Convalescent Plasma Therapy for COVID-19 in Nepal   

Coronavirus disease- 2019 (COVID-19) is caused by a virus, namely, severe acute respiratory syndrome- 2 (SARS-CoV-2) or Novel coronavirus (2019-nCoV). The disease emerged in Wuhan, Hubei province, China, and the condition was declared as pandemic on March 11th, 2020 AD by World Health Organization (WHO). Presently, there are no specific drugs that have been approved yet for the treatment. However, besides a few drugs, front-liners have been using convalescent plasma (CP) therapy as compassionate care. It is reported that convalescent plasma therapy has some effect in increasing the survivable rate. Convalescent plasma therapy is classic adoptive immunotherapy, applied to the prevention and treatment of many infectious diseases for more than one century. The application of this therapy dates back to the early 20th century. Over the past two decades, this therapy has been used to treat SARS, MERS, and 2009 H1N1, 1918 flu, polio, measles, rabies, Hepatitis B, and Ebola — with varying levels of success with satisfactory efficacy and safety. Hence, with such a date, convalescent plasma therapy was considered as a proposed treatment for COVID-19.

Convalescent Plasma in Nepal

After there were reports that the convalescent plasma has a positive effect on COVID-19 infected patient, the National Health Research Council (NHRC) of Nepal started the observational study on 7th Bhadra, 2077, BS. The study is currently being conducted in 15 hospitals throughout Nepal. The research is being conducted under the supervision of doctors following the guidelines with the help of the Nepal Red Cross Society (NRCS). According to NHRC, for the plasma therapy, plasma is taken out from a COVID-19 recovered patient after 14 days of his/her recovery. COVID-19 positive patients wanting to undergo this therapy should contact NHRC for further process.

Plasma therapy was used for the first time in the country to successfully treat a 60-year-old coronavirus patient, in Kathmandu in last week of July. The procedure was performed at Tribhuvan University Teaching Hospital, Maharajgunj. After this, different hospitals and medical colleges also have started the Convalescent plasma therapy throughout the Nepal.

There are different registeries and campaigns created by the youths and COVID-19 recovered patients for the plasma collection as plasma bank. Such groups can be found in social media sites like facebooks.

What is Plasma and Convalescent Plasma?

Our blood is made up of four main components: red blood cells are the one that carries oxygen around the body, while white blood cells support immune function, and cell fragments called platelets form clots to stop bleeding. Plasma is the liquid component and comprises more than 50 percent of blood volume.
Plasma helps circulate proteins, nutrients, and hormones throughout the body. It also contains antibodies, which are protective proteins that bind to an antigen's surface (a foreign invader protein) and help the immune system dismantle it. 
Convalescent plasma is the part of blood recovered from diseased patients. In therapy, this plasma is given intravenously to people who do not have antibodies to the same disease and, therefore, get immunity.

Is Convalescent Plasma helpful for COVID-19?

The concept behind treatment with a plasma transfusion is to infuse antibodies from a recovered person into sick. This helps to provide a required boost to their immune system. However, it should be noted that a dose of antibodies doesn't directly stimulate a person's immune system to start creating their own antibodies, but it does offer some protection. According to various papers and articles published, there is still an ongoing debate regarding plasma therapy in COVID19 infected patients. However, few researchers suggest that the treatment might shorten the length of illness and reduce the disease's severity. Many researchers and doctors are using COVID-19 survivors' blood to prevent coronavirus infection in the first place; however, many more studies are yet to be done. 
Note: Plasma therapy is not a vaccine, as vaccines use the immune system's memory response to train it to detect and respond to specific pathogens. Also, researchers believe that the coronavirus antibodies may begin to fade within two to three months and do not provide life-long immunity like in few other diseases.

Adverse reactions of Convalescent Plasma Therapies

The most common adverse reaction of CP therapy is transfusion-related events such as fever with or without chills, severe allergic reactions, transfusion-related acute lung injury, circulatory volume overload, bleeding disorders, and blood cell breakdown. Also, the risk of transfusion-transmitted infections, such as human immunodeficiency virus, hepatitis B virus, hepatitis C virus, and syphilis, can occur. Therefore, it is necessary to properly investigate, monitor, and pay attention to these things before, during, and after transfusion of CP.