Only one thing is clear about our immune system: it's extremely complex and even after a century of prodding it, we still don't know it well enough to prod it in targeted ways and know what to expect.
Especially, suppressing the immune system is always dicey, since its not just one variable you tune up or down. However, there _is_ a magic bullet of sorts out there, Intravenous immunoglobulin (IVIG).
IVIG is just concentrated antibodies made from plasma of thousands of donors. Its original use case was to clear out a patients antobodies to suppress any antibody-mediated autoimmune response, but turns out IVIG can have global immunosuppressive effects through other mechanisms as well. Importantly, it's very "benign" - almost no known side effects, and your general immunity is still left intact. This has led to extensive use of this drug off-label for anything dealing with excessive immune responses.
The more and more I think and look, the more I'm convinced IVIG might help worsening covid patients. Indeed, a case study from China suggests it can be beneficial (3 of 3 very sick patients fully recovered) but of course a proper study is needed (IVIG is quite possibly the worst drug to try and ramp up production). On the other side, a pre-covid trial of IVIG on ARDS patients (already on EMCO) showed no effect, though I personally felt the study was too broad. More studies are also needed, because I'm sure any _new_ IVIG made, since it pools thousands of patients' plasma, is bound to have anti-covid antibodies as well, and this could have some potentially dangerous effects as well (Antibody-Dependent Enhancement). But I'm still cautiously optimistic and am hoping to write to some experts after gathering more data to see what they think.
Isn't the original use of IGIV as a supportive therapy for people not producing antibodies (for whichever reason)?
In the case of COVID-19, plasma therapy (which transfers antibodies from a survivor to an infected) is one of the more promising short term mitigations.
Yes, that was the original use. But turns out it has other effects as well, one of which is through the increased dosage of a small fraction of antibodies with increased suppresive activity.
You have to be careful with concoctions that have direct antivirus activity though, because it can have a dangerous side effect (ADE). However this is also a very important intervention possibility (probably more important than just IVIG), but it needs to be done in an extremely controlled fashion. But the two approaches are supposed attack in completely opposite angles so I think they should be discussed and tested independently.
Issue with this report and others from China is that they seemed to treat all patients with a concoction of antivirals, one of which is not even available outside of China and russia. No way we can make fully conclusive inferences from this data :(
I don't see how that's going to be meaningfully useful in a pandemic. We don't have anywhere near the infrastructure required to harvest plasma on that scale. It's possible it might be a useful treatment once we get back down to a stable baseline but before a vaccine is available.
I just don't see how the number of lives this will save is going to be significant vs. other more obvious mitigation strategies.
There's a deep temptation among the technical set here to look for magic bullets. There isn't one. Stay home.
Of course stay home. No one's saying we found the cure. We still want to know what can help patients who get sick anyways (given what's happening in the US now, stupid people make stupid choices but doesn't mean they shouldn't be treated).
Of course I flagged that IVIG could be the worst thing we can try to scale up. Doesn't mean we shouldn't find out if it works or not.
I think you'd be surprised at the infrastructure that out there for plasma collection. I was doing due diligence on one of these companies a few years back and was surprised to learn that the pharmaceutical company owns thousands of plasma collection clinics. The IV Ig market is quite large.
That said, you're right, this could never be used with every infected patient, but companies could probably produce enough for the sickest patients.
Especially, suppressing the immune system is always dicey, since its not just one variable you tune up or down. However, there _is_ a magic bullet of sorts out there, Intravenous immunoglobulin (IVIG).
IVIG is just concentrated antibodies made from plasma of thousands of donors. Its original use case was to clear out a patients antobodies to suppress any antibody-mediated autoimmune response, but turns out IVIG can have global immunosuppressive effects through other mechanisms as well. Importantly, it's very "benign" - almost no known side effects, and your general immunity is still left intact. This has led to extensive use of this drug off-label for anything dealing with excessive immune responses.
The more and more I think and look, the more I'm convinced IVIG might help worsening covid patients. Indeed, a case study from China suggests it can be beneficial (3 of 3 very sick patients fully recovered) but of course a proper study is needed (IVIG is quite possibly the worst drug to try and ramp up production). On the other side, a pre-covid trial of IVIG on ARDS patients (already on EMCO) showed no effect, though I personally felt the study was too broad. More studies are also needed, because I'm sure any _new_ IVIG made, since it pools thousands of patients' plasma, is bound to have anti-covid antibodies as well, and this could have some potentially dangerous effects as well (Antibody-Dependent Enhancement). But I'm still cautiously optimistic and am hoping to write to some experts after gathering more data to see what they think.