Op-Ed: A Promising Treatment for COVID-19 Patients with Therapeutic Plasma Exchange Mind the horns!

Plamen Kenarov

How to treat those infected with COVID-19? So much information has come out on the subject in the past months, often contradictory, that it has created serious confusion, even among medical professionals. The anecdotal has permeated the scientific to such an extent that sometimes it’s been hard to distinguish one from the other. Some ideas, like the use of the anti-malarial drugs, have proved dangerous; others, like President Trump’s suggestion to inject disinfectant into the bloodstream, have been downright mad.

The long-awaited COVID-19 vaccine is of course one general solution to the problem, but even if our scientists manage to create one – which is far from certain at the moment – the clinical trials, certification, manufacturing and global distribution would take many months, and perhaps years. At this point, the best we could do as physicians is to come up with good enough solutions to keep patients, especially the critically ill, in a stable enough condition while they recover.

One method of treatment that has received little public attention so far but has a very high potential to be effective against COVID-19 is therapeutic plasma exchange (TPE), also known as plasmapheresis. During the course of the illness, patients could experience abnormally elevated levels of inflammatory mediators in their blood (cytokines, for example, and various pathogenic proteins from decomposed cells, bacteria and viruses), which are known to lead to rapidly progressive septic shock, respiratory and organ failure, and eventually death.

TPE, simply put, removes and replaces the plasma from a patient’s blood through a special filtration device. It thus reduces the concentration of inflammatory mediators, as well as the actual viral load in the organism, helping the process of recovery. The procedure is generally low risk, with rare or no side effects, and could be performed in a minimally invasive manner, using one or two peripheral veins of the hand. It could be especially beneficial for treating COVID-19 patients with moderate to severe symptoms.

A large host of diseases have previously shown positive response to TPE treatment, including multiple sclerosis, hepatitis C and some cancers. Patients infected by viruses like H7N9 (avian influenza), pH1N1 influenza A and Coxsackie B have also reacted positively, and especially those with acute respiratory conditions.

TPE treatment of patients with COVID-19 have been recently recommended by Chinese scientists, among others, and small-scale clinical trials are already under way in several countries, including Spain and the United States. The initial results look encouraging, as noted by publications in peer-reviewed journals like Critical Care. In light of this, the U.S. Food and Drug Administration recently issued an emergency use authorization, approving TPE for treating patients with COVID-19.

In addition, plasma extracted from already cured individuals who have developed anti-bodies to COVID-19 could be reintroduced into sick patients as a form of passive immunization, the so-called “convalescent plasma therapy,” already widely covered in the media. This, too, has shown promising results, as reported by The Journal of the American Medical Association (JAMA).

It is important to note here that TPE is not and cannot be a panacea for COVID-19 and does not cure the root cause of the disease. It can only be a supportive therapy, giving time to the patient’s organism to recover. Time, however, is sometimes the most valuable resource in medicine.

Fighting the effects of COVID-19 is a complex task with no simple or quick solutions. Social distancing measures, the use of personal protective equipment, as well as future vaccine and drug development remain the main pillars of any strategy. For people most critically affected by the disease however, therapeutic plasma exchange could prove a life-saver. The required equipment, knowledge and trained medical professionals are already in place in numerous countries. Of course, more and larger clinical trials are still needed to determine the real effectiveness of TPE treatment in COVID-19 patients, but governments around the world would be wise to explore further this simple, relatively inexpensive and very promising option.

Prof. Dr. Plamen Kenarov is an anaesthesiologist and the Head of the Intensive Care Unit for Neurological Diseases at Tsaritsa Ioanna University Hospital in Sofia, Bulgaria. He has over four decades of professional experience and has published numerous articles in international medical journals. His work focuses on, among other issues, acute respiratory distress syndrome (ARDS) and therapeutic plasma exchange.

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