The Washington Post - USA (2021-12-22)

A4 EZ SU THEWASHINGTONPOST.WEDNESDAY,DECEMBER 22 , 2021

BYKATIESHEPHERD

ANDLAURIEMCGINLEY

Convalescentplasmamaybe
another tooltohelp prevent
coronavirus infections sparked
by the omicron variant from
turning severe if patientsreceive
it soonafter developing symp-
toms,according to data present-
ed Tuesday.
Thetreatment,which contains
abounty of disease-fightinganti-
bodies, couldexpand doctors’
repertoirefor fighting the now-
dominant variant thatresists
manytreatments.Convalescent
plasma—taken fromblooddo-
nated by peoplewho have recov-
ered fromcovid-19 —could join
the monoclonalantibody sotrovi-
maband soon-to-beauthorized
antiviral drugsas an important
therapy for peoplewho become
ill.
Scientists from the Johns Hop-
kins BloombergSchoolof Public
Health and Johns HopkinsUni-
versitySchoolof Medicinepub-
lishedfindingsshowing thatgiv-
ingplasmaearly during the
course of illness reducedhospi-
talizationbyhalfinaclinicaltrial
thatspanned fromJune 2020to
October2021.Theresults,pub-
lishedonthe preprint website
MedRxiv,supportthe early use of
antibody-rich convalescentplas-
ma to prevent hospitalization in
patientswho are not yetcritically
ill.
“Our findingssuggest that this
is anothereffective treatmentfor
COVID-19withthe advantages
beinglow cost, wideavailability
and rapid resilience to the evolv-
ing SARS-CoV-2,” Kelly Gebo, a
co-leadauthorof the study and a
professor of medicine at theHop-

kins SchoolofMedicine,said in a

statement.

Theclinicaltrial usedplasma

collected beforevaccines were

widelyavailable,DanielF. Han-

ley, aprofessorof neurologyat

the HopkinsSchoolofMedicine,

said at anewsbriefing Tuesday.

Thetrialconcludedbefore omi-

cron arrivedin the United States,

but researchers saythe results

offer hopefor treating the highly

transmissible variant.

Otherstudieshave shown that

plasmafrompeoplewho have

beenbothvaccinated and have

recovered fromcovid-19contains

significantly higheramountsof

antibodies,makingit morelikely

to promotean immuneresponse

against omicron,said David Sul-

livan, co-leadauthorof the study

and aprofessor of molecular

microbiologyandimmunologyat

the Hopkins SchoolofPublic

Health.

And with vaccinesin wideuse,

experts said it shouldbe easierto

collect such antibody-plentiful

plasma.

“Wedothink thatthisvacci-

nated plasmais away forward

thatwillprevent hospitalizations

becauseof the high titers,”Sulli-

vanadded.

Theinfrastructure to produce

convalescentplasmafromblood

donated by people with high

levels of antibodies exists widely

acrossthe United States and

internationally.Becauseof that,

the treatment could be made

availablerelatively quickly,re-

searcherssaid.

“Weuse blood transfusions

everysingle dayinthe hospital. It

isoneofthemostcommon,safest

proceduresperformed in medi-

cine,”said AaronTobian,director

of the Transfusion MedicineDivi-

sionatJohnsHopkinsUniversity

SchoolofMedicine.“Nowwe

have data showing thatblood

transfusions of convalescent

plasmareducehospitalizations,

and we thinkeveryone should be

aware of it.”

Thevalue of convalescentplas-

ma has been controversialfor

muchof the pandemic. Earlylast

year,demandfor the treatment

skyrocketed, as physiciansdes-

peratetohelp patients sawitas

one of the fewmeasuresthat

mightbe beneficial. But disap-

pointing studies and apolitical

outcry involvingconvalescent

plasma chilled enthusiasmfor

the treatment.

TheTrump administration

pushedthe therapy as an option

for hospitalizedpatientsearly in

the pandemic, before its effec-

tivenesswas proved. In August

2020,whenthe Food and Drug

Administration gave emergency

authorizationtoconvalescent

plasma, President Donald Trump

and then-FDACommissioner

Stephen Hahn sharplyoverstat-

ed thetreatment’s effectiveness,

leading to widespreadcriticism.

In February, theFDA nar-

roweduse of the plasma to the

antibody-rich versionand said it

shouldbeused early in the

treatment of hospitalized pa-

tients.

Severalclinical trials have

raised questionsaboutwhether

it worked, leadingthe World

Health Organization this month

to recommendagainstgivingthe

treatmentto covid-19 patients.

But morerecentdata appears

to suggest thatgivingthe right

kind of plasmaat the righttime

can provehelpful.

Therenewed interestinconva-

lescentplasmato treatcovid-

reflects newdataand adearth of

treatmentsto counterthe omi-

cronvariant, whichaccounted

for morethan 73 percent of new

coronavirus casesin the United

States duringthe weekending

Dec. 18.

Most versions of another treat-

mentknownas monoclonalanti-

bodies, whichis designedto keep

patientsout of the hospital,don’t

appearto workagainst omicron.

ThePfizer-BioNTechand Mod-

erna vaccines offer protection

fromseriousdisease and hospi-

talization resulting from omi-

cron,especiallyif peoplegeta

thirddose.

Pills to treatcovid fromMerck

and Pfizer,which maybeauthor-

ized by the FDAassoon as this

week,offer helpbut comewith

limitations:TheMerckdrugis

less effective than expected from

preliminarytrial results,and the

Pfizer medication will be in short

supplyfor sometime.

Based partly on the Johns

Hopkins trialonconvalescent

plasma,several scientists are pe-

titioningthe FDAtoexpandthe

authorization for convalescent

plasma to include outpatients.

Currently,plasmais authorized

only for hospitalizedpatients —

who are far sickerand less likely

to benefit, scientists say.

“Extending the [emergency

use authorization]to the outpa-

tientspace wouldimmediately

givephysiciansasafeanddesper-

ately neededtool to combatthe

rapidlyescapingomicronvariant

and immediately fill the gap

created by the loss of activity” of

monoclonalantibodies, the sci-

entists said in an emailexplain-

ing the letter to the FDA.

“The keything is omicron,”

Arturo Casadevall, aco-authorof

the letter to the FDAand of the

study published Tuesday, said in

aninterview.

Theelimination of most

monoclonalantibodies“has tak-

en out amain line of defense,”

said Casadevall, chairof microbi-

ologyand immunologyand in-

fectiousdiseasesatthe Hopkins

SchoolofPublicHealth. He said

manyhospitalshave established

clinicsto administer monoclonal

antibodiesand thatthose facili-

ties can be used for convalescent

plasma.

Thetreatmentmayalso playa

majorrole internationally, if the

WHOreconsiders its stanceon

usingplasma to treatcovid-

patientswho have not yetdevel-

opedsevere illnessfromthe vi-

rus.

“This is abig deal for the

developing world,”said Alfred

Sommer,anepidemiologistand

former dean of the Hopkins

Schoolof Public Health.

In low-incomenations,conva-

lescentplasmamaybethe most

widelyavailabletreatmentop-

tion becauseit is relativelyinex-

pensiveand the infrastructure to

produceand distributeit to pa-

tientsexists.

“This is atooltolowermortal-

ity,”Sommer said,explaining

thatcountries such as South

Africa routinely collectblood

frompatientsandcanquicklytell

whetherthe plasma is rich in

antibodies.“Theycoulddo this

tomorrow.”

Liise-annePirofski, aprofes-

sor of medicine, microbiology

and immunologyatAlbertEin-

stein College of Medicinewho

signedthe letter to the FDA, said

expandinguse of convalescent

plasmato include outpatients is

“critical, amatterofnational

security” to helpbeatback the

omicronsurge.

Afederal official who spokeon

the condition of anonymitybe-

causehe was not authorizedto

discuss theissuesaidhe expected

the FDAtoseriously consider

allowingconvalescentplasmato

be administered to outpatients.

Still,some infectious-disease

experts remainskeptical.

JeanneMarrazzo,director of

infectiousdiseasesat the Univer-

sityofAlabamaat Birmingham,

said she will be cautious in

accepting the newfinding on

convalescent plasma “in the

wakeofprior studies thathave

failedto showbenefit. Theprac-

ticalities of using it as wide-

spreadtherapy are also daunt-

ing.”

But the study authors said

theirfindingsindicate convales-

cent plasmamaybeespecially

useful whenothertherapiesare

in shortsupply.

“Asthe changing,often unpre-

dictablelandscapeof the COVID-

19 pandemicdemandsmultiple

treatmentoptions —especiallyin

low- and middle-incomenations

wherefrontline therapies, such

as vaccinesand monoclonalanti-

bodies, maynot be readilyavail-

able —our study providessolid

evidence thatantibody-rich con-

valescent plasmashould be part

of the outpatient arsenal,”Sulli-

vansaid in astatement.

[email protected]

[email protected]

Frances Stead Sellersand Paulina

Villegas contributed to this report.

Early use of convalescent plasma reduced hospitalizations, new study finds

and strategists have urged party
leadersto put forth anew message
onthepandemic.
But moreimmediately,health
expertsfear abrutalperiod of
exploding caseswilloverwhelm
healthsystemsand disruptthe
nation’s economy. Newconfirmed
infectionsinthe UnitedStates
haveroughly doubledsinceearly
November,rising from about
76,000 casesonNov.9to about
153,000cases on Tuesday, accord-
ing to TheWashington Post’s roll-
ing seven-dayaverage. Hospital-
izationshavealsoincreased by
nearly50percent sinceearly No-
vember,risingfromabout 47,
onNov.9to morethan69,
now,drivenbythe olderdelta
variant.
Earlyreportssuggestthatmany
people experience only mild
symptomsfromomicron,andvac-
cineboostersappeartoprotect
against severeillness, although
the WhiteHouseisbracingfor a
newsurgeofhospital patients,
drivenbyunvaccinated Ameri-
cans and peoplewithlimited im-
muneprotection.
Theomicronvariantaccounted
for 73 percent of newcoronavirus
casesintheUnitedStatesbetween
Dec. 12 and 18,according to mod-
eled projectionsfromthe Centers
for Disease Controland Preven-
tion. TheCDC also published new
analysis late Mondaythatwarned
thatone worst-case scenario is
likely to lead to massive peaks in
infection exceedingearlier rec-
ords as soon as January.
DespiteBiden’smessage,signs
of disruption appearedthrough-
out the nation.New York Mayor-
electEric Adamspostponed his
Jan.1inaugurationceremony,and
the National Hockey League an-
nounceditwould become thefirst
major professional sports league
inNorthAmericatohaltitsseason
becauseofaspike in cases. Mean-
while,the National BasketballAs-
sociationonTuesdaysaiditwould
forgeaheadwithscheduledgames
thisweek.
“Frankly,we’rehavingtrouble
comingupwithwhatthe logic
wouldbebehindpausing right
now,” NBACommissioner Adam
Silver said in an interviewwith
ESPN. “Thisviruswillnotbeerad-
icated and we’regoingtohaveto
learn to livewithit.”
Dozens of NBAplayers have
beensidelined by virus infections
orcloseproximity to peoplewho
had tested positive, butleague of-
ficials are reviewing whether it
willrelax protocols for players
who are vaccinatedand showing
no symptoms of thevirus.
Atthe WhiteHouse,Biden ac-
knowledgedAmericansare“tired,
worried and frustrated”bythe
persistent virus, whichhede-
scribedasa“toughadversary,” but
hestressedthat“we’veshownthat
we’retougher; tougherbecause
we have the power of science and
vaccines thatprevent illness and
save lives.”
Speaking directly to parents,
Biden said,“We don’thave to shut
downschools because of covid-19.

VIRUSFROMA

We can keep our K-12 schools

open. That’s exactly what we

shouldbedoing.”

Bideneventoutedformerpresi-

dentDonald Trump’s recent ac-

knowledgment thathereceived

his booster shot as Biden pressed

Americansto getvaccinatedand

boosted.Fewer thanone-third of

fully vaccinated people have re-

ceivedabooster shot.Opposition

to vaccines has beenespecially

prevalentamongRepublicansasa

numberofprominent pro-Trump

media figures have spread disin-

formation aboutthe shots.

“Maybeoneofthefewthingshe

and Iagreeon,”Biden said of

Trump.

TheWhite House is also taking

stepstoaddress massivetesting

shortagesacrossthecountry, mag-

nifiedbyimagesoflengthylinesin

major metropolitanareas as

Americansstruggle to find tests

before the holidays. Alackluster

testinginfrastructurehasplagued

the country’spandemic response

since thestart, and Biden prom-

isedduringhis campaign and

againaspresidenttoaddressthe

problem.

ButBidengrewdefensiveon

Tuesdaywhen pressedonwhy

Americanswere stillhavingtrou-

ble finding access to tests.

“Itdidn’ttakelongatall,”Biden

said. “Whathappenedwas the

omicron virus spreadevenmore

rapidlythananybody thought.”

As partofthe newplan,the

administrationwill startdeliver-

ingahalf-billionfreerapidteststo

homes next month, and health

officialswillset up awebsite

whereAmericans can orderthem.

More immediately,the federal

government is settinguptesting

sites acrossthe country,starting

withone in NewYork Citythis

week.

TheBiden administration has

emphasized increased testingas

one of the pillars of its pandemic

response,butithasbeencriticized

forfailingtoprovideat-hometests

at lowcost. Americans areoften

paying $25 for apack of twotests,

if theycan find anyatapharmacy.

“The Trump administration’s

biggest testing failurewas trust-

ing CDCscientists in thebegin-

ning to develop testsand thatput

us waybehind whentheyfailed.

TheBiden administration’stest-

ingfailureisprobablyworse,” said

Chris Meekins,aRaymondJames

financial analystand former fed-

eral emergency-responseofficial,

faulting the White Housefor fall-

ingbehindother nationsthisyear

inrollingout rapid tests.

He added: “500milliontests

sounds nice,but is woefully inad-

equateforwhatwewillneedandis

waytoo late.Omicronislikely to

be largely over by the timethese

testsbecome widelyavailable, but

maybe theywillbeready forthe

nextvariant.”

To relieve overrun hospitals,

the federal governmentwillsend

emergencymedical teamstosix

states —Michigan,Indiana, Wis-

consin, Arizona, NewHampshire

andVermont—thepresidentsaid.

Someofthosestates,suchasMich-

igan,hadbeensufferingfromcase

surges even beforethe announce-

mentof thefirstomicron casein

the United States thismonth.

Theadministrationwillalsode-

ploy an additional 1,000military

doctors,nurses, paramedics and

other health-care personnel to

strained medical centers in Janu-

aryand Februaryasneeded, and

Biden is settoorderthe Federal

Emergency ManagementAgency

to work with states and territories

to preparemore hospital beds

aheadofexpected surges.

Some public health experts

cheered Biden’s latestplan, saying

itmetthe moment.

“A for effort,”said LucianaBo-

rio, asenior fellowwiththe Coun-

cilonForeign Relations andfor-

mer acting chiefscientistatthe

Food and DrugAdministration.

“It’satoughvirus. It’s atough

pandemic. People are tired. The

keynow is to keep hospitals oper-

atingtoavertneedless deaths.”

But Julia Raifman, an assistant

professoratBoston University’s

School of Public Health, said she

was focused on what she saidwas

Biden’s failuretodeliveranearlier

plan:the lengthynational pan-

demic strategy, released on the

president’sfirstday in office, that

promisedto“guideAmericaoutof

the worstpublic health crisisin a

century.”

“That’saverygood planthat

has everything thatweneed in it,”

saidRaifman,postingonTwittera

listofthe plan’s promises, which

included nationwide masking,

better virus data and creating a

sense of common purpose.

“COVIDleadershiphas not only

notimplementedit, theyhavedi-

rectlycontrovertedvirtuallyevery

item,”sheadded on Twitter.

And James Hamblin, alecturer

attheYaleSchoolofPublicHealth,

faulted Biden for devoting so

muchofhis speechto afamiliar

mantra:urgingvaccineskepticsto

getshots.

“Anypoliticianwhopleadswith

constituents to getvaccinated

risksfurther polarizing peopleon

this issue,” Hamblin said,adding

thatthe message should be driven

by medicalexperts.

Also Tuesday, Rachel Levine,

the assistantsecretaryfor health

at the Departmentof Health and

Human Services, warned nursing

homeproviders thattheir resi-

dents remaindisproportionately

vulnerable to omicron giventheir

ageand comorbidities, and that

earlier vaccine protection may

havewaned.

“Gettingtheboostersmusthap-

pen in the next couple weeks,”

Levine said on aconferencecall.

“Wereallyhaveone, two, three

weeks until everywhere, the surge

is here,and hospitals are poten-

tially overwhelmed.”

Many nursing home providers

are racing to administer boosters

amidevidence of rising infections

in their facilities.

Biden’s speechcame three

weeksafter he unveiledhis initial

plan to combatawinter surge,

which included campaigns to in-

crease vaccinationsand booster

shots, morestringenttestingfor

internationaltravelers,and plans

to makerapid at-homecoronavi-

rus testingfreefor morepeople.

Butwiththeemergenceofthenew

variant, the WhiteHouse moved

to add measures to protectAmeri-

cans.

On Tuesday, Bidensignaled his

administration was considering

reversingone suchmeasure: the

bans restricting travel to the Unit-

ed States fromseveral countries

that hadlargecovidoutbreaks

driven bytheomicronvariant.

“Look,rememberwhy Isaid we

put atravelban on is to see how

much timewe had beforeithit

here so we can begintodecide

what we neededby looking at

what’shappening in other coun-

tries,”Biden said. “But we’repast

thatnow.And so it’s something

thatisbeingraisedwith me by the

docs.And now I’ll have an an-

swer.”

[email protected]

[email protected]

[email protected]

Meryl Kornfieldcontributedto this

report.

Biden says U.S. can fight virus without extreme measures

DEMETRIUSFREEMAN/THEWASHINGTONPOST

President Biden speaks from the StateDining Roomat theWhiteHouseabout efforts to fightthe omicronvariant of the coronavirus. He

saidAmericans who have beenvaccinated and boosted are largelyprotected fromserious illness and cancelebratethe holidaysasnormal.

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50k

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2k

4k

0

1m

2m

3m

4m

Jan. 2021

Jan. 2021

Jan. 2021

Dec. 21

Dec. 21

Dec. 21

Feb. 29, 2020

Feb. 29, 2020

Feb. 29, 2020

7-dayavg.

7-dayavg.

7-dayavg.

As of 8p.m. Tuesday

51,353,

156,04 7

497,375,

807,

1,

1,542,

7-dayaverage

7-dayaverage

Total

DEATHS

Total

VACCINE DOSESADMINISTERED

Newcoronavirus cases, deaths and

vaccinedosesinthe U.S., by day

Total

CASES

7-dayaverage