Introduction: The historical treatment of convalescent plasma was successful against RNA viruses. However, the significance of COVID-19 convalescent plasma therapy has not been clinically proven consistently in most studies and the available data showed contradictory results so far. Our study aims to evaluate the role of convalescent plasma therapy as an adjunctive treatment for severe and critically ill COVID-19 patients.Methods: This study was an open-label, non-randomized comparative clinical trial that was conducted at Dr. Kariadi Hospital, Semarang, Indonesia. This study sample are hospitalized severe and critically ill COVID-19 patients were assigned with a 2:1 ratio to receive convalescent plasma and local standard of care. The primary outcome was the clinical status 30 days after the interventionResults: A total of 73 patients received convalescent plasma and 38 patients received local standards of care. Both of the groups had similar clinical ordinal scales (median was 5, p=0.65), while patients in the study groups had significantly higher SOFA scores and P/F ratio. The control group had a worse overall mortality rate (61.1% vs 18.4%) with a hazard ratio of 3.5 (95%CI, 2.1-5.9) compared to the study group. From the subgroup analysis, we found that patients in the study group without mechanical ventilation support had the best survival rate compared to other groups HR: 0.0047 (95%CI, 0.01-0.19). The clinical outcome 7 days after convalescent plasma infusion was also significantly improved in the study group (median baseline & day-7, 5 & 3, p<0.001). From the multivariate analysis of therapeutic variables, convalescent plasma was the most significant variable for survival outcome (OR=0.089, 95%CI, 0.029-0.27; p<0.001). There was one case of anaphylactic shock and was excluded.Conclusions: The convalescent plasma administration significantly improved clinical outcomes and overall survival rates compared to those who received local standards of care.

Introduction: Covid 19 is a respiratory system disease caused by SARS-COV2. Geriatric patients with Covid-19 equipped with multiple comorbidities and a high vulnerability have high morbidity and mortality rates.Case illustrations: A 75-year-old woman presents with confusion and fever. She was treated in the previous hospital for 7 days, experienced a deterioration of consciousness and had respiratory failure, thus was referred to Kariadi Hospital.She had comorbid hypertension, type 2 diabetes mellitus and grade 2 osteoarthritis genu bilateral. Bodyweight 45kg, height 150cm, BMI 20kg/m2,blood pressure 100/58 mmHg,pulse 110x/minute, Respiratory rate 28x/minute, Temperature 38.5?, 93% oxygen saturation, Frailty Index 0.7, Katz Index G, Norton score 11/20. Leucocytes 9100,Lymphocytes 10%, Neutrophil Lymphocyte Ratio 2.2, Blood Glucose 247mg/dL, CRP 4.41mg/dL, Ferritin 5472.28,D-Dimer >20,000ug/dL, Fibrinogen498 mg/dL, Procalcitonin 0.39, Chest X-ray showed pneumonia infiltrates with cardiomegaly. The RT-PCR swab examination showed positive SARS-Cov-2. Brain CT showed lacunar infarct and aging atrophy cerebral. the patient was admitted to intensive isolation room because of acute respiratory distress syndrome and covid coagulopathy. After clinical improvement, the next problems that must be addressed in isolation rooms are frail, confusion, cerebral syndrome, immobility and grade 1 decubitus.Conclusion: Management of frail geriatric patients with Covid-19 has its challenges because of the high mortality rate. It requires a comprehensive and multidisciplinary approach.