Top health and medical experts have asked India’s apex science adviser to help remove convalescent plasma from the national Covid-19 treatment guidelines, expressing concern that the guidelines are misleading patients and families into believing that plasma helps.
A group of 18 doctors, public health specialists and researchers has written to Krishnaswamy VijayRaghavan, principal scientific adviser to the Indian government, saying the current guidelines have given rise to irrational and non-scientific use of plasma.
The latest updated April 22 guidelines by the Indian Council of Medical Research (ICMR), the National Covid-19 Task Force and the All India Institute of Medical Sciences, New Delhi, say that plasma “may be considered” in early moderate disease within seven days of symptoms with no use after seven days.
The experts have underlined that current global evidence — including the results of a nationwide ICMR study last year — does not show any benefit of plasma therapy in Covid-19 patients, yet plasma continues to be prescribed rampantly in hospitals across India.
“Families of patients run from pillar to post for getting plasma which is in short supply and reports of black-marketing are common,” the experts wrote to VijayRaghavan, seeking his intervention to get the current guidelines revised.
The experts have acknowledged what treatments to offer to which patients and at what stage of the disease are “complex clinical decisions”, but treatment guidelines should necessarily be based on existing research evidence.
“The public — patients and families — should know that there is no evidence to recommend plasma,” said Vivekanand Jha, a senior nephrologist and executive director at The George Institute for Global Health, New Delhi, and one of the signatories to the letter.
“Multiple clinical trials have found that plasma does not hasten recovery or reduce mortality,” Jha told The Telegraph. “When plasma is not available and a patient dies, the grieving family should not mistakenly believe that it might have made a difference.”
Jha and the other signatories have cited clinical trials in India, the UK and Argentina that found no benefit of plasma therapy in Covid-19 patients. They have sought the removal of plasma from the treatment guidelines and said blood banks should be instructed about this revision.
After its clinical trial in 39 hospitals last year had failed to find any benefit, the ICMR had cautioned against plasma therapy but had not recommended against its use. Although the guidelines recommend only restricted use, doctors say the demand for plasma has spiked during India’s second Covid-19 wave.
Researchers say they cannot explain why the updated April 22 guidelines had retained plasma as an option.
“Many of us are foxed — institutions such as the ICMR and AIIMS are viewed as apex authorities on medical matters,” one of the signatories told this newspaper. “With authority also comes responsibility.”
The experts have also cautioned that there is early evidence linking the emergence of coronavirus variants with “lower susceptibility” to the immune responses in people given plasma therapy.
“This raises the possibility of more virulent strains developing due to the irrational use of plasma therapy which could fuel the pandemic,” they wrote.
The signatories include Yogesh Jain, a paediatrician and public health specialist, Soumyadeep Bhaumik, a public health specialist, Shahid Jameel, a virologist, Gagandeep Kang, a clinical microbiologist, C.S. Pramesh, a medical oncologist, Anant Bhan, a bioethicist, and Amar Jesani, editor of the Indian Journal of Medical Ethics, among others.
Virologists say variants are also likely to emerge from the vast pool of constantly replicating viruses that are multiplying inside the hundreds of millions of infected people worldwide.