“Immune survivors” of Covid-19: Protective antibody for treatment and prophylaxis?

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Dr. Daniel Lucey, who has responded to, and monitored information on outbreaks since 2001, has provided a series of updates and analysis on the outbreak, now an epidemic of 2019-nCoV, the novel coronavirus identified in Wuhan China, since Jan. 7. He continues to respond to developments and data on the outbreak here.

Is it likely that persons who survive the novel coronavirus (initially called “2019-nCoV”, “NCP” and now as of Feb. 11 “COVID-2019”) are immune to reinfection?

Yes (but exceptions might exist).

Are clinical trials to define such immunity and its duration needed ASAP?

Yes.

In the absence of licensed antiviral drugs or vaccines for COVID-19, how might plasma and B-cell donation from such survivors help?

Immune plasma with polyclonal antibodies against the virus could be studied in a clinical trial to determine if it helps treat infected patients at risk for, or who already have, serious disease.

Could B-cells from COVID-19 survivors that make specific types of antibody against the virus be used to develop monoclonal antibodies against the virus?

Yes.  (This approach has been successful for other diseases such as Ebola (“mAb114”)).

Could either immune plasma polyclonal antibody, or a monoclonal antibody developed from specific B-cells, be studied in clinical trials not only for treatment of patients, but also for prophylaxis (prevention) of disease?

Yes, for both pre-exposure prophylaxis (PrEP) and also for post-exposure prophylaxis (PEP).

Could antibody levels serve as a “correlate of protection” for vaccines against COVID-19?

Yes, possibly. T-cell immunity (CD8+ CTLs) could also play a role in addition to B-cell antibody immunity.  Antibody correlates of protection exist for some vaccines such as Hepatitis B.

If a person was truly an “immune survivor of COVID-19” could they safely help provide care to patients with acute ongoing disease?

Yes, although clinical protocols should be followed to determine safety from reinfection, especially if effective antibody (neutralizing, ADCC, other) levels are not maintained over time.

Given reports of health care personnel being infected and insufficient personal protective equipment (PPE) in some parts of China, how might such antibody approaches help?

Potentially as a treatment and also as prophylaxis (PrEP and PEP) against COVID-19. (The half-life of some polyclonal antibodies against other pathogens is approximately 3 weeks).

Might clinical trials testing such antibodies against COVID-19 be studied in certain high-risk settings such as large outbreaks on cruise ships or other settings?

Perhaps, if approved by the nation(s) involved under a clinical protocol with informed consent and ethics committee approval.

Given shortages of PPE reported in some parts of China, the lack of specific antiviral treatment,  and the spreading international pan-epidemic of  COVID-19, likely including unrecognized spread in parts of Africa and Latin America, should use of a live-attenuated vaccine or intentional low-dose transient exposure to the virus by small numbers of health workers or others be undertaken outside of China?

No. Not at this time.

Should mass production of complete COVID-19 Personal Protective Equipment (PPE) be mass-produced in multiple nations immediately, in addition to the ongoing effort in China?

Yes. Not only for the “Global North”, but for the “Global South” i.e., Humanity. And to help prevent sustained transmission in both Hemispheres, and thus prevent year-round transmission like influenza, and unlike SARS.

Dr. Daniel Lucey

Daniel Lucey, M.D. MPH, FIDSA, FACP, is an infectious diseases physician and adjunct professor of infectious diseases at Georgetown University Medical Center, a senior scholar at the Georgetown University O’Neil Institute, Anthropology Research Associate, Smithsonian Museum of Natural History and a member of the Infectious Diseases Society of America Global Health Committee.He has served as a volunteer medical responder to outbreaks that included the West Africa Ebola crisis. He has collected information on outbreaks starting in 2001 with cases of anthrax in 2001, and including smallpox vaccination 2002, SARS 2003, H5N1 Flu 2004, MERS in 2013, and Ebola in April, 2014, He has gathered, and is updating information on the current outbreak of pneumonia first reported in Wuhan City in the Hubei province of China.

 

 

 

 

 

 

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