A seafarer from the virus-hit Japanese cruise ship M/V Diamond Princess is the first Filipino COVID-19 survivor to donate his antibody-rich plasma to help other COVID-19 patients still battling the disease.
Ceasar Ian Frias, 31, heeded the call of the Philippine General Hospital for donors to help critically ill COVID-19 patients recover from the disease in a treatment called convalescent plasma therapy.
Two hospitals have made a public appeal for plasma donations—the PGH and the St Luke’s Medical Center. The treatment was used successfully in China and is also being tested in the United States, as approved by the FDA, and is seen as a game changer in treating COVID-19 patients in the ICU.
Dr Jonas del Rosario, spokesperson of the PGH and a clinical associate professor at the UP College of Medicine said, “The treatment is called convalescent plasma therapy, since plasma contains the antibodies that can neutralize the virus the patient had.”
Frias joined two other donors in giving their plasma which will later be infused to patients stricken with COVID-19. The donation coincided with the commemoration of Araw ng Kagitingan which made the day doubly meaningful for the hospital’s first batch of donors. ”I was telling him ‘This is the Araw ng Kagitingan, it’s so very timely that he was the very first one.’ I called him bayani,“ Dr del Rosario shares.
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“And I was telling him ‘Look maybe your story will inspire people to come out and also change the views of a lot of our kababayan on COVID-19.’ Hopefully that will inspire other people to not be ashamed of what they have especially if they have something that can actually extend the life of someone. I was telling them that they have this gift now, this plasma with antibodies that can neutralize the virus that can save the life of someone who’s struggling with the disease. Your blood has a gift, it is a gift of life.”
The donors were honored as modern heroes. “We were clapping and we were yelling and I said, ‘Mabuhay kayo kayong mga bayani!’ And they were smiling and I could see some tears in their eyes,” Dr Del Rosario recalls. “I think they just felt so good and finally there is something good that happened from this ordeal. I said, ‘There’s always a reason why sometimes things happen and this is probably the light at the end of the tunnel. This is the reason why you were chosen to get COVID-19.’”
Frias says he was surprised over the ceremony PGH put together about their donation. “Hindi ako nagdalawang-isip, gusto ko lang makatulong,” he tells ANCX. “Hindi ko ine-expect na ganito pala ang mangyayari. Big deal pala!” A nursing graduate who worked as a steward on the Diamond Princess, he says the act of donating lifted his spirits. “The whole time nakaka-depress, natatakot akong humarap sa ibang tao, tapos ito pala ang naging ending—puede pala kami tumulong.” Since testing positive for COVID-19 last March 10, Frias has kept his bout with the illness a secret, telling only his family.
The other two donors, both nurses, are 33-year old Roselle Gale Arranz and 28-year old Erika Joy Soriano. “They are all able bodied,” adds Del Rosario, singling out Frias as being healthier than most. “He was so fit he was able to overcome that illness quite easily. And I’m sure his plasma is teeming with antibodies that can kill the virus and hopefully he can give it to someone who needs it.”
Frias, along with over 400 seafarers was quarantined in the Clark Southeast Asian Games facility, after their arrival last February 26 from Japan. For some time, Frias was a PUI and eventually tested positive for COVID-19. He has since recovered and has tested negative for the disease.
But Frias, has yet be reunited with his wife and children. “Even though he is COVID negative now he hasn’t been brought (to his hometown) because there is some concern in the community that he might be contagious, so he is still in a hotel even though technically speaking, clinically speaking he looks fine, he looks well and his blood tests show he was already cured,” says Dr. Del Rosario. “In fact people in the hotel are sort of anxious that he is billeted there.”
As of April 9, the St. Luke’s Medical Center was still in the process of screening its donors, but Dr. Francis Lopez, a hematologist and oncologist who also heads the hospital’s bone marrow transplant unit, says they will harvest from their first plasma donor at 11 AM on April 10 and will transfuse to a COVID-19 patient immediately after.
How it’s done
Dr. Lopez explains the procedure: “We’re collecting the plasma of patients who have recovered from COVID-19. When somebody donates blood one can separate the components of the blood. We take out the liquid portion and that’s called the plasma. Now moving on to our current situation, when our patients are infected with COVID-19 and they recover, they produce antibodies and these are antibodies that help fight the infection or degrade the COVID-19. We can get this from patients who have recovered from the infection and use the plasma which we can collect from them and infuse it, transfuse it to our critically ill patients who are in the ICU. “
St Luke’s Medical Center Global City currently has 7 donors in the process of screening while its Quezon City counterpart has 6 potential donors. A donor is required to have two negative nasal swabs done by PCR. This procedure is called Polymerase Chain Reaction or PCR which identifies a component of the virus (nucleic acid). The donor is then asked to come to the hospital and the blood will be taken from him using an apheresis machine.
“If one can imagine a dialysis machine it’s something like that,” Dr. Lopez explains. “It’s a cell sorter. You program the machine to select and only get the cells that you want. For example, a patient has dengue and you need platelets so you will program the machine and it will only collect the platelets. If a patient has leukemia and has a very high white blood count, we can use the machine and collect the white cells only.” In the case of COVID-19, the machine will be programmed to collect only the plasma. “After one to two hours we will be able to collect around 500 cc of plasma and the plasma will be rich in antibodies hence the term convalescent plasma.”
Dr Mae Campomanes, a pulmonologist at St. Luke’s says that having this additional treatment option can give hope for the doctors treating the critically ill patients. “The foreseen shortage of resources like ventilators may be addressed by having our patients be weaned off earlier than what we’ve been seeing in the first two weeks of the crisis. And of course if they get well that’s a triumph for everyone.”
But first there are tests
The protocol is different for the PGH where only one COVID-19 negative test is required but the patient has to exhibit being symptom free for two weeks which has to be verified by a physician. “We have to check them, the donor himself,” says Del Rosario. “Obviously the first thing that has to be there is—you had COVID-19. And that is proven by a positive test based on PCR. You are diagnosed with COVID-19 and you have recovered from it. Two important criteria for recovery is one: you should test negative. When we test you for COVID-19, you will be negative and you have shown clinical improvement, you are asymptomatic, you are not having any fever, cough, diarrhea or whatever signs and symptoms of COVID-19, you are free of that illness at least two weeks.”
Dr. Del Rosario further explains that this will be followed by a standard blood donation screening, to make sure the donor is clear of other illnesses like hepatitis and HIV. “Once you pass that second stage then that’s the time now that you can actually donate for plasma.”
Both St. Luke’s and PGH are making sure the procedure will be smooth and hassle free for their donors. For the latter, the plasma collection is done away from the hospital—which works for patients hesitant to go near PGH. “They know that PGH is a COVID-19 referral center. They don’t want to go there. They’re afraid they’ll get the illness again or pick up something. So what we have done is we arranged a different place, not in PGH, but somewhere in the UP College of Medicine, far from PGH,” Dr del Rosario explains. “We have prepared a room there where they can donate. We also pick them up. There is a service because we don’t want them to be traveling in this time that there is enhanced community quarantine. We will pick them up and bring them back to where they are. We will make them comfortable. And it’s a place where they will not look at it and say, ‘Oh, I’m in a hospital.’”
No need to fear
As for St. Luke’s, Dr. Lopez assures donors will be guided through the process. “May we ask those other patients not to hesitate. We can answer their questions and their concerns. I remember one patient was very concerned to come back to the hospital. We basically guided this patient through the whole process. I was actually with this donor just to allay his fears. One patient has already two negative nasal swabs. He didn’t have to have another nasal swab with us, he went straight to our laboratory in the second floor and he had all the blood tests done on April 8. The laboratory on the second floor is far away from the COVID floors. The other [donor] still needed a nasal swab which is done in a different area of the hospital—in the out-patient department. I met them at the out-patient department just to make sure that the flow will be smooth. I met the two donors on the morning of April 8 for their nasal swab. What I did was to make them come at 8 AM so that there will be less people in the out-patient department. Because we are now in the process of screening our own health care workers here. So we made them go first so that there will be less people. After they were finished, we continue with our health workers. So [we do] small things like that to really help the donors. “
Dr Campomanes says about 27-30 % of patients admitted for COVID infections in St. Luke’s go into severe illness. “This novel approach to treatment using convalescent plasma is seen to be additional treatment for severely ill patients. So this could run the spectrum from respiratory failure to circulatory compromise meaning the blood pressure can go down, etc. Other organs can get involved but the main brunt of the infection starts with the lungs.
“So apart from all the medications that have been started for COVID treatment, convalescent plasma has been seen to be of potential benefit to these patients to shorten the mechanical ventilator days, meaning the patients can be weaned off the machine sooner, their symptoms disappear much sooner and the conversion in the blood comes sooner. So overall, based on studies done in China, there seems to be little risk to the patient as well as to the donor, and overall it seems to provide a more beneficial effect. Of course all the team members have to come together to decide which patient will benefit from such an approach, not all patients will probably need this regimen.”
There are now six patients from PGH who are candidates for getting the plasma. The program has two teams: the the donor team and the recipient team. “There is a separate criteria for donation, totally independent and then there is a different criteria for receiving it, explains Dr. del Rosario, “ I just want to remind everyone that this is being used as a compassionate therapy. We are preparing to do the clinical trial wherein we will be part of a multi sector study, that is the only way really to be able to gather evidence in a scientific way and hopefully something will come out of it. The clinical trials are ongoing in some countries and we want to be part of that because it’s a new disease. It will take awhile for the results of the clinical trial to come out. But since there is a need now and while clear cut evidence is still lacking we have at least the rationale for using it, we will give it to some patients and that is called compassionate use so it’s like an experimental phase.”
Dr Campomanes is hopeful about the prospects of convalescent plasma therapy, recalling the difficulty of the initial outbreak in the country. “We’ve lost track of time actually. In the beginning, the first two weeks, I felt fearful because we were not quite aware of what we were battling. And actually the number, the flow of patients, was just tremendous in the first two to three weeks. It was really very tiring.
to go on duty, like you were a resident once again,” Campomanes says. “After the fear, it evolved into fight mode. After the second, third week, I think we go to duty now more confident in our resolve to battle this thing with the patients.”
The patients suffering from COVID-19, Campomanes says, also suffer from a crisis of isolation. “When they are admitted, even if they are not in the ICU, they are by themselves. And you know us Filipinos, we are always surrounded by family— and so having the disease plus being by themselves is really a very big change especially for the elderly. When we visit them, they really value our conversation although [this is ] quite brief understandably because there’s just so many of them. They really appreciate the little time we spend even if it’s just short, just to allay their fears. We feel it’s a bit lighter, even the wait in the ER has been shorter, so maybe the quarantine has really done some good because the inflow of patients has slowed down.”
56 inquiries and counting
The response to the call for donations has been heartening. PGH has had 56 inquiries about its donation program. “I also heard that Iza Calzado was willing to donate her blood. She is just trying to fulfill the 14-day recovery period. I also know that Howie Severino said he will donate to PGH,” Dr. del Rosario shares. “Maybe you know some more celebrities and senators, those big names. If they will be seen donating to PGH I am sure other people will follow suit.”
PGH estimates the cost of the collection and transfusion of the plasma at PHP 30,000 to 40,000. But indigent patients will not be charged for the treatment. Dr del Rosario is optimistic about the prospects. “Who knows, by Sunday somebody will be rising from the dead and it’s resurrection! It’s very possible if we are able to give this plasma before Sunday, who knows, somebody will be coming out of the ICU because of those antibodies.”
Both St Luke’s and PGH continue to make their appeals to those who have recovered from COVID-19 to donate their plasma. “I’d like to congratulate all the survivors of the COVID-19 infection. We’re thankful that you are well, probably now at home, and probably—since you are still in quarantine—you probably have time to think about how you can help those who are still feeling the ravages of this infection. Consider this as your role in helping the others combat the infection, “ says Dr. Campomanes. “It will probably make your experience worthwhile, having passed through the suffering and actually later on helping. In the end [this] might be something that will be a unique opportunity for you as a COVID-19 survivor, so don’t hesitate to ask questions. We know that you will feel uncomfortable for another test, another prick, but you’ve been through this. We will hold your hand as we do the first steps of this donation.”
To donate please contact the following:
Ms. Mona Lisa Beltran at 8-723-0301 ext. 4725 or Dr. Mae Campomanes, Dr. Ryan Llorin and Dr. Jay Datukan
Ms. Icar Beguias at 8-789-7700 ext. 2096 or Dr. Gwen Dy-Agra, Dr. Mench Villavicencio, Dr. Carmella Bingcang and Dt. Francisco Lopez
Philippine General Hospital:
Dr. Sandy Maganito at 0917 805 3207 or visit http://tinyurl.com/UPPGH-BDC for more details
As of April 10, according the Department of Health, there have been a total of 4,195 COVID-19 cases in the Philippines with 140 recoveries and 221 deaths.