Jordan: The dream, of course, is a cure. A drug that works, a vaccine arriving faster than anyone could hope for. Something that ends COVID-19 once and for all. Something that gets us back to normal. But that dream is a long way off. A vaccine is likely a 2021 thing at best. A drug that works is, well, we have hope and there are a bunch of trials underway around the world. And there is one experimental treatment. It’s never been fully analyzed and it might be a long shot. But it also might hold the key to, if not stopping the virus, then at least learning more about how patients recover, and what sort of immunity they have and how we can transfer that. This treatment is a worldwide experiment, but one study in particular involves more than 40 hospitals and 1000 patients here in Canada. And I would tell you the details, but I would definitely explain them poorly. So instead I will let our guest do it as soon as Claire gives us the latest on how Canada is grappling with COVID-19.
Claire: Health Canada has approved a new test kit made by Spartan bio-science in Ottawa. And this is a portable device, and hospitals can use it independently without having to send any samples to a provincial or national lab. It can also be used in airports, border crossings, and pharmacies, and you get your results in under 30 minutes. The company’s expected to start shipping the device this week. We are expecting some new guidelines today from the World Health Organization on if and when a country should start to ease restrictions. And this is because COVID-19 is at different stages around the world. Some countries are thinking of easing restrictions, some are thinking of putting more in place. And actually we’re seeing that disproportionate number of cases also around Canada. Prince Edward Island, for instance, has not seen a new case in five days, but the chief medical officer there says she’s not ready to lift any restrictions. In Ontario, it’s a bit of a different story. Medical experts believe that this week is when we’ll see the height of the outbreak. And while that does offer a bit of hope, Premier Doug Ford is also echoing what everyone else is saying about not easing restrictions just yet.
News Clip: We just have to hang in there a little bit until we, we don’t jump the gun. I know everyone’s getting antsy. I see it and I hear it. People want to get out there, but what happens if we do that and all of a sudden this comes back and bites us in the backside and just comes back with vengeance or another wave comes through. I’d rather be safe than sorry. I want to be cautious.
Claire: And Ontario will remain in a state of emergency for at least another 28 days. As of Monday evening, over 25,000 cases of COVID-19 in Canada with 833 deaths.
Jordan: I’m Jordan Heath Rawlings. This is The Big Story. Michael Doyle is a freelance journalist who looked into this experiment for the Globe and Mail. Hi Michael.
Michael: Hi. How are you doing, Jordan?
Jordan: I am doing very well. I gather you’re well and away from the city?
Michael: I am away from the city and I am stowed away in a basement right now and somewhere in the middle of nowhere. I won’t even tell you where.
Jordan: Yes, basements for all. So before we start getting into this, just so we have a baseline for you to explain this to us, can you start just by telling us what plasma is and how it’s different from the regular blood that someone is used to going to donate?
Michael: Yeah, for sure. It’s actually a component of blood. So plasma is the straw, yellow, liquidity aspect of blood that kind of carries various aspects of blood to the body. So for this trial that we’re going to be talking about, scientists are looking to extract that liquid aspect of blood, which also importantly carries antibodies.
Jordan: Right, and now maybe you can outline the theory behind how we could get a treatment out of plasma.
Michael: Yeah. The conceit’s actually quite as simple and obvious when you, when you think about it, and it’s also, you know, a hundred-ish year old form of treatment, where the idea is if you extract plasma from a convalescent, which is a recovered patient or a patient that’s recovered from a disease or an illness, in this case, COVID-19, and you take that antibody-rich plasma and inject it into a sick patient that’s struggling to fight off the infection, that the antibodies within that plasma will help give the patient that boost to stave off the worst symptoms of the illness. And in this case, kind of the hopeful genius behind this will be that if these patients are treated early enough in that kind of first stage of hospital care before they become acute and have to go to the ICU and be ventilated, then that will reduce the incredible stress on the, on the health care system that we all fear.
Jordan: Can you give me a bit of that history? You mentioned that this is a hundred year old process, so I assume that it’s worked in the past.
Michael: Yeah. I went down a crazy series of rabbit holes with this one, reading all kinds of old journal papers, a lot of old research on this, and it started– the very first experiments with this started around the 1918 Spanish flu epidemic, which obviously is a huge epidemic that wiped out about a third of the global population at the time. And it was used at the very end of that epidemic as an experimental procedure to kind of treat some of the last patients, in around 1919- 1920. And it was done very sparingly. And, like basically at the time we didn’t even know what a virus was, for example. So it was a very rudimentary, series of experiments, pretty rough experiments. You’re using flasks to try to separate the plasma from the rest of the blood. But there was some sort of anecdotal research at the time revealing, you know, a certain number of positive results. This was documented, actually was documented by the U S Navy among other places, and it was collected in like a meta analysis of all of this 1918 research that was done by the US Navy, about 14 years ago. That meta analysis has been floating around for, as I said, 14 years, and it’s become this kind of therapy that’s been used, it’s been called a Hail Mary type therapy, or a last ditch attempt therapy, with diseases that are not curable, or we don’t have a strong a form of therapy for it. So, for example, SARS, 2003- 2004, it was a treatment that was used in places like South Korea on about 80 patients to combat SARS. And then it was used as well to fight MERS, with some success. But again, very limited. And finally Ebola, which, kind of an interesting one. It was used to treat an Ebola outbreak in 2014 in West Africa with, again, some success stories out of that. Thing is for the last like 70 years, we’ve had various effective treatments. Antibiotics, antivirals, various medications and other therapies that were by and large, quite successful in and combating quite a few of these infectious diseases that we’ve encountered in a large scale. So we’ve never really had to test convalescent plasma therapy until now, of course, because with COVID-19, there is no known treatment or cure, of course, for the outbreak.
Jordan: So in a second we’ll talk about the big experiment that Canada’s involved in, but have we done any small scale trials with this therapy on COVID-19 yet, and do we have any results from them?
Michael: Yeah. Earlier this year, particularly in March, we started seeing very small experimental trials. Now there’s a difference between what’s called like an observational trial and a control trial. An observational trial is basically take a small number of patients, you’re desperate, use an experimental form of treatment, and you throw that treatment at the illness and see what the results are and you observe those results, take notes, publish a paper on it. That’s kind of what’s happened up until this point. There have been no real, no controlled trials. So there was a very promising one in China that kind of started tipping the global experts in transfusion medicine off, were five patients that were quite ill, that had been suffering from COVID-19 for a number of weeks and were all ventilated and in critical care, were treated with this experimental treatment. And three of them actually recovered really quickly and ended up walking out of the hospital. And at the time, the paper was published in late March. The other two patients had not fully recovered yet, and I’ve not been able to track down what happened to them. But in New York city, very shortly after this paper was published, they started experimental use of a convalescent plasma as well. And that’s expanded quite wide in places like United States where there are many trials now spinning up into action.
Jordan: So tell me about the larger experiment that Canada has become involved in. What is it and kinda how did it start?
Michael: It’s being dubbed the CONCUR trial, and it’s basically a dream team of transfusion scientists and doctors across Canada that have gotten together. So there’s about 20 scientists and doctors that have partnered for this, from places like UBC, McMaster, University of Toronto, University of Montreal. And this came together very quickly. The lead Dr. Donald Arnold, who’s out of McMaster University, he said that a trial like this usually takes six months to a year just to hammer out the language on it. And in this case, it came together over a couple of Zoom calls late at night, one weekend, and basically they got it done in four days. So this was an extraordinarily fast turnaround. Obviously the pressing nature of this has inspired a lot of people to do a lot of really hard and free work, in the late hours, early morning hours, to get this thing done. The trial itself, the Canadian trial will, their hope is to get at least a thousand patients involved in this. So huge number of patients, much bigger than the 5, 10, 80 patients we’ve seen in previous observational trials with convalescent plasma. The hope is to get 1,000 recovered COVID-19 survivors to donate their plasma and then treat a thousand or so patients in hospital, and hopefully catch them in that critical window of seven to nine days into their known infection, before they become quite ill, before they have to be elevated into the ICU and be ventilated. And hopefully it will be a treatment that staves off those progressive symptoms that we’re seeing.
Jordan: How does that actually work on the ground? First of all, I guess at that kind of scale, which sounds difficult to organize, but also just practically? So I guess they don’t do straight blood transfusions? They dry out the plasma and then inject just the plasma into the patients?
Michael: Yeah. They’ve got these special machines. It’s going to be run by Canadian blood services and Hema Quebec, who are the two organizations that control the blood supply in Canada. And they are deeply involved in this, their scientists are involved in this as well. And so they’re going to set up plasma donation across Canada, at their sites. Now, obviously everything is quite tricky right now given the need for social distancing, but as we know that the need for blood donations are greater than probably ever before right now. So they’re going to also set up plasma donations for convalescent patients, convalescent survivors of COVID-19. The experience, from what I’ve been told is pretty much exactly the same as that of donating blood normally. It’s about 45 minutes in the chair. It’s not painful, it’s just very straight forward. They have a machine that actually pulls the plasma and then gives you back all of the other aspects of your blood into your body right away. So they’re just taking that plasma from you. They’re going to take about 500 millilitres, that’s kind of the aim. And one unit of plasma, and they’ll be able to use that to both study the antibodies within a recovered COVID-19 patients blood, but also then treat various patients across Canada with it.
Jordan: Have you talked to any of the convalescent patients who are waiting to donate blood or who are going to?
Michael: I have actually, yeah. I’ve spoken to– I spoke to one of the people who’s actually on the steering committee for this, kind of an interesting fellow. He and his entire family contracted COVID-19 while they were on a ski trip in Colorado, towards the beginning of this year. And they had very mild symptoms, so they didn’t end up being hospitalized. And in fact, they wouldn’t have known they had COVID-19 unless– if it weren’t for news reports about various other skiers in the area that had returned to places like Canada and were starting to exhibit symptoms. And he recognized the name, he was like, Hey, we were just in this town, so maybe we should get tested. And they were all positive except for one of their kids, which is kind of an interesting thing in terms of when you’re looking at immunity and antibodies. I’m sure that kid would probably be somebody who’d be interesting to study in terms of their immunity. But that’s a, that’s a totally different topic. But yeah, so he actually has stepped forward and he’s become the representative patient on the steering committee. Now when you do a big trial like this, you need a representative patient. So he’s volunteered for that. And he said that he’s kind of, you know, he wants to be one of the first people up to donate. And felt very strongly that after you go through this experience, there’s an incredible level of helplessness that’s felt right now by everybody. And you know, survivors are in a unique position right now to be helpful, to maybe stem the tide on this. So, he felt that as there are more and more survivors across Canada, those survivors would, he was convinced, would feel compelled to step forward and donate.
Jordan: What kind of timeline are we talking about for this? Is this ramping up right now? Obviously a thousand convalescent patients and a thousand actual patients will take some time. Do we know how long until we have a sense of if this will work?
Michael: The sense I got in staying in contact with a variety of these scientists and doctors that are putting this together is that they’re moving extraordinarily quickly. I know that Canadian blood services are highly motivated to get this set up. And you know, this is gonna be something that is going to be available ASAP. And basically you can reach out to the Canadian blood services or Hema Quebec, and they’ll be able to tell you exactly which centres, where those centres will be for convalescent donations. And in terms of like the timeline of the trial, it’s as soon as they start getting a viable donations. They of course have to study the plasma to make sure that it has the kind of threshold of antibodies they need for it to potentially be effective in a sick patient. As soon as they start seeing that number, those donations coming in, my understanding is they’re going to start freezing and shipping out the plasma across Canada. What’s interesting about this is, is that it’s a truly, I was told, it’s sort of like truly a national project that initially Hema-Quebec and the experts at the University of Montreal were developing their own trial independent of this and that very quickly, they all folded into one giant trial. So if there’s blood that’s viable in Quebec, that could be helpful to a patient in British Columbia, they’re going to put that plasma on ice and ship it across the country very quickly. What’s nice about both Hema-Quebec and Canadian Blood Services is that they’re obviously national organizations and well-established. So they’ve got a really smart approach to shipping these types of products very quickly already. So they’ve already got that kind of a supply chain and logistics sorted out. So they’re going to start doing this right away. And the plan is that in the coming months, shortest time span would be three months, but more reasonably it’ll probably be between five and nine months, they’ll have a very clear idea based on the controlled nature of the trial as to whether or not this is going to be a highly effective therapy for a lot of people, or if it’s just sort of selectively effective. And if so, why?
Jordan: Was there anything else that you learned while reporting this about kind of the ramifications of this research and how it could be applied that you found really interesting?
Michael: Yeah. Actually what’s really exciting about this is that there are going to be a whole bunch of concurrent sub-studies that are going on in the CONCUR trial. I know, for example, they’re really curious about looking at taking a sort of concentrated version of these antibodies from the plasma and seeing if they can create a serum that could work as a preventative treatment. So for example, if a frontline healthcare worker is obviously exposed to coronavirus, in the line of duty while they’re working, say if they’re extubating a patient or something like that, then they can get an injection of this highly concentrated serum of the antibodies to help their body immediately fight it off. And so they’re going to be exploring treatments along those lines as well. And then more sort of generally, I mean, this is a very simple form of therapy that has never been broadly studied before in history anywhere. So getting the kind of down to the bottom of whether or not convalescent plasma therapy is widely effective in treating various infectious diseases, this is an extraordinary and unparalleled moment. I mean, all of the experts that I’ve spoken with about this have said, you know, essentially the reason why we don’t already know the answer to this is because we’ve never faced something like COVID-19 before. And we’re, you know, oddly well positioned now in this terrifying moment to see if convalescent plasma is going to be a treatment. And who knows, maybe it’ll be something that’s used widely to stave this off and to save some lives and then in the future, something that can be used more widely and in a more kind of confident capacity to treat other infectious diseases.
Jordan: Well fingers crossed then, it’s a nice to have something hopeful to talk about. Thanks Michael.
Michael: Yeah, no problem at all. I really enjoyed researching this cause as you said, we’ll see if this treatment works or not, but it’s at least a glimmer of hope.
Jordan: Michael Doyle is a freelance journalist and writer. That was The Big Story. You can find all the big stories on the website, thebigstorypodcast.ca. You can find them in your favourite podcast player, Apple, Google, Stitcher, Spotify. Doesn’t matter. You can of course, always talk to us on Twitter at @thebigstoryfpn. And you can literally talk to us by making a voice memo with the voice recorder on your phone and emailing it to thebigstorypodcast@rci.rogers.com. We love to play him and today we have a friend of the podcast, Norm Wilner and his partner telling you how they’re doing in lockdown. Thanks for listening. I’m Jordan Heath Rawlings. We’ll talk tomorrow.
Norm: Hey Jordan, it’s Norm. You know, from work. Just checking in because we thought it would be interesting to explore this little challenge of telling people how we’re coping. Kate Adderly, my wife and I, we’re accustomed to working at home, cause we do together and we’ve learned how not to get on each other’s nerves most of the time. And weirdly enough, we’re both still kind of busy. I’m still writing movie stuff for NOW and also producing one of their podcasts and Kate is–
Kate: I’m still busy. I edit other people’s work. I edit books. I write knitting patterns. I designed knit ware as well. So we’ve both got lots of work to do. The nature of our work is that we’re quite happy to entertain ourselves. Goodness knows we’ve got lots of movies to watch. I get excellent built-in recommendations, so I’m never making a poor choice on Netflix, and I’ve got all of the crafting I could possibly do. I’ve got yarn for years. You know, dabbling in crochet, embroidery as well.
Norm: It’s a time to learn new skills. But yeah, I don’t think either of us actually expected to discover that we are an essential service. Both kind of are right now. So we’re still producing. We’re still working.
Kate: People need the movie recommendations and they’re looking to take up craft and we can provide those things.
Norm: We’re here to distract you.
Kate: Stay safe, everyone.
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