NEW YORK FOREIGN PRESS CENTER, 799 UNITED NATIONS PLAZA, 10TH FLOOR
MODERATOR: Hi, everyone. My name is Daphne Stavropoulos and I’m today’s moderator. Welcome to the Foreign Press Center’s videoconference briefing on COVID-19 and the Survivor Corps. Please keep your microphone muted until you are called on to ask a question. If you have technical problems during the briefing, you can use the chat feature and we will try to assist you. As a reminder of today’s ground rules, this briefing is on the record. I’d like to introduce our briefers today, Diana Berrent and Dr. Eldad Hod.
Ms. Berrent is a New York state resident who was infected with COVID-19 in March and survived. She is the founder of – excuse me, she’s the founder of Survivor Corps, an advocacy group that mobilizes COVID-19 survivors to donate blood and plasma that could be used to treat COVID-19 patients, and encourages them to participate in any medical or scientific studies nationwide that could help stem the tide of this pandemic.
Dr. Hod is an associate professor of pathology and cell biology at Columbia University’s Vagelos College of Physicians and Surgeons and transfusion medicine expert. He’s also the lead investigator of a clinical study at Columbia University Irving Medical Center that is screening the blood of COVID-19 survivors for antibodies. People who have been exposed to the virus and produce antibodies may be able to donate serum to help others with the disease and may be immune to reinfection and able to return safely to work.
This press briefing is an opportunity to hear Diana’s story, from infection, recovery, to standing up Survivor Corps, which at last look has over 30,000 members, to being the first in New York state to be screened for antibodies in Dr. Hod’s clinical study. She will also share what’s next in store for Survivor Corps. Dr. Hod will also explain how antibody-rich plasma may be used to treat individuals with COVID-19. As a reminder, our briefers’ opinions are their own and don’t represent those of the United States Government. Ms. Berrent and Dr. Hod will provide some opening remarks and then I will open our meeting to questions and answers. Diana, please, go ahead, and welcome.
MS BERRENT: Hi, how are you? My name is Diana Berrent and I’m the founder of Survivor Corps. I was one of the first people in my area to be diagnosed with COVID-19. I got sick on March 13th and received a positive diagnosis on March 18th, and as soon as I received that diagnosis, I realized that if I was going to be one of the first people in my area to be diagnosed with COVID-19, if all went well, and it did, I would be one of the first survivors. And with that realization came both a tremendous responsibility, and yet more an opportunity, as I realized that I would be developing antibodies in my system that I – my body reacted just the way it was supposed to to this virus and figured out how to fight it off with those antibodies, and that eventually, a couple weeks after me, there would be more and more and more survivors out there.
And so I started Survivor Corps under three weeks ago as a Facebook group that has already grown to well over I believe 31-, 32,000 members at last count, and we are launching our webpage – our website – at www.survivorcorps.com. And our goal is to motivate individuals who are either struggling with COVID – if they qualify for those studies – but mostly survivors to donate their plasma in an effort to treat ill patients and contribute towards medical research, but moreover support the scientific, medical, and academic community in every possible effort in recruiting volunteers to help stem the tide of this pandemic. In under three weeks, we have created what has become the fastest growing grassroots movement in America that – with a forward-looking, solution-based approach where we can all come together and be a part of finding the cure. So within a week of our existence, the Washington Post put out a call for ideas for best ideas in America to stem the tide of the pandemic. They chose 20 ideas, and I’m proud to say that we were – that Survivor Corps was number one.
I also had the privilege of – because I was early in the curve of getting COVID-19 and recovering from COVID-19, I was participant number 0001 in Dr. Hod’s study at Columbia, and I can tell you a little bit about that process. I registered for their program; I was contacted. I went to Columbia and I was re-tested for the virus. I had originally received a positive diagnosis on the 18th, as I said, and once it had been determined that I no longer had the virus in my system and I did have the antibodies and a high enough level of antibodies, I was cleared to give my plasma and to donate. As an added bonus, it turns out that I am a universal donor, which I understand only four to five percent of the population is, so as Dr. Hod referred, a bit jokingly perhaps, but my plasma was considered liquid gold. I then went to the New York Blood Center on the – took the first possible appointment to donate my plasma, which was an absolutely painless – the most – one of the most rewarding experiences of my life, truly, 32 minutes from beginning to end, and with that the ability to contribute to a cure was just an incredibly powerful experience. And I’m scheduled to go back tomorrow and every seven days for as long as I am allowed.
And what we are doing is really putting out a call to action to all Americans who have been affected by COVID to be part of the solution and support the scientific community in every way that we can. And so far, I am happy to say that we have been flooding these studies with volunteers so that each hospital doesn’t have to do its own outreach program and PR program. We can serve as a clearinghouse to all of them, and it is really tapping into an innate humane desire to help and to give back, and is motivating a lot of people through their own processes of – while they’re home and sick and scared. I see on our Facebook group people counting down the days until they are also able to donate plasma and participate in any other trials and studies going on.
So I donated my plasma last Wednesday. It arrived at Columbia and Dr. Hod has seen it in person, back there, ready to be used. So with that, I will hand it over to Dr. Hod.
DR HOD: Thank you, Diana. We were very fortunate to have you as our first participant, and you helped us a lot in our recruitment efforts thus far to fill up our blood bank with other – more liquid gold that we can use to potentially save others. And so I thought what I would do is first maybe give you a little overview of the uses of convalescent plasma and what we’re hoping to do with it here at Columbia in New York, along with a number of other centers across the country.
And so if you think about it, Diana cleared the virus and she made antibodies, and she made sufficient antibodies to clear that virus, and so we could potentially use that to help protect others with the disease. Now, this concept is not new; we didn’t invent this. This has been tried for over 100 years for other viruses that – it’s been tried for SARS1 in 2003, where some preliminary evidence from Hong Kong suggests that it might be beneficial. For the MERS, there just wasn’t enough convalescent plasma to really do a study. And for COVID-19, there are some preliminary studies from China that suggest that this may be beneficial, but these are not controlled trials. They’re just a few patients here and there that suggest that there may be benefit, and hopefully no harm.
And so the issue with harm we’ll talk about a little later, but at the moment in the United States, the way it’s working is that there are really two mechanisms for getting plasma in the blood bank. And so through the Red Cross, the Mayo Clinic, and funded through BARDA, the country is basically trying to build up a natural resource of convalescent plasma that could be used to treat anyone in any hospital, for free, for compassionate use. And so what that means is that if a patient is very, very ill, on a respirator, in the critical care unit, not doing well, and a physician wants to try using convalescent plasma in that situation, it’s a pretty straightforward process. And assuming there’s a supply – which is why we need people like Diana to help us generate the supply – then that patient should be able to receive it.
The – not that there is anything wrong with that approach, but one issue with that approach is that it will be very difficult for us to figure out whether it works or not. And at least scientifically and theoretically, there are some concerns that giving convalescent plasma in the wrong situations may actually be harmful. So it doesn’t – it’s not necessarily always going to be beneficial. So if you think about it, if someone is very sick and they have virus in their lungs, and you give them an antibody that’s going to target the virus, you may cause the immune system to cause more inflammation and actually make it more difficult to breathe rather than cure the patient.
And so we want to proceed a little more cautiously and do clinical trials that are going to help us determine for which situations this might be useful. And so we have Diana’s plasma units that’s – it was more than one – in our blood bank, and we’re saving them and hoping to begin clinical trials next week where we get – try to use them in various situations in randomized controlled trials. And so what that’s going to mean, actually, is that 50 percent of the patients we treat are going to get convalescent plasma, but 50 percent of the patients are going to get non-convalescent plasma. So they’re going to get plasma from people who donated before December, and that’s the only way we’re going to find out whether this works or not. And I know that these are ethically challenging decisions, but we need to find out whether it’s going to be harmful before we can begin rolling it out to the whole population.
And so we’ve put forward – and this is along with collaborators at multiple different institutions, led by a group at Hopkins and also at Mayo. And so we’ve put forward at the moment three trials that we’re going to push forward with the convalescent plasma we’ve been collecting at the Columbia blood blank. The first one is for health care workers. And so the evidence from prior uses of convalescent plasma suggest that if it’s going to work, it’s probably going to work better the earlier you give it, and so before someone is really sick. And so the people right now who are on the front lines being exposed on a daily basis – the nurses, the respiratory technicians, the phlebotomists, and the doctors – we could potentially protect them by giving them some of the convalescent plasma before they go on their shifts. And so if they test negative right now for COVID-19 – and they would get randomized, and so some of them would get it and some of them would get regular plasma – and then we would track them over time to see if there’s a difference in conversion rate, or a difference in whether they develop the disease or not.
And the idea behind doing this as a multicenter study, as opposed to just trying to do it on our own, is that if we share the data and try to do this as quickly as possible with as many subjects as possible, we will hopefully be able to get an answer much more quickly. Because if it does improve outcome, then we want to stop the study and just begin giving all health care workers convalescent plasma.
The next indication we’re going to be looking at are for those that come into the hospital, test positive, but aren’t sick enough to end up in the critical care unit. They could potentially even go home, where they might have other contacts. And so the idea there would be giving them convalescent plasma and seeing whether we can prevent them from coming back to the hospital, or prevent them from ending up on a respirator.
And then the third indication we’re hoping to start is for those sick patients who are in the ICU, and they’re critically ill, and we want to see whether we can make a difference in that situation. There’s also some discussions about beginning a study in pediatrics, and we – those are still under discussion, and so we haven’t begun those yet, but that’s potentially upcoming.
And in general, if someone gets convalescent plasma, the antibodies do circulate for quite some time, which is why we’re testing them for high titer. And the issue of testing is somewhat challenging because there aren’t – there are currently no good tests that are FDA-approved that we feel comfortable using, rolling it out for everyone, and those tests are still being developed. And so all the testing we do for antibodies is still somewhat on shaky ground. We’re still developing the tests; we’re still figuring out which tests are going to tell us which antibodies are better than others. So this is all being worked out in the background, and that’s why sometimes this takes longer than people hope.
But I think for the convalescent plasma story, Diana was our first, and this is really an opportunity for the other survivors to step up and do something that could potentially help this situation in our country and throughout the world. So I’ll end with that and we can take questions.
MODERATOR: Thank you so much, Dr. Hod and Diana. We really appreciate your opening remarks. Let’s first hear from those who are participating via the Zoom app and then I will turn to those who’ve called in. And for those of you joining via the Zoom app, please click on the raise hand button at the bottom of the participant list and indicate you have a question, or you can also use the chat feature at the bottom of your screen, and I will call on you. As a courtesy to our briefers, please provide your full name, your outlet, and specify to whom you’re directing your question. Thank you.
Let’s see. The first question in the queue is from Alex. Alex, please go ahead.
QUESTION: Yes, good afternoon. Thanks a lot for the opportunity. There’s this conventional wisdom, Diana, that – or (inaudible) call it paradigm, if you may – that we have to choose between our economy and our lives. How can you ensure that we protect both?
Second question, I —
MODERATOR: Alex, can you please state your full name and your outlet, please, before you go ahead?
QUESTION: Yes. Absolutely, sure, of course. Alex Raufoglu of Turan News Agency of Azerbaijan. I have second question as well.
MS BERRENT: Okay, so that – about the economy, is that for me?
QUESTION: That’s correct.
MS BERRENT: Okay. So right now we’re not there yet in terms of the science. We need – there’s a obvious, strong suspicion of immunity, of a period of immunity that follows once you have both a combination of the negative test for the virus and the – a positive and high enough count of antibodies. I will let Dr. Hod go into the details on that, but from what I have gathered, there – the suspicion is that this is similar to other viruses and will confer a degree of immunity, and once that is confirmed – right now we are being given a binary choice between saving the economy and saving lives, and I see Survivor Corps as being an offramp to that terrible choice because we can get people back to work.
And again, a lot of this has to do with that antibody test that’s being rolled – the many, many antibody tests and how reliable they are, and it has to be done in conjunction with a negative diagnostic test. So it is a bit more complicated than it seems initially, but we can get people back to work safely while still sheltering at home the most vulnerable in our communities.
QUESTION: Makes perfect sense. And I understand that Survivor Corps is a Peace Corps of COVID generation, if you may, right. And that being said, given our audiences, do you have any suggestion or plan internationally down the road?
MS BERRENT: I’m sorry. I didn’t hear the last part of your question.
QUESTION: Yeah. Any international suggestion or any plan that you could do internationally down the road, given our audiences?
MS BERRENT: International?
MS BERRENT: Yeah, absolutely. So right now we are a full national movement, a grassroots movement, and there has been tremendous interest in – from a global audience in trying to look at this as a best practice and seeing what we’re doing, and not necessarily us expanding globally, but allowing everyone else to copy what we are doing. There’s nothing – we’re not raising money, we’re not – we are only raising awareness.
And so in the same way that we are trying to equitably distribute volunteers to every program around the country, we want to distribute our ideas to every country in the globe, because we need to come together as a global community to fight this together. And it is part of the global human spirit to want to help and to want to give back. So it is a very powerful idea, and we’ve already received a lot of interest from other countries wanting to mimic the same program on possibly a more proactive rather than reactive basis as we have.
MODERATOR: Thank you.
QUESTION: Thank you so much.
MODERATOR: The next question is from Alexis. Alexis, can you please go ahead and introduce yourself and your outlet and direct your question?
QUESTION: Hi. Thank you – yeah, my name is Alexis Buisson with the French daily newspaper La Croix. It’s my understanding – and this is – I guess the question’s for Diana. It’s my understanding that to donate your plasma you need to have tested positive for the virus. I was wondering, like, for all the people who couldn’t get a test and who displayed all the symptoms of COVID, is there a way for us to – for these people to participate?
MS BERRENT: I’m going to start off and then hand it to Dr. Hod. So right now the qualifications to participate in these plasma programs and other studies vary from research institution to research institution. And so while I had to be – I – in order to qualify for Columbia’s program, I needed to have a positive diagnosis before I could go through that process, the follow-up process, or even get into the program. There are other programs that are relaxing their standards, and I believe that the FDA is also relaxing their standards on who is able to participate, but I’ll let Dr. Hod go into a bit more of the details on that.
DR HOD: I’ll explain to you part of the issue. It’s partly Diana’s fault. So because of Diana, we now have over 2,000 people in our queue waiting to be screened at Columbia, and so the issue there is that we don’t have the capacity to screen everyone. And we don’t want people using – we are testing people for antibodies, which could – for people who don’t know for sure whether they’ve had it or not, that can give them the answer. And we don’t want – we’re trying to build the national resource of convalescent plasma. We’re not focused on diagnosing people. I think that’s also an important thing that we’re also working on in parallel. But for the convalescent plasma story, we need to screen people who we think are more likely to have antibodies because we need to be efficient in the process.
And so actually I think if you – because there are now multiple ways where you can donate convalescent plasma, most places will not give you the results of the antibody testing purposefully because they don’t want this to be a mechanism for people to get diagnosed. And also those – these antibody tests are still first or second generation tests. They’re not perfect. And if you give someone a wrong result, that has consequences. And so we still are working on better assays, better tests, and this should not be the mechanism for people to get diagnosed. We need to be as efficient as possible so we can built up a resource of convalescent plasma as quickly as possible.
MS BERRENT: And just to follow up on that, yes, according – with the New York Blood Center right now, who is one of our official partners, you do not get the answers to that test, because we don’t want people to – they have a limited amount of resources. We are all obviously waiting with bated breath for a well-tested, widely available antibody test to be nationally available, but we’re not there yet.
QUESTION: Great. Thank you.
MODERATOR: Okay. The next question is from Niki. Niki, please go ahead and introduce yourself and direct your question to our briefers.
QUESTION: Can you hear me?
MODERATOR: Yes, we can.
QUESTION: Great. Good afternoon to all of you. Hi, Diana. Hi, doctor. My questions will follow. I’m Niki from the Indo-Asian News Service. It’s a newswire headquartered in India, South Asia. And I also work with a think tank called Observer Research Foundation. I have two questions, one for Diana and one for the doctor. Diana, do you think back to the moment when you actually got this? Does your head like circle back to that moment when you might have touched something or some surface? Tell us about that.
And for the doctor, my question is: How does plasma function inside the body? What – a lot of the research like Dr. Siddhartha Mukherjee has been writing has been focused on how the virus is circulating in our societies, but very less is written about what does it do inside? Similarly, what does plasma do inside our bodies to make us better? Thank you.
MS BERRENT: I’ll start off because my answer will be fairly simple and more straightforward, I imagine. I did figure out where I had contracted it. I was at a meeting, a professional type meeting, on the evening of Monday, March 9th. It’s important to note that there were eight people at the meeting, so for all the rules that suggest that gatherings under 10 are acceptable, this was – definitely flies in the face of that. And it was a business type meeting, not a social meeting. They were people who I had only met a couple of times before, so there was no touching, there was no food involved, nobody was sitting particularly close to one another. We were in a room fairly spaced apart for about an hour. Of the eight people, I believe seven contracted it, and sadly one has passed away from COVID-19 since.
Dr. Hod, I’ll let you —
DR HOD: Regarding the question about what the plasma does. And so it’s – what we believe or what the science would suggest is that there are antibodies in plasma. So your immune system, when it learns to fight a virus – and this is sort of how a vaccine works as well. So when you get a vaccine, the vaccine is teaching your immune system how to fight the virus and then your immune system makes antibodies against that virus that will protect you should you see that virus the next time.
And so with convalescent plasma, the idea here being is that someone who has already cleared the virus, has learned to fight the virus, and has produced potentially life-saving antibodies. And so we can collect the plasma which contains the antibodies and then give it to others. And this is something that we currently can do because we have so many survivors out there that have these antibodies.
But this is not going to be the ultimate solution to the problem, because plasma is difficult to transport. And so we’re already working with industry partners on the next step, and this is partly why they’re building such a large national resource of plasma, is that you can pool all the plasma together, virally inactivate it, and then extract out the antibodies and create something called hyperimmune globulin. So these are purified antibodies that you can put in little vials and then theoretically ship them around the world very easily. It’s currently being done – that’s one of the treatments for rabies, for example. If someone gets exposed to rabies, the treatment for it is hyperimmune globulin to rabies. And so that is the next step. And then ultimately we need a vaccine or something that’s going to get us to fully be able to reopen society. But these measures can protect people for quite some time because antibodies circulate in your system for months.
QUESTION: Thank you.
MODERATOR: Thank you, Dr. Hod and Diana. Let’s now move on from Niyi from Brazil. If you could go ahead, introduce yourself, and direct your question.
QUESTION: Okay. Good afternoon, everybody. My name is Niyi Fote. I’m representing Brazil here. I have, like, two questions. Okay, the first one is like to Dr. Hod. So how long –I don’t know how long – will it take you to know about the result? You mentioned three trials that you are having right now, like one for the health care workers and the one that tested positive and the one in ICU. How long do you need – I don’t know – to be able to know the result of all these trials that you’re doing? And the second question would be the plasma – I think it takes about like – if you apply, it’s going to take about two weeks or like a few months? And after that, what’s going to happen – I don’t know – after these application?
DR HOD: So regarding the first question of when we’re going to know, so that’s going to depend partly on the effect size. What that means is if there is a very big effect, if it’s very protective, then we would know relatively quickly, because whenever you do a clinical trial you have something called stopping rules and interim looks at the data.
So we have a plan to look at the data at periodic time points so that we could see whether there is a big difference between those who were randomized to the control or those who got the convalescent plasma. And there are ethical boards who sit there and statisticians who will sit there and review the data and decide whether the data is sufficient to stop the study. That’s another reason why we want to do this, to the extent possible, as a multicenter trial with more institutions working together, because then we’d get to the numbers we need much more quickly, and we can provide the results in maybe weeks to months – or to a month as opposed to waiting three years like some trials can take.
And so that’s the answer to the timing. Can you just remind me the second question, if it was to me?
QUESTION: So, okay, it’s like the – the antibody therapy, I think it lasts for a short time, like weeks or a few months. So after that, what’s going to happen?
DR HOD: Well, so if we continue to have a supply – and that might buy us time to develop new vaccines or new treatments, so it’s going to be a temporizing measure – you could always dose it again. There’s nothing to stop us from dosing it again for essential workers who are going to be exposed. And again, it’s really to buy us those – a mother protects her baby with antibodies. So babies are born without the ability to make antibodies, and the antibodies the baby gets from their mother protects them for the first three or four months of life. And so it’s sort of a similar concept. It’s going to protect people for two, three months, and then either we’ll have to dose again or have other – hopefully in two, three months it’s – we’re going to be in a different place and we’ll have other options for treatment.
QUESTION: Thank you very much.
PARTICIPANT: Daphne, please un-mute your microphone.
MODERATOR: Sorry for that, everyone. Let’s go ahead to Dmitry from Inter TV. Dmitry.
QUESTION: Oh, yeah, I’m here. Hello. Thank you so very much for this briefing, and I just have two short questions, one for the – you told already how you got the virus. Just to have this personal touch in our stories, can you tell the story of your illness and your survival? How difficult this was for you? How long it was for you?
And a question for doctor. Doctor, it is an opinion in the social media – I guess it’s wrong, but I need your opinion. People thought that, okay, there’s no – they’re senseless to find a cure because virus is mutating so fast that at the moment, when you will find a cure, an effective cure, we will have business with a completely different version or type of the virus. So it is true? I just need your opinion. Thanks so very much.
MS BERRENT: I will go first and tell you a little bit about my illness. I was extremely lucky. I think I had what was a very average case of COVID-19. I, in turn, gave it to my husband, who had a – I would call a very mild case, and he never would have even gotten tested had I not already gotten a positive diagnosis.
I woke up on – with 102 fever and I felt like I had an anvil on my chest. There was nothing subtle about it, although I hesitate to go into too many of the details of my symptoms because what I’ve found through Survivor Corps is that the virus really presents itself as a constellation of symptoms with each person having a different subset. And so not – it’s – listening to one person’s anecdote, anecdotal stories about their experience and their symptoms is not terribly helpful in helping an individual determine their course of action. Anyone with a single symptom should assume that they are positive and isolate immediately. But that information could be useful to the medical community.
And so one of the interesting things that we are seeing from Survivor Corps is we are seeing that some of the same stories appear over and over again because the only people who are getting tested on the back end of the virus are the ones going to donate their plasma. And the requirements for most of these programs are 14 days symptom-free, keeping in mind that “symptom” is an undefined term with this because of how I just explained that the symptoms really can vary wildly.
And what – we started to see a lot of reports of people coming back to our group and reporting, well, I went to go donate plasma and it turns out I have the antibodies but I still have the virus in my system. And they are – now, that doesn’t mean they’re necessarily contagious, but it doesn’t mean that they’re not, and their doctors have told them that they need to return into quarantine for another week till they’re ideally 21 to 28 days, and at that point, you’re also, from what I understand from Dr. Hod, your antibody count is higher at that point.
But in terms of that information that we were seeing, it really flies in the face of the CDC guidelines that are out right now and mimicked by most states, including New York, which allow – which are telling people to – that they can return – they can go back out into the world wearing a facemask at 72 hours post-symptomatic. And so Survivor Corps is creating a fascinating dataset that we hope to be able to use to help the medical community because it is really one of the few of its kind.
DR HOD: So regarding your question about the virus mutating and whether we should bother trying to find a cure, I’ll tell you the short answer is I truly don’t know. But the longer answer is that if there’s one glimmer of hope in this whole story it’s that this has brought the scientific community together to try to fight this thing. And we’re working round the clock, working with colleagues that I’ve never worked with before. I was not even a COVID researcher four weeks ago or five weeks ago when I started down this path. I was studying something completely different. But so many teams have gotten together and have tried to put their egos aside to just get something done and to find a cure, and if it does mutate and we have to figure it out again in a year, we’re going to do that. I’ll be here again in a year. I mean, we’re all committed to doing something and to making lives better and saving lives. That’s why we went into the health care field. And so I don’t – I guess I’ll just leave it at that.
MODERATOR: Thank you, Dr. Hod. The next question comes from James Reinl. It’s in the chat. He is working for The National, and it’s for Dr. Hod. “There are a bunch of efforts globally to discover vaccines, treatments, and antibody tests for COVID. Where does your research fit into these efforts, and how likely is it to play a significant role in our recovery from the pandemic?”
DR HOD: So I’m not a vaccine researcher. I wasn’t a vaccine researcher before, and I’m more of a transfusion medicine or a blood doctor, so I focus on plasma, and in plasma is where the antibodies are, and part of doing convalescent plasma is being able to test for antibodies. And so we have literally spent the last month developing tests for the antibodies. These are complicated tests. We are going live today with the new test that we’re going to begin offering our health care workers here at Columbia.
But again, these are still not perfect tests. So there are still false positives and false negatives that require some interpretation. We’re not there yet with a perfect test, but we think it’s good enough – the test we have currently is good enough to begin rolling out to our communities. But these take time because they’re – we’re not getting the test from manufacturing. We’re building it in-house, which means that there are shortages reagents – of reagents and things like that. And so our capacity is growing and we’re rapidly ramping up, but it’s going to take some time.
But – and so that’s where sort of my research focus has been, on the antibody testing and the convalescent plasma. And regarding the antibodies, it gets even more complicated because currently we’re just testing – well, we’re testing for antibody titer, which tells you how much antibody is there, but there are other tests you can develop that will test how effective the antibodies are, and that’s called a neutralization titer, which is really what we want to know.
So there are antibodies that specific to – that target specific parts of the virus that neutralize it. In order to do those tests, you need a facility where you can grow live virus to see if you can inhibit the virus using the antibodies, and those are tests that are currently under development in – at our institution and at other institutions, and those are really the tests we want to use on the convalescent plasma to see which ones might be more effective or not. But before we can even roll out those tests, we have to figure out how they work and be able to, in a sense, mass produce them so we can do it on a larger scale.
MS BERRENT: Can I jump in there for a moment? And Dr. Hod, please correct me if I’m wrong here. But the antibody test that Dr. Hod is describing is not the same antibody test that these 70 companies are trying to develop for mass production that you’re hearing about that will be at-home finger-prick tests or saliva tests, and they’re – so we’re talking about two very different levels of testing. Those home kits, from what I understand, that are in rapid development are more like a pregnancy test where it’ll just show whether you’re positive or negative, not the level. So you go get a pregnancy test – a pregnancy test from the drug store; it tells you whether or not, a positive or negative, but then you go get your blood tested to see what your hormone levels are. And so there is a bit of a discrepancy with that, so I just want to make it clear that those are two different antibody tests that we’re talking about.
Is that correct, Dr. Hod?
DR HOD: And if I could just add regarding those home pregnancy-type tests, I’ve evaluated a number of them using the convalescent plasma donors and other serum samples that we have in our hospital, and they’re not perfect. Again, I’m going to stress they’re not perfect tests and you get a lot of false negatives and sometimes you can get false positives because many of us have had other coronaviruses in the past. It’s a virus that is endemic, and so – and some of the antibodies you might have made to another coronavirus can cross-react with those tests. And so a positive test doesn’t necessarily mean you have COVID-19 either. And so that’s why these tests are taking so long to develop. They’re not simple tests, and interpreting them are not simple and can be dangerous in certain situations if done at home inappropriately.
MS BERRENT: And a positive antibody test also, on its own, does not mean that you are not contagious. So you can take one of these at-home tests, get a result that you do have antibodies, but you could still have the virus alive in your system and still be contagious. So when – I know there have been – there’s been a lot of talk about immunity passports. It’s going to be a little bit more complicated than I think is being presented in the media right now.
DR HOD: Just to add one other thing is that we still don’t truly know whether it’s protective if you have a certain level of antibodies, and what type of antibodies are protective. And so all these things take time for scientists to figure out, and we’ve basically gotten to where we are in five or six weeks here in the States. And so these things take time and they’re difficult questions to answer.
MODERATOR: Thank you both. The next question comes from Magda. Magda, can you introduce yourself and let us know who you have a question for?
QUESTION: Good afternoon. Thank you for doing this meeting on Zoom. I am Magda Sakowska, correspondent to Polish TV Polsat News. I have a question to Diana and also to Dr. Hod. Diana, do you know how many people encouraged by your grassroot movement have donated plasma already?
MS BERRENT: No, we’re not keeping count at this point. I mean, we’ve only existed for three and a half weeks and I have a presence that’s larger than I could have ever anticipated. I will say, though, that the only complaints I get from the members of our group is that they’re not getting called back fast enough from – they have applied to every program available, but these programs are working – as Dr. Hod said, they’ve been set up and on a dime and they are working as fast as they can and constantly upgrading their portals and their systems to accommodate more and more people. So we – our mission is to overwhelm them with volunteers, and for better or for worse, we’re doing our job.
QUESTION: And Dr. Hod, am I correct – I don’t know if I understood it correctly – are you already in the phase when you are giving the plasma treatment to patients, or you are going to start it in a few weeks?
DR HOD: No. So we’re hoping to start it next week with clinical trials. So that’s where we’re going to use it in a randomized way to figure out where it may be effective. But for now, we’ve just been collecting it in our blood bank because we think we need somewhere around 400 units in our blood bank to support the clinical trials we want to do, and so we’re building up our supplies so that we can build the infrastructure to now do the clinical trial, which is also challenging in this environment right now.
QUESTION: And doctor, one more question. I understand that giving the plasma to health care workers that are not infected already is a precaution?
DR HOD: So yes, that would be prophylactic use. And so again, the thought there would be that we would be providing them with antibodies, and then should they get exposed at work or at home or anywhere else on their way to work, then that would protect them from getting severely ill from the virus because now they would have the protective antibodies already. So it wouldn’t be teaching their immune system to fight it; it would just be giving them the protective antibodies up front.
QUESTION: Thank you very much.
MODERATOR: The next question comes from – in the chatroom from Gakushi Fujiwara from Asahi Shimbun. He is asking: How should – this question is for Diana: “How should we be prepared for a future outbreak? New York City is the epicenter for the pandemic and Japan is now following, even though very slowly. Do you have any suggestion or advice as a survivor?” Thanks.
MS BERRENT: Mass testing. Mass testing. And keeping people – and massive effort to keep people home. I mean, what I – I then did every interview that I’ve done for the past three weeks with the same message: Act as if you are already infected and every single person you infect is either your best friend or your grandmother. We can’t be safe enough. We need to keep people home as much as possible, but we need the mass testing. That has been a tremendous problem in New York. Access to testing has not gone as well as it could have. Let’s say that. You can learn from our – what we’ve not done.
MODERATOR: Thank you. The next question is from Yuliya. Yuliya, please go ahead.
QUESTION: Hi. Thank you so much for doing this briefing. My name is Yuliya Olhovskaya with Channel One, Russia. I have a question to the doctor. As I know a lot of countries are working on developing of this antibody test, so is there any kind of international cooperation on this issue? Because as I know, Europe is working on this; Russia is working on this; China is working on this.
And the second question is how are you going to solve these ethical questions you mentioned which can come up in the trial? Thank you.
DR HOD: So regarding collaborations, the scientific community has shared all constructs that have been developed. And so we got our construct – the construct for making the test, you need – you basically need to be able to make viral protein to see if the antibodies will bind it. And so in order to make the viral protein, it’s not a straightforward process, but the constructs you need to do it have been shared openly with everyone, and we got it from someone else. And then you have to grow it and produce it and purify it, and we’re still waiting for industry to large-scale manufacture it, but hopefully that’s coming as well. And then that will make it a lot easier to transport across the world. Once manufacturing can – once the test is good enough that it can be manufactured in large scale, then that will solve that problem.
Regarding the ethical questions, so whenever you do a clinical trial – and that’s where we are now, is going through the ethical review board – and so you can’t begin a clinical trial before a panel of ethicists and other physicians and people from the community have a chance to review your protocol and decide whether it is – whether the risk – whether the benefits outweigh the risks, essentially, because at the end of the day that’s what we’re dealing with. There’s going to be some risks. There are some risks to getting plasma. So plasma can cause transfusion reactions, and so there will be some people who develop transfusion reactions from our plasma therapy. And it’s rare, but they can even be fatal. And so there are risks to plasma; it’s not 100 percent safe. But the benefits we think outweigh the risks in this situation, and then it will ultimately be up to an ethical review board to determine that.
MODERATOR: Thank you. Another question is coming in from Elena from Portugal. Elena, can you introduce yourself, please? Elena, do you still have a question?
QUESTION: Yeah. Can you hear me?
QUESTION: Okay. I’m Elena from the Portuguese News Agency. I wanted to ask Diana, I’ve been hearing about bracelets that could be created when the economy reopens and the businesses are to reopen, bracelets for people who have had the virus and they are recovered so they could go freely to places and showing those bracelets would show that they are not contagious to the virus. So what is your opinion on that? Do you think that’s something could help Survivor Corps and help the data set that you’re gathering?
MS BERRENT: So I think what you’re talking about is what we’ve been referring here to as an immunity passport. Is that correct?
MS BERRENT: I believe what you’re referring to is what we’ve been talking about as an immunity passport?
QUESTION: Yeah, yeah.
MS BERRENT: Okay. So there’s – yes, I am 100 percent in favor of such a thing existing, and I think that it is absolutely necessary in order to avoid that sort of binary choice between the economy and lives that we spoke about earlier, as well as getting a volunteer force to be able help out in their communities. But we need to really heavily consider the technical aspects of that.
So first of all, calling it an immunity passport, as it has been here, is a misnomer, because we don’t know the immunity yet in that we have strong suspicions of immunity, but until it is absolutely confirmed what we can talk about is whether or not you are contagious to others. And again, Dr. Hod would have to double in on this one for me, but again, I do believe that you need to not only have a reliable antibody test – and again, we talked earlier about the reliability, different levels of reliability among different antibody tests – have a high enough antibody count, and also at the same time be able to have a negative diagnostic test that you no longer have the virus in your system, and they need to be done in tandem. And right now in the United States, those tests are just not available. They’re not – we don’t have enough tests to be testing our front-line workers on the front end, let alone giving multiple tests to patients who’ve already recovered.
MODERATOR: Thank you so much. The next question is coming in via the chat. It’s from Mr. Hisashi Yamada from TV Asahi of Japan. The question is for Diana: “What are you interested in doing, other than donating your plasma to help the community, once you know that you are totally safe with antibodies?”
MS BERRENT: Well, first of all, I – not only have I donated my plasma, I have donated blood to a private biotech company; I have submitted myself for every clinical trial that Columbia is offering, every program and trial that I have qualified for that I’ve found on our Survivor Corps daily updated list. And so we are – as much as we are supporting the plasma program, we are supporting every scientific study. Anything that we vet out as being a legitimate effort to find a cure that needs survivors, we are mobilizing our army of volunteers to do just that, and I am personally doing that as well. It’s a call to action that I’ve taken on myself, and I hope that that’s an inspiration to others.
I – was there a last part to that question? Sorry.
MODERATOR: No, I think you’ve answered it, actually.
MS BERRENT: Okay.
MODERATOR: Thank you. So let’s – we can – folks who have – are participating through the Zoom app a chance to ask questions, and I’d like to turn it over to those who have called in. If you are on the phone and you have a question, please unmute yourself by pressing *6 and we’ll go question by question.
If you’ve called in and you have a question, to unmute yourself press *6 and go ahead.
Well, it doesn’t look like any of our participants who’ve called in have questions today. If there are – I’ll give everyone just a moment or two more to ask a question through the Zoom app by raising your hand or asking a question through the chat feature.
Okay. There is one question coming from Pearl. Pearl, please go ahead.
QUESTION: Hi. Sorry, I missed some of your presentation there, but the one question I’d like to ask you is when you first received your COVID test results, how did that make you feel? And throughout your experience, is there anything you thought should be improved for somebody who’s first receiving that positive result? Thanks.
MODERATOR: Pearl, can you please just state your full name and your outlet?
QUESTION: Okay. Pearl Matibe, Open Parliament.
MS BERRENT: I’m assuming that was a question for me. So when I received my positive diagnosis, it was done via phone call. I have received no written documentation and I have tried extensively to get that documentation. I think that that is something that could be – definitely be improved upon. And again, I want to go back to the guidelines that – I mean, we are told to stay at home and treat ourselves at home, and again, let me restate that I didn’t need anything other than Tylenol and Gatorade to recover. I was very lucky. I never came close to having to go to the hospital. Although I did have some profound symptoms, my – the respiratory infection was the first thing to clear up, so I – it was scary, but not in the way that it is for obviously anybody who ends up in the hospital.
But if I – going through the process, being early in the curve, I’ve had the opportunity to be a bit of a canary in the coal mine. And so I’ve seen some of the breakdowns of the system as we’ve gone along. And again, one of those big mysteries – not mysteries, but one of those big issues right now is – I believe are those CDC guidelines on how long one should stay quarantined, and the 72 hours from resolution of symptoms to me seems woefully inadequate and could potentially lead to a massive wave of reinfection.
MODERATOR: Thank you, Diana. We have another question from Niki.
QUESTION: Hi, Diana. Hi, doctor. I had spoken with you earlier. I’m from Indo-Asian News Service. A follow-up after hearing a lot of your other answers, Diana: In the social distancing guidelines that are currently in place, are there some things that you wish were there, considering you’re a survivor? Because for the common people in our neighborhoods, the questions remain: Do we go out? Can we go for a run? Can you go for a walk? I know it’s deeply simplistic but would love to hear from you.
MS BERRENT: Well, I have one very simple suggestion. I get asked this all the time, and look, there are a lot of people who are not lucky enough to be able to stay home, so we also need to recognize that and keep those people under consideration. There are still people delivering my mail and picking up my garbage and so on and so forth, and there are essential workers for whom it is not an option, and there are people who are in crowded, crowded apartment complexes where – and there are women in homes where – and men – who could be victims of domestic violence. It’s not a simple answer.
That said, the best advice in terms of not getting the virus in the first place is just this: no one in, no one out, no exceptions. I – until I see scientific proof that a mask helps – I’ve now seen stories that this six feet is actually 13 feet, that it gets tracked on your shoes. We’re learning more and more about this every day. This virus is a mystery, and until the science proves things out, I think the best course is to stay home, and again, no one in, no one out, no exceptions, and that’s the best way.
QUESTION: Doctor, my question to you is about the plasma and the process of getting it. So how many ml do you actually draw? How much do you really need?
DR HOD: So the question of dosing is an issue because we don’t know. We think that one unit is enough, and one unit is about 200 to 250 milliliters, and that’s based on calculations about the antibody concentration in the plasma versus the size of an average adult.
Now, some countries are approaching this a little differently, and instead of giving one unit – for example, in Italy I know they’re planning on giving it one unit every day for three days, for example, so different – there are different approaches in different places. But when Diana donated, she donated more than one unit. And so it’s not a regular blood donation. They actually put you on a machine that spins down your blood and it gives you back your red cells and just takes off the plasma on top, and so from that process you can get from many people three and sometimes even four doses from a single donation. And so one person could potentially provide three or four doses to help us, so to help at least three or four different people. And then you could now donate every seven days, and so one person could theoretically over the course of a month donate 10 to 12 units of plasma to help others.
MS BERRENT: Can I ask a follow-up question to that, Dr. Hod?
DR HOD: Sure.
MS BERRENT: So when I went to donate at the New York Blood Center, I was told that I could donate every seven days, and so I made a standing appointment, but I was also told that there was a max of a three – of three times, and that was being under consideration for being changed. Do you know what the status is of that process or why —
DR HOD: Fortunately the – sorry to interrupt. The blood industry is highly regulated by the FDA, and so these are all FDA guidelines. And I don’t have any links to that process or their thinking, but I could tell you that initially, you could only donate plasma every 28 days and that got changed to seven days because, again, we want to build this national resource.
But you have to remember, we’re trying to make sure that what we do is safe for you, the donor, safe for the phlebotomists at the blood center who need to bleed you, who have to come in day in and day out and they have to bleed 50 people a day – think about what that means for them. They don’t get the – they don’t have the luxury of staying home. And we also want to make sure it’s safe for the recipients, the people getting the plasma. And so that’s why the FDA has a strong role to play in this process, and they make their rules and their decisions based on the safety.
MS BERRENT: One thing that’s interesting to note is that there has been relaxations implemented recently on who is eligible to give blood in the United States, and we’re hoping to see more – I personally am hoping to see more of that relaxation going forward.
MODERATOR: Thank you both. We’re just about out of time, but I think there has been somebody on the phone waiting patiently to ask a question.
QUESTION: Hi, this is Patrick Redding for The Guardian. Can you hear me?
MODERATOR: Yes, we can.
QUESTION: Great. So I just had a quick question for Dr. Hod. In relation to people using plasma before these clinical trials are tested and everything is finalized, I’m just curious what the risks are for people using plasma now, before further research has been done. Thank you.
DR HOD: So again, it’s being used for compassionate use, which basically means that the patient is on a respirator and is very, very ill. And so there’s really – we have no other options. And so in that situation there are theoretical scientific risks, but we don’t know for sure whether it may be helpful or harmful, and it may depend on the specific antibodies that are in that specific plasma unit that you give. And so there are so many things we still don’t know. So again, it’s sort of a last resort.
We would like to do the trials first so that we could find out, but there are a lot of people suffering right now and this is something we could potentially do. I understand the desire to give it in those situations. And there are some – again, they’re not controlled trials and so you cannot make a conclusion that they work, but there are some preliminary reports from China that it may have some benefit and at least not harmful in that setting.
But again, we don’t have the controls and we don’t know for sure, and so that’s why we want to proceed gingerly at Columbia.
MODERATOR: Well, I think that takes us to 3 o’clock, and we want to be very respectful of both Diana and Dr. Hod’s time. We thank you so much for participating in today’s Foreign Press Center briefing. That concludes today’s briefing. Thank you for joining us, for everyone who called and participated via the Zoom app. I will share today’s transcript and video link as soon as they are available with everyone. And with that, thank you and have a great day.
MS BERRENT: Thank you for having us. Bye-bye.