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Speaker 1: Hi, this is new because of the coronavirus. I am

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Speaker 1: currently staying at home in Rome, where my wife serves

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Speaker 1: as the United States Ambassador of the Holy See. She's

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Speaker 1: leading the embassy in dealing with all the different changes

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Speaker 1: being brought about by the pandemic. To bring you this

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Speaker 1: episode this week, I'm recording from my home, so you

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Speaker 1: may notice a difference in audio quality. On this episode

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Speaker 1: of Nuts World. With a spread of COVID nineteen, we

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Speaker 1: are looking for treatments for patients currently infected with the virus,

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Speaker 1: while we also try to find a vaccine or a cure.

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Speaker 1: I'm joined today by doctor Arturo Casa Daval, who is

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Speaker 1: both a medical doctor and a doctor of philosophy, and

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Speaker 1: he is chair of Molecular Microbiology and Immunology at Johns

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Speaker 1: Hopkins Bloomberg School of Public Health. He has been a

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Speaker 1: leading national voice on developing a convalescent plasmotherapy to treat

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Speaker 1: COVID nineteen. I am please is to welcome as my

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Speaker 1: guest for sure all could you just share with us

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Speaker 1: from it what attracted you to public health and how

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Speaker 1: you got to where you are today, Sir Nude, I'm

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Speaker 1: originally from Cuba. I came here when I was eleven,

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Speaker 1: and I saw in love with science, and I've been

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Speaker 1: in life and science all my life. And I worked

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Speaker 1: with antibodies put in the LA past thirty years, and

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Speaker 1: I knew the history of this field, and I knew

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Speaker 1: that in the past convalescent plasma had been used in

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Speaker 1: many epidemics, including the nineteen eighteen epidemic and even more

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Speaker 1: recently in two thousand and three in stars. And therefore

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Speaker 1: I put two of my great interests together, one of

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Speaker 1: them was science and antibody, and the other one is history,

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Speaker 1: and thought that it was very important to try to

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Speaker 1: get this deployed for those of us who don't have

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Speaker 1: your scientific backgrounds. Can you take a minute and explain

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Speaker 1: what convalescent plasma is so that the average American could

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Speaker 1: understand it. Yes, So, let's say that a person gets

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Speaker 1: COVID nineteen. The majority of people will get better on

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Speaker 1: their own, some get more ill, and some of them

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Speaker 1: get into respiratory failure, and a small number die. Those

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Speaker 1: who survives make antibodies. Antibodies are proteins that are in

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Speaker 1: the blood and they can kill the virus. So once

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Speaker 1: convalescent means that you have gotten better. Once you're better,

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Speaker 1: there is in your blood these antibodies that can be

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Speaker 1: used to prevent disease and to treat disease. And the

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Speaker 1: idea is that those who survive will donate their plasma

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Speaker 1: and then this plasma would be used to treat those

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Speaker 1: who are sick or given it to people who are

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Speaker 1: exposed who make it sick to prevent them from actually

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Speaker 1: getting sick. So you can maintain the police, you can

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Speaker 1: maintain the doctors, etc. What is the difference between plasma

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Speaker 1: and blood? When you have blood, you have red cells,

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Speaker 1: white cells, and liquids floating in a liquid. This is

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Speaker 1: why the blood is a liquid. So if you were

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Speaker 1: to remove these cells, you're left with a liquid, and

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Speaker 1: that liquid is the plasma and that's where the antibodies

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Speaker 1: are found. Okay, So in essence, you're taking the liquid

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Speaker 1: out of your certain percent of somebody's blood. It's almost

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Speaker 1: like they're blood donors, except in this case they become

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Speaker 1: plasma donors. Now, do they have to donate the whole

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Speaker 1: blood for you to then take the plasma out of it? Yes?

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Speaker 1: And no. In some cases you can donate the whole blood,

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Speaker 1: like what for example, if you don't for a blood

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Speaker 1: donation the blood center, they separate your red cells and

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Speaker 1: your white cells and the plasma, and the plasma is

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Speaker 1: used for other things. Currently use plasma in surgery in

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Speaker 1: people that have prompts with corrulation. But you can also

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Speaker 1: have something known as aphorisis a complicated word, but what

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Speaker 1: it means is that you can go to one of

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Speaker 1: these standards and they put an ivy onto you and

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Speaker 1: they actually can remove the liquid without taking the cells.

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Speaker 1: You can remove as much as six hundred milli leaders,

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Speaker 1: which is enough to treat two people. In many cases.

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Speaker 1: Here in the United States, the Red Cross is going

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Speaker 1: to be asking you donate blood and they'll make the

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Speaker 1: plasma out of it because they'll save the red cells

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Speaker 1: for people who need them. And then they'll take the

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Speaker 1: liquid and they test it for antibody to see if

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Speaker 1: they can use it on people with COVID nineteen. What

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Speaker 1: seems to be the dornenst with people who are susceptible

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Speaker 1: of the pandemic and people who might carry it but

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Speaker 1: then never get sick. People who have predisposing conditions, people

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Speaker 1: who have diabetes, heart disease, long disease seem to be

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Speaker 1: at higher risk or disease, and by disease I mean symptoms.

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Speaker 1: You can be infected and have no symptoms. That's the

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Speaker 1: majority of people. Those are the asymptomatics. And then the

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Speaker 1: people that go onto disease that is that they have

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Speaker 1: a fever, that they have shortness of breath, that they

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Speaker 1: have malaise often tend to have associated conditions and these

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Speaker 1: conditions can make the disease worse. But it's also important

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Speaker 1: to realize that we're having people that are completely well

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Speaker 1: that doesn't have any conditions that are also getting sick.

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Speaker 1: And as to who gets sick and who doesn't, there

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Speaker 1: is a lot of factors that come into this. All

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Speaker 1: we can say is, if you look at a population,

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Speaker 1: those who have pre existing conditions are more likely to

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Speaker 1: get sick. But we know very well that even people

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Speaker 1: that have heart disease and have long disease I get

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Speaker 1: exposed to this, not everybody gets and that there's an

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Speaker 1: element of chance in there that it makes it very

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Speaker 1: hard to predict who will be ill and who will not.

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Speaker 1: So just part of it just become pragmatic. If you

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Speaker 1: end up clearly having head the virus but not having

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Speaker 1: gotten sick from the virus so that you then become

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Speaker 1: available potentially as a donor. Is that correct? Yes, we

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Speaker 1: think that anybody who recovers is a potential donor. So

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Speaker 1: even people who have been sick and I've been sitting

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Speaker 1: at home, and once the fever breaks, once they have

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Speaker 1: no more symptoms, we want them to wait at least

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Speaker 1: fourteen days. Twenty eight days may be the right amount

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Speaker 1: because what we are finding is that a lot of

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Speaker 1: these people still test positive for virus. Now we don't

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Speaker 1: know if their infections are not because the test looks

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Speaker 1: at the RNA, it looks at nucleque acid, so the

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Speaker 1: virus may not be infectious, but we want to be

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Speaker 1: super careful and we don't want to send them to

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Speaker 1: a transfusion facility where they could infect others. What would

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Speaker 1: you guess or the potential donors at the present time

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Speaker 1: in the SOW many people are we really talking about, Well,

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Speaker 1: we're talking about thousands of people who have already volunteered.

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Speaker 1: The problem today new is not donors. The problem today

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Speaker 1: is logistical is ramping these ups. It's complicated because think

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Speaker 1: about it, You've got to find people who you can

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Speaker 1: establish that they had the disease and that they had

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Speaker 1: a positive test for COVID nineteen who have recovered, who

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Speaker 1: now have to go for a second test to show

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Speaker 1: that they don't have it anymore. And then you got

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Speaker 1: to make an appointment and they need to go to

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Speaker 1: a facility, and they got to donate their plasma, and

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Speaker 1: then that plasma has to be processed. It takes about

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Speaker 1: a day, and then it can be used on a patient.

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Speaker 1: And the good thing though, is that most people can

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Speaker 1: help two others. That is, if you go for a

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Speaker 1: plasma donation, most people can make two units. So at

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Speaker 1: least the mass helps in that regard. Now, is there

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Speaker 1: a cycle time where if I came in and you

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Speaker 1: took my plasma, could I then come back in fourteen

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Speaker 1: days or twenty eight days? The blood banks have a

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Speaker 1: said number of days in which says one people to

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Speaker 1: recover fully. But that is absolutely true. Don't quote me

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Speaker 1: in the actual number of days. It's probably on the

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Speaker 1: order of weeks. But they can come back and then

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Speaker 1: help out other people. Part of what I'm worried about

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Speaker 1: is as fall and the potential of the virus sort

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Speaker 1: of reigniting. But if you by then had identified enough people,

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Speaker 1: you could have a pretty powerful system of donors capable

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Speaker 1: of really cutting down dramatically the risk to right there

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Speaker 1: is something else going on that will hopefully be available

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Speaker 1: on the fold that is better than this. Pharmaceutical companies

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Speaker 1: can take the antibody out of the plasma and produce

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Speaker 1: a product that is called gama globula. Then this is

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Speaker 1: going on right now that pharmaceutical companies are collecting plasma

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Speaker 1: themselves to provide a different product, which is just the

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Speaker 1: antibody with nothing else in it. And the advantage of

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Speaker 1: that is that it's going to be an industrial product

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Speaker 1: that is consistent from badge to badge in terms of activity.

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Speaker 1: The problem is that that is not available right now

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Speaker 1: and it's just going to take them months to ramp

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Speaker 1: up to do this. So between now and the availability

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Speaker 1: of this product which is made out of plasma, and

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Speaker 1: many of us think that compolescent plasma is a very

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Speaker 1: helpful potential stopcout solution. So what means to be done

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Speaker 1: to maximize the implementation the convalescent plasma system logistics? Logistics logistics.

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Speaker 1: The country doesn't have a mechanism in place for doing this,

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Speaker 1: so we are essentially creating and the good thing is

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Speaker 1: that there are now multiple places collecting plasma in the

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Speaker 1: New York area. The New York Blood Center, the Red

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Speaker 1: Cross is collecting plasma. The problem is the ramp up.

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Speaker 1: I believe things are getting better every day, but the

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Speaker 1: problem is that this needs to be done faster. I'm

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Speaker 1: not somebody who thinks in terms of maximizing this production.

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Speaker 1: I think there are a lot of very smart people

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Speaker 1: probably who could look at this as a supply and

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Speaker 1: demand and do it. It's complicated because she's talking about

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Speaker 1: different states, different places or collection, and I do think

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Speaker 1: that it will be very helpful. Right now, this is

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Speaker 1: all being done at a crassroots level. It has been

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Speaker 1: done by universities, and it's being done by hospitals. Is

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Speaker 1: there was more of a national coordination. Why isn't she

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Speaker 1: or somebody empowered to do this? Actually, all the government

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Speaker 1: agencies have been extremely helpful. The FDA has been deleted

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Speaker 1: in this because this product falls within their domain. Plasma

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Speaker 1: is a regulated product in the United States, and they

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Speaker 1: have been doing their part. If you want to think

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Speaker 1: about the challenges, is imagine creating essentially a new industry

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Speaker 1: from scratch that it's going to produce a product that

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Speaker 1: previously wasn't being done, and I think that the situation

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Speaker 1: in two weeks is going to be dramatically different than

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Speaker 1: it is today. Another thing that's going to happen is

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Speaker 1: that most all four potential donors today can donate because

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Speaker 1: most of the Americans who have COVID nineteen are in

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Speaker 1: some stages of either being sick or recovery. In a month,

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Speaker 1: a lot of these people would have recovered, so we're

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Speaker 1: going to have a much larger pool or potential donors.

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Speaker 1: It's interesting. Part of what usually just in is that

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Speaker 1: we should ensure that the logistics system exists within thirty

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Speaker 1: days to match up with the patients who would then

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Speaker 1: be available in significant numbers. That's right. It's a grassroots effort,

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Speaker 1: but I think it would really help if there were

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Speaker 1: some companies who know how to organize something like this.

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Speaker 1: I mean, I can tell you that our effort throughout

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Speaker 1: the grassroots that are a website which you can go to,

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Speaker 1: which is cc PP nineteen dot org was created with

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Speaker 1: help donated from Amazon. The FDA has done all they

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Speaker 1: can to help, and in fact, the FDA is brought

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Speaker 1: into Red Cross to try to help with their system

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Speaker 1: of collections as you're describing it. This is probably a

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Speaker 1: very short term implementation, and then it gets superseded by

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Speaker 1: the development of the manufactured anybody's you're absolutely right, this

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Speaker 1: is never going to be a pharmaceutical product because in

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Speaker 1: a way, you are taking plasma from donors and using

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Speaker 1: it in others, and you know, pharmaceutical products are consistent.

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Speaker 1: The antibody that will be made from plasma will be

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Speaker 1: a pharmaceutical product. But between now and then, the option

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Speaker 1: that we're dealing with is basically taking something from survivors

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Speaker 1: that they carry in their blood and using it, and

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Speaker 1: that is going to be very useful as long as

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Speaker 1: we don't have something else, But then eventually we'll be

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Speaker 1: superseded by a better products. I'm just trying through. Whether

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Speaker 1: it's a public health system or a couple of very

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Speaker 1: large hospitals, somewhere, there has to be somebody with organizational capability.

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Speaker 1: I think that they would help from more coordination. Like

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Speaker 1: give you an example, the New York City has lots

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Speaker 1: of donors today, but the capacity to produce this is

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Speaker 1: the number of places that you can go and donate

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Speaker 1: in a few weeks. I suspect the curve in New

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Speaker 1: York city will have come down, and yet this is

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Speaker 1: going to be needed in other parts of the country,

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Speaker 1: and you really want to be thinking about a system

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Speaker 1: by which this can be deployed across the country, across

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Speaker 1: state line. It's involving different jurisdictions and things like that

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Speaker 1: until we have better products and plays. So people who

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Speaker 1: are listening to this should recognize that one of the

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Speaker 1: options they should be looking for if they are one

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Speaker 1: of their loved ones comes down with the virus, is

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Speaker 1: to see whether or not in their region it's possible

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Speaker 1: to get condulescent plasma solution that could in fact save

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Speaker 1: their life. That's right, mute, you're ahead of me. I

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Speaker 1: can tell you that my inputs is full of people

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Speaker 1: writing to me and saying, my loved one is in

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Speaker 1: the intensive ka unit. How do you get this stuff?

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Speaker 1: And right now, what I've been advising them to say

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Speaker 1: is talk to the person's doctor and see if it

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Speaker 1: can be obtained locally called the Red Cross, and see

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Speaker 1: if they happen to have something available. But right now

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Speaker 1: the supply is insufficient to meet the demand. How hard

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Speaker 1: is it locally to manufacture this? It's not hard. Let's

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Speaker 1: just say you go in Johns Hopkins. You come into

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Speaker 1: our transfuction facility, you see there for a couple of hours,

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Speaker 1: you donate your plasma. Your plasmas then tested for viruses,

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Speaker 1: is tested for blood porne pathoges, things like that, and

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Speaker 1: then within a day or two it is it's put

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Speaker 1: in a refrigerator, and then it's ready to use, provided

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Speaker 1: that all the quality checklists are followed. The one thing

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Speaker 1: that I want to add is that we haven't discussed

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Speaker 1: yet is advocacy. The history of plasma is encouraging. If

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Speaker 1: you look back in nineteen eighteen, the doctors thought that

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Speaker 1: it worked. If you look back at multiple epidemics, people

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Speaker 1: have always thought that it worked. But that has never

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Speaker 1: really being good control clinical trials. And the reason for

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Speaker 1: that is obvious. When you're in the middle of an epidemic,

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Speaker 1: people tend to rely on something that probably has very

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Speaker 1: little toxicity and yet it has potential benefits. But one

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Speaker 1: of the things that we're gearing up here in the

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Speaker 1: United States to do is to do formal clinical trials

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Speaker 1: where we're going to test this stuff in a way

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Speaker 1: that you compare it people who get it to people

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Speaker 1: who don't get it. And we think that this can

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Speaker 1: be done relatively quickly because there are so many cases.

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Speaker 1: This should be like a three or four week experience, shouldn't.

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Speaker 1: That's exactly right, and in fact, I will add that

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Speaker 1: here in the United States comblescent SARA is being used

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Speaker 1: today as a compassionate use. The SBA has allowed it.

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Speaker 1: There are probably between fifty and one hundred people that

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Speaker 1: have been treated by the way. Compassionate use just means

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Speaker 1: that your doctor says that this could be useful. Therefore

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Speaker 1: you try to get a unit or two to treat

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Speaker 1: your patient. We should be able to compare to those

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Speaker 1: people two people who were comparable who did not get it.

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Speaker 1: And that's what the Chinese have done. They're reporting in

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Speaker 1: the literature good results. The Italians are reporting good results.

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Speaker 1: But again these and not control clinical trials. We want

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Speaker 1: to do things right. If you can already identify fifty

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Speaker 1: or one hundred patients who have been treated, do we

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Speaker 1: have some notion of what those outcomes were? We don't

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Speaker 1: have it yet. Hopefully, if these people will begin putting

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Speaker 1: the information out, the information that we have on plasma,

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Speaker 1: the best information is coming out of China. The Chinese

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Speaker 1: used it and they're reporting in some of our best

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Speaker 1: medical journals like JAMA and p and as they're reporting

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Speaker 1: encouraging results with important caveat that these are a series

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Speaker 1: of patients. That is, you treated a one, two, three,

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Speaker 1: four to five, six. You didn't do a trial in

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Speaker 1: which you created two arms. This one is going to

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Speaker 1: get plasma and this one is not. So the data

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Speaker 1: is encouraging, but it doesn't have the premature of a

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Speaker 1: very high quality data that the way we make medical

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Speaker 1: decisions today. Let's say that they tried it on a

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Speaker 1: hundred people. Yeah, if none of them die, isn't that

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Speaker 1: a pretty good sign? That would be a very good

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Speaker 1: sign if we had that data. Or for example, if

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Speaker 1: you could say that the people who get treated, the

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Speaker 1: majority of them got off a respirator. Right. So that's

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Speaker 1: the kind of data we're going to be looking for

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Speaker 1: as soon as we get a sense of what's going on.

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Speaker 1: What about on the Chinese reporting, I mean, do they

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Speaker 1: have zero deaths or a decline in the total number

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Speaker 1: of deaths? Their papers don't include that. What they include

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Speaker 1: is the experience with using it, so they for example,

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Speaker 1: the paper that was reported the presidings the National Academy

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Speaker 1: of Science, which is one of the most prestigious journals

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Speaker 1: in the world. At the beginning of last week. This showed,

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Speaker 1: for example, that they had treated like ten or fifteen

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Speaker 1: patients and they had done well and that their virus

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Speaker 1: had come down. So it's encouraging. You're looking at that

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Speaker 1: and you say, you know, this may help. It doesn't

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Speaker 1: appear to have any significant side effects. Let's try it

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Speaker 1: from the Italians. I hear you're in a Rome, right, yes,

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Speaker 1: I am. In the newspapers there have been reports that

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Speaker 1: the Italians are used in plasma in order in Italy,

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Speaker 1: and the newspaper reports are favorable. But again, as a

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Speaker 1: scientist and physician, I'd like to see the data before

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Speaker 1: I come to that conclusion. Right in your judgment, is

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Speaker 1: the general momentum going to get this set up in

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Speaker 1: the next thirty to forty five days, or is there

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Speaker 1: something that either the White House or NIH or FDA

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Speaker 1: or somebody needs to do that would sort of close

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Speaker 1: the gap and accelerate getting this done. I think it

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Speaker 1: will be great if somebody at the high level, that

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Speaker 1: is an HHS for example, took a look at all

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Speaker 1: these efforts and say, okay, they're doing pretty well. There's

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Speaker 1: something we can do to help them do this better.

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Speaker 1: People also want to know where donate. If you have

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Speaker 1: recovered from COVID nineteen, and if you know that it

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Speaker 1: was COVID nineteen, please consider donating, and there are at

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Speaker 1: least three ways you can do this. You can call

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Speaker 1: the Red Cross, they are coordinating receiving plasma. If you're

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Speaker 1: in the New York area, you have the New York

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Speaker 1: Blood Center and in your area, no matter where you're

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Speaker 1: in the country, many hospitals are gearing to do this

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Speaker 1: and there is a need for this, especially in community hospitals.

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Speaker 1: If you want we can help you, please go to

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Speaker 1: CCPP nineteen dot org. There is a way in which

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Speaker 1: you can register as a potential donor and you just

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Speaker 1: have to put in minimal information and we will try

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Speaker 1: to match you with your shipcode. We will put that

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Speaker 1: donor information on our show page. Thank you, Thank you

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Speaker 1: so much. Newtsworld is produced by Gingwish three sixty and iHeartMedia.

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Speaker 1: Our executive producer is Debbie Myers and our producer is

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Speaker 1: Garnsey Slow. The artwork for the show was created by

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Speaker 1: Steve Penley. Special thanks the team at Gingwish three sixty.

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Speaker 1: Please email me with your comments at newt at newtsworld

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Speaker 1: dot com. If you've been enjoying Newtsworld, I hope you'll

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Speaker 1: go to Apple Podcast and both rate us with five

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Speaker 1: stars and give us a review so others can learn

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Speaker 1: what it's all about. I'm newt gingwish this is Newtsworld