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By Anne Blythe

Nima Eftekhary had heard enough about COVID-19 in March that he pretty much knew when he woke up several months ago with a bad headache, body pains and general malaise that he probably had contracted the coronavirus that had been spreading around the globe.

His fiancee had returned from New York recently and had already exhibited some of the same symptoms.

What happened over the course of the next couple of weeks left the 32-year-old orthopedic surgeon with this message for anyone wondering about the disease.

“It is not ‘just the flu,’” Eftekhary said on Friday. “It’s not even close to the flu.”

For 10 days, Eftekhary fought fever. At one point, he was so short of breath that he thought about going to the hospital for an oxygen boost. He never had felt sicker, he said.

“I couldn’t breathe at rest,” the Charlotte resident said, adding that it became difficult at times to talk. “I would have to stop mid-sentence and take a breath. Phone calls were like workouts.”

Both Eftekhary and his fiancee are better now and most of their symptoms are gone, though his sense of taste and smell has not come back fully.

“I feel like I’m finally done with it,” Eftekhary said. “I’ve gotten used to less intense taste of food.”

An avid runner who used to put in double-digit miles routinely on his runs, Eftekhary is slowly building back up to such rigorous workouts. He’s gotten up to 11 miles on a run, but more often sticks to about five miles.

Teaching others about COVID-19

It was difficult for Eftekhary and his fiancee to get tested in March when North Carolina had a testing supply shortage. At the time, the recommendation was to reserve tests for health care workers and others on the frontlines of the pandemic, as well as for those with severe complications from the virus.

Eventually, the couple prevailed.

Since then Eftekhary has tested negative for the virus and makes sure that any patients he sees are aware of that. He has found that many in his neighborhood and community are curious about his experience.

“So few people in my area know anybody who has tested positive for COVID, so they want to know more about it,” Eftekhary said.

His fiancee has taken an antibody test and learned that coronavirus antibodies were present in her blood. He did not receive an antibody test.

A mechanical tray agitates the bag to mix the blood with anticoagulants and prevent clotting. Photo credit: Waldszenen, Wikipedia Creative Commons

Back at work, helping others

Now, Eftekhary has become a plasma donor, allowing others to use his antibody-rich blood as they fight a COVID infection.

Donation of convalescent plasma has a long history. Before the antibiotic era, blood from patients who had survived dreaded disease was one of the few weapons to treat others. Convalescent plasma was used during the 1918-1919 global flu pandemic, and more recently, it was a treatment during the SARS crisis, and with Ebola as well.

For Eftekhary, getting into the queue to donate his plasma required persistence and patience. Had he not been a physician with what he described as “reasonable health care literacy,” offering his antibody-rich blood might have been a benevolent idea that Eftekhary had abandoned instead of persevering as he did.

His experience comes as health care centers across the state are ramping up plasma studies in response to COVID-19.

Paul Bolin, chairman of the internal medicine department at East Carolina University’s Brody School of Medicine, is one of the physicians working with Vidant Health in Greenville on a convalescent plasma study.

Vidant Medical Center in Greenville first administered plasma rich with antibodies from the blood of someone who had recovered from the coronavirus on April 23.

In mid-May, Bolin stressed that enough evidence had not been gathered yet to draw any conclusions about the treatment.

“What I’ve seen, I really do think there’s promise for this,” Bolin said, adding that much more information needs to be gathered over the coming weeks and months. “My experience is like one day in the weather forecast. It’s really a drop in the bucket.”

Plasma promise

The Vidant study is being done in conjunction with the Mayo Clinic as part of the Federal Drug Administration’s Expanded Access Program. There are more than 2,300 sites participating in the study, with 7,000 physicians treating 23,364 patients, 17,674 who had been infused.

In a report released in mid-May, looking at data from the first 5,000 patients, the Mayo Clinic revealed that early indicators suggest the antibody-based therapy is safe to use on those with severe illness from COVID-19.

The patients who had received the convalescent plasma between April 3 and May 3, were extremely sick already, two-thirds were in an ICU and one in five were experiencing multi-organ failure. For those patients, the seven-day mortality rate was 14.9 percent, which was about the same as for patients who didn’t receive the plasma.

The early report was not intended to address how well the treatment worked. Instead, it was focused on safety and ensuring that giving the plasma didn’t make patients worse. So, even though that mortality rate seems high, it tracked with the death rate already in those types of patients and appears not to have made them worse, which is important information.

If the Mayo Clinic study continues to show promise Bolin said they will have data about convalescent plasma use that could prove helpful in the event of another wave of the pandemic, and perhaps other pandemics ahead.

“Once we have an answer, we’re not going to stop,” Bolin said.

Challenges of getting and giving plasma

Luther Bartelt, an assistant professor in the UNC-Chapel Hill Division of Infectious Disease in the School of Medicine, talked about UNC Health’s participation in the Mayo study.

In the early days of plasma collection, much of the nationally available supply was going to New York, where the need was greatest and the state’s health care system was overwhelmed.

The UNC Medical School joined forces with the UNC Blood Donation Center in Chapel Hill to collect plasma on its own from people who have been diagnosed with COVID-19 and are interested in helping others.

Donors can come every 28 days, Bartelt said.

By using the UNC Blood Donation Center, Bartelt said, there could be an opportunity to collect more specifics about the donors and spin off other studies looking at the experience the donor had with the virus, the level of antibodies present in the blood and measure that against the effectiveness of the convalescent treatment.

“Plasma, it’s very heterogeneous,” Bartelt said. “We’re trying to understand it.”

At UNC Health and in the Greenville hospitals, the physicians noted that many of the patients being hospitalized with COVID-19 have underlying conditions or are from high-risk groups for more severe complications.

By mid-May at UNC Health, there had been an influx of patients from nearby meat processing plants, many of whom were young, according to Bartelt.

In Greenville, Bolin noted that many of those fighting severe cases of the virus had vitamin D deficiencies. He suggested paying attention to that, too.

“We all could improve our health habits,” Bolin said, suggesting that North Carolinians get their blood sugar levels in control, give up smoking and tend to other health issues that have been highlighted as high risk.

Blood donation. Photo credit: Pxfuel, Creative Commons

‘Overboard with political agenda’

One of the biggest challenges Vidant had confronted with their plasma study, Bolin said,  was finding enough to treat extremely ill patients.

Eftekhary said the donation process could be simplified. He had to push and fill out a lot of paperwork just to enroll. Then the donation process can take more than an hour, and in some cases several hours. He has donated plasma twice, once in Charlotte and once in Chapel Hill.

“A hotline would help. People need to be able to get an appointment when they call,” Eftekhary said. “It’s something you’re doing to help somebody else. It’s not a fun experience at all. It takes a lot of time.

As a doctor and someone prone to helping others when he can, Eftekhary urged people to take the presence of the virus seriously and to heed the advice of the health experts.

“It’s getting a little overboard with the political agenda,” he said.

The arguments over face coverings and erosion of freedoms have little appeal to him and strike him as “extremely selfish.” People should wear a mask if asked, he said, to help protect others, particularly the more vulnerable. Through the course of this pandemic, he said, many will come to know someone who died or became sick from COVID-19.

“This is real,” Eftekhary said. “It’s not a conspiracy theory.”

Anne Blythe

Anne Blythe, a reporter in North Carolina for more than three decades, writes about oral health care, children's health and other topics for North Carolina Health News.