hospitals in New York quickly began asking to participate, said Dr. Bruce Sachais, chief medical officer of the New York Blood Center, which will collect, test and distribute the plasma. | On Tuesday, the Food and Drug Administration gave permission for the plasma to be used experimentally on an emergency basis to treat coronavirus patients, and hospitals in New York quickly began asking to participate, said Dr. Bruce Sachais, chief medical officer of the New York Blood Center, which will collect, test and distribute the plasma. |
| “Our main focus is, how do we implement this quickly to help the hospitals get product to their patients,” Dr. Sachais said. “We have blood centers in New England, Delaware and the Midwest, so we can do the same thing in other regions. We’re working with other blood centers and hospitals that may collect their own blood and want to do this. We may not be able to collect enough plasma in New York to help the entire country, so we want to share with other centers to help them.” | “Our main focus is, how do we implement this quickly to help the hospitals get product to their patients,” Dr. Sachais said. “We have blood centers in New England, Delaware and the Midwest, so we can do the same thing in other regions. We’re working with other blood centers and hospitals that may collect their own blood and want to do this. We may not be able to collect enough plasma in New York to help the entire country, so we want to share with other centers to help them.” |
| Dr. Reich said that an email asking Mount Sinai staff members who had recovered to consider donating plasma went “a little viral,” and quickly drew 2,000 responses. | Dr. Reich said that an email asking Mount Sinai staff members who had recovered to consider donating plasma went “a little viral,” and quickly drew 2,000 responses. |
| But volunteers will have to be carefully screened to meet strict criteria. The donors will include people who tested positive for the virus when they were ill, recovered, have had no symptoms for 14 days, now test negative — and have high levels, also called titers, of antibodies that fight the virus. Dr. Reich said that because there were delays and shortages in testing, the number of people who qualify may be low at first. | But volunteers will have to be carefully screened to meet strict criteria. The donors will include people who tested positive for the virus when they were ill, recovered, have had no symptoms for 14 days, now test negative — and have high levels, also called titers, of antibodies that fight the virus. Dr. Reich said that because there were delays and shortages in testing, the number of people who qualify may be low at first. |
| “Our expectation, based on reports from the Chinese experience, is that most people who get better have high-titer antibodies,” Dr. Sachais said. “Most patients who recover will have good antibodies in a month.” | “Our expectation, based on reports from the Chinese experience, is that most people who get better have high-titer antibodies,” Dr. Sachais said. “Most patients who recover will have good antibodies in a month.” |
| People who qualify will then be sent to blood centers to donate plasma. The procedure, called apheresis, is similar to giving blood, except that the blood drawn from the patient is run through a machine to extract the plasma, and the red and white cells are then returned to the donor. Needles go into both arms: Blood flows out of one arm, passes through the machine and goes back into the other arm. The process usually takes 60 to 90 minutes, and can yield enough plasma to treat three patients, Dr. Sachais said. | People who qualify will then be sent to blood centers to donate plasma. The procedure, called apheresis, is similar to giving blood, except that the blood drawn from the patient is run through a machine to extract the plasma, and the red and white cells are then returned to the donor. Needles go into both arms: Blood flows out of one arm, passes through the machine and goes back into the other arm. The process usually takes 60 to 90 minutes, and can yield enough plasma to treat three patients, Dr. Sachais said. |
| People who have recovered have antibodies to spare, and removing some will not endanger the donors or diminish their own resistance to the virus, Dr. Sachais said. “We may get rid of 20 percent of their antibodies, and a couple days later they’ll be back.” | People who have recovered have antibodies to spare, and removing some will not endanger the donors or diminish their own resistance to the virus, Dr. Sachais said. “We may get rid of 20 percent of their antibodies, and a couple days later they’ll be back.” |
| The plasma will be tested to make sure it is not carrying infections like hepatitis or H.I.V., or certain proteins that could set off immune reactions in the recipient. If it passes the tests, it can then be frozen, or used right away. Each patient to be treated will receive one unit, about a cup, which will be dripped in like a blood transfusion. As with blood transfusions, plasma donors and recipients must have matching types, but the rules are not the same as those for transfusions. | The plasma will be tested to make sure it is not carrying infections like hepatitis or H.I.V., or certain proteins that could set off immune reactions in the recipient. If it passes the tests, it can then be frozen, or used right away. Each patient to be treated will receive one unit, about a cup, which will be dripped in like a blood transfusion. As with blood transfusions, plasma donors and recipients must have matching types, but the rules are not the same as those for transfusions. |
| “We think this is going to be an effective treatment for at least some patients, but we don’t really know yet,” Dr. Sachais said. “Hopefully, we’ll get some data in the next few weeks from the first patients, to see if we’re on the right track.” | “We think this is going to be an effective treatment for at least some patients, but we don’t really know yet,” Dr. Sachais said. “Hopefully, we’ll get some data in the next few weeks from the first patients, to see if we’re on the right track.” |
| “In other coronavirus epidemics I don’t think we have strong evidence,” he said. “We don’t have controlled data. There were reports from SARS and MERS that patients improved.” | “In other coronavirus epidemics I don’t think we have strong evidence,” he said. “We don’t have controlled data. There were reports from SARS and MERS that patients improved.” |
| He said the decision to try this approach was based in part on reports from China that it seemed to help patients. But the reports are not based on controlled studies or definitive data. | He said the decision to try this approach was based in part on reports from China that it seemed to help patients. But the reports are not based on controlled studies or definitive data. |
| Updated June 22, 2020 | Updated June 22, 2020 |
| A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico. | A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico. |
| The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth. | The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth. |
| The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave. | The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave. |
| So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement. | So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement. |
| Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks. | Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks. |
| A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study. | A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study. |
| The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April. | The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April. |
| States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people. | States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people. |
| Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days. | Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days. |
| If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.) | If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.) |
| If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others. | If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others. |
| If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested. | If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested. |
| Dr. Sachais said an article in a journal that was not peer-reviewed described treating 10 patients in China with one unit each of convalescent plasma, and said it appeared safe and seemed to quickly lower their virus levels. | |
| “It’s anecdotal,” he said. | “It’s anecdotal,” he said. |
| A researcher not associated with the new treatment plans said there was evidence to support using plasma from survivors. | A researcher not associated with the new treatment plans said there was evidence to support using plasma from survivors. |
| “Four to six or eight weeks after infection, their blood should be full of antibodies that will neutralize the virus and that will theoretically limit the infection,” said Vineet Menachery, a virologist at the University of Texas Medical Branch. | “Four to six or eight weeks after infection, their blood should be full of antibodies that will neutralize the virus and that will theoretically limit the infection,” said Vineet Menachery, a virologist at the University of Texas Medical Branch. |
| In studies in mice, he said, “If you can drive the virus replication down tenfold to hundredfold, that can be the difference between life and death.” | In studies in mice, he said, “If you can drive the virus replication down tenfold to hundredfold, that can be the difference between life and death.” |
| He described the use of convalescent plasma as “a classic approach that is a really effective way to treat” — if there are enough donors with enough of the right antibodies. | He described the use of convalescent plasma as “a classic approach that is a really effective way to treat” — if there are enough donors with enough of the right antibodies. |
| A potential risk, he said, is that the patient’s immune system could react against something in the plasma, and cause additional illness. | A potential risk, he said, is that the patient’s immune system could react against something in the plasma, and cause additional illness. |
| Although hospitals will gather information about the patients being treated, the procedure is not being done as part of a clinical trial. There will not be a placebo group or the other measures needed to determine whether a treatment works. | Although hospitals will gather information about the patients being treated, the procedure is not being done as part of a clinical trial. There will not be a placebo group or the other measures needed to determine whether a treatment works. |
| “People are so desperately ill now, it isn’t the right time,” Dr. Reich said. “They’re in the hospital, they’re sick, in intensive care, on ventilators. Some get sick so quickly, and it’s such a severe illness in some people, we feel it’s not the right moment.” | “People are so desperately ill now, it isn’t the right time,” Dr. Reich said. “They’re in the hospital, they’re sick, in intensive care, on ventilators. Some get sick so quickly, and it’s such a severe illness in some people, we feel it’s not the right moment.” |
| He said the doctors were relying on science and evidence as much as possible. | He said the doctors were relying on science and evidence as much as possible. |
| But he added: “You see this steamroller coming at you, and you don’t want to sit there passively and let it roll over you. So you put together everything you have to try to fight it. This has the potential to help and also the potential to harm, but we just won’t know until it’s later in the process of the disease and people have had an opportunity to try different things.” | But he added: “You see this steamroller coming at you, and you don’t want to sit there passively and let it roll over you. So you put together everything you have to try to fight it. This has the potential to help and also the potential to harm, but we just won’t know until it’s later in the process of the disease and people have had an opportunity to try different things.” |
| Survivors seem eager to help. | Survivors seem eager to help. |
| “We’re getting a lot of requests,” Dr. Sachais said. “One center sent a survey to patients who are getting better, and there were hundreds of responses saying they were interested in being donors. This is going to bring people together. People who’ve survived will want to do something for their fellow New Yorkers.” | “We’re getting a lot of requests,” Dr. Sachais said. “One center sent a survey to patients who are getting better, and there were hundreds of responses saying they were interested in being donors. This is going to bring people together. People who’ve survived will want to do something for their fellow New Yorkers.” |