It’s a little bit of science and a lot of logistics. We are seeing improvements in radiological findings and even in lab tests, and we’ve been able to deliver plasma to patients in our community.
Matthew McClain, MD, an MSK radiologist with Rome Radiology Group—a Strategic Radiology member practice located in the foothills of the Appalachians in northwestern Georgia—has always paid attention to infectious disease outbreaks—SARS, MERS, H1N1. On the morning of January 5th, he noted that the numbers coming out of Wuhan, China seemed higher than in previous outbreaks.
Early risers who convene in the morning over the newspaper, Dr. McClain remarked to his wife that they should keep their eye on the novel cornonavirus. “In China, soon after, they were trying everything they could, repurposing drugs used for the treatment of HIV,” he recalled. “It was similar to the Ebola outbreak, when they were bringing patients to Emory and treating them with convalescent plasma.”
As McClain watched the virus spread unchecked, he wondered whether convalescent plasma therapy, first introduced in the 1800s and used during the Spanish Flu Pandemic of 1918 could help; in February, he began to write an Investigational New Drug (IND) application to submit to the FDA, and as the pandemic reached U.S. shores, he opened conversations with local hospitals, sharing the idea that convalescent therapy could be both beneficial and deployable on a local scale. That was when he encountered his first challenge: “It was not easy getting people to listen to a radiologist on this subject.”
Building a Coalition
He started to build a local coalition beginning with Rome Radiology president Kirk Kizziah, MD, and including: retired radiologist Bill Harbin, MD; John Hostetler, MD, an infectious disease specialist; Ann Hook, the former oncology services director at Redmond Regional Medical Center (RRMC); Leonard Reeves, MD, who runs the Medical College of Georgia campus in Rome; and Gary Voccio, MD, director of the Northwest Georgia Public Health District.
The Medical College of Georgia has enlisted a phalanx of residents who have been stalled by the pandemic to help with patient interviews to ensure protocol compliance. They founded a nonprofit, Plasma Therapy, to help generate plasma donors and community support, and aligned with Blood Assurance to begin collecting plasma throughout the region. Dr. McClain's son, a pre-medical student at the University of Georgia, built a website and a Facebook page and was enlisted to the board as its information officer.
On March 13, the Journal of Clinical Investigation published a paper, The convalescent sera option for containing Covid-19, making the case for an effort to assemble a national research network to investigate the effectiveness of convalescent plasma for treating Covid-19 patients by a team at Johns Hopkins University School of Medicine. Dr. McClain reached out to Arturo Casadevall, MD, and Shmuel Shoham, MD, and Dr Shoham shared his IND with Dr McClain. He began to adapt that for his community, but when the Mayo Clinic received approval for an expanded access protocol, Dr. McClain determined that the Mayo protocol offered the quickest route to deployment, and he applied to become the principal investigator at two of Rome’s hospital sites, Floyd Medical Center and Redmond Regional Medical Center.
While the whirlwind activity has limited his access to sleep, Dr. McClain is encouraged by the early results. “It’s a little bit of science and a lot of logistics,” he said. “We are seeing improvements in radiological findings and even in lab tests, and we’ve been able to deliver plasma to patients in our community.” Two and a half weeks after treatment was deployed, they have lost two of 17 patients who are getting the plasma, both in their 90s. “Two patients are too many, but it is an improvement over what we have been seeing,” he said. One patient with end-stage COPD on a ventilator who received treatment was discharged after a week. Another patient who was on a ventilator for three weeks and continuously shedding virus was also released from the hospital following treatment and is no longer shedding virus.
If there are other radiology practices with an interested in either working with RRG to enroll patients in the region or establish their own local effort, Dr. McClain would be happy to share what he has learned. “If we can get the word out, and if I can help someone reproduce this and reduce the amount of work to get it up and running, then that would be great,” he said. Dr. McClain welcomes your emails at firstname.lastname@example.org.
Hub is the monthly newsletter published for the membership of Strategic Radiology practices. It includes coalition and practice news as well as news and commentary of interest to radiology professionals.
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