Convalescent Plasma Use in the United States was inversely correlated with COVID-19 Mortality: Did Plasma Hesitancy cost lives?

Abstract

The US Food and Drug Administration (FDA) authorized treatment of hospitalized COVID-19 patients with Convalescent Plasma (CCP) via the Expanded Access Program (EAP) and the Emergency Use Authorization (EUA), leading to the use of CCP in some 500,000 patients during the first year of the pandemic. We tracked the number of CCP units dispensed to hospitals by blood banking organizations and correlated that usage with hospital admission and mortality data over the course of the year. CCP usage per admission peaked after issuance of the EUA, with more than 40% of inpatients estimated to have received CCP between late September and early November 2020. However, following reports of randomized controlled trials that failed to show clear benefit from CCP, usage/admissions declined steadily to a nadir of less than 10% in March 2021. We found a strong inverse correlation (Pearson correlation coefficient of -0.5176 with P = 0.00242) between CCP usage/hospital admission and deaths occurring two weeks after admission, and this finding was robust to examination of deaths taking place one, two or three weeks after admission. Changes in the number of hospital admissions, prevalence of variants, and age of patients could not explain these findings. We estimate that the retreat from CCP usage, a phenomenon we termed plasma hesitancy, might have resulted in 29,000 to 36,000 excess deaths in the period from mid-November 2020 to February 2021. These results highlight the need for additional studies to ascertain the variables associated with efficacy and/or provide other explanations for the robust relationships observed in this study.

Convalescent plasma associates with reduced mortality and improved clinical trajectory in patients hospitalized with COVID-19

“…Indeed, our data aligns with two recently published studies including a multisite RCT and a large retrospective study in hematologic malignancies, which demonstrate a 56% reduction in 28-day and a 48% reduction in 30-day in-hospital mortality, respectively (26,27). Finally, these results corroborate work from Casadevall and colleagues showing an inverse correlation (-0.52) between the number of COVID-19 deaths occurring within two weeks from hospital admission and CP usage within the United States (30). We believe our data to be applicable to diverse groups as well as important in contemplating design of future RCTs.…”

Updated Clinical Evaluation of the CLUNGENE® Rapid COVID-19 Antibody Test

“…Serology tests, or immunoassays, play a significant role in the fight against COVID-19 [6,7]. A prior history of SARS-CoV-2 infection is associated with a lower risk of infection, with an estimated protective effect of up to seven (7) months following primary infection; this supports the conclusion that convalescent plasma with specific antibodies to SARS-CoV-2 has powerful antiviral activity, which can reduce the viral load and mortality in patients with active COVID-19 infection [8][9][10].…”

“…Serology testing also has the potential to monitor the presence of antibodies. Studies confirm that a prior history of SARS-CoV-2 infection is associated with a lower risk of infection, with an estimated seven (7) month protective effect [9,10]. The association of SARS-CoV-2 Seropositive Antibody Test with Risk of Future Infection has now been established [28].…”

Convalescent Plasma—A Light at the End of the Tunnel: A Systematic Review and Meta-analysis of Randomized Controlled Trials

“…Apart from the reaffirmation of the FDA for the Emergency Use Authorization for early CP with the adequate amount of antibodies in hospitalized patients again in February 2021, the guidelines of American Association of Blood Banks and Brazil also emphasized the early use of CP with high content of specific antibody. 20 …”