Well, there are few recovered individuals, and each has only so much blood... Better go get 'em, before someone else does!

If you want to produce antibody sequences from recovered patients in cell culture, you would have to get a hold of the patients' plasma cells, sequence their antibody genes, and then produce them by recombinant means, figure out which ones target CoV effectively, and scale-up production of those. All this is easily said. In practice it's years of technically extremely challenging work, if all goes well. I'm sure folks that do this kind of thing have begun.

(In practice, vaccinating a lab animal, like a mouse would be the more commonly used starting point than recovered patients.)

Not sure by what mechanism "Stem Cell"s might contribute here.

JAMA:

March 19, 2020 COVID-19: Can We Expedite Treatment? Gary Ordog, MD, DABMT, DABEM | County of Los Angeles, Physician Specialist, Retired The authors discuss human rights pertaining to avoiding infection during the next 18 months. We are supposed to wait while a vaccine is tested for dosing schedule. "Flattening the curve" may only prolong the inevitable infection with the virus. What are our rights to preventative and curing treatments? The most vulnerable of our population currently appear to be older and medically compromised individuals. Also, the most severely ill will require ventilators, ICU beds and critical care staff, and all are currently utilized to capacity, resulting in an increasing number of newsworthy disasters already. I suggest that prophylaxis and treatment should be made available, as a medical right, in this time of impending catastrophe. Treatments that have not had time to advance to final approval may be beneficial for saving life or limb, with those patients on the exponential end of " the curve" probably glad to sign a 'waiver of liability.' As far as prophylaxis and treatment, I refer first to the vaccines that are being tested correctly and for dosage. With a century of vaccine research, I think they have a pretty good estimate of the required dose. Can we not ramp up production and start giving it to the most vulnerable, at least? Secondly, there are currently thousands of patients who have recovered from COVID-19, can these not be a source of gamma globulin for the more serious ill, at least? Stem cell lines are another possible therapy. Thirdly, there are various antiviral drugs which are safe and possibly effective but obviously have not had the time to be tested. For example, remdesivir appears to be effective against other Corona viruses, probably would have some effect against Covid-19. Could we not ramp up production of these agents and allow our vulnerable patients to have access to them, when otherwise it looks like high mortality and morbidity, with our only treatment available being "social distancing?" Thank you for allowing me to make these comments. GJO

What I know Takeda is building on its work with immune globulins, which are blood-derived antibodies. To do so, they are looking for plasma donations by coronavirus patients who recovered. Again it will take some time in development, trials, and final use. The convalescent sera option for containing COVID-19 can be explored an is also being explored by FDA.

Talking about Ig. There are asymptomatic patients. I supposed that their plasma are as valuable as those from recovered patients. Therefore, testing of contacts who do not get ill is necessary

I belief in herd immunity to fight it in public. Natural vaccination with flat curve in public an stay tune individual immunity with good nutrition, good taking rest, vitamin C for antioxidant and antiinflammation.

1. Hyperimmune gamma globulin from those who have survived and developed the antibodies to fight off the virus, is one of the first treatments in an epidemic like this. That is why blood donations are ramping up (see the ads). This is useful for the seriously ill who are overwhelmed, until they produce their own antibodies.

2. Herd immunity is at the cost of high morbidity and mortality.

3. Urgent, immediate vaccination is the real answer, right now.

I see that they are starting to do this now, called " convolescent plasma." Also, there is a massive blood donor advertising drive by the Red Cross. This is good.

Gary Joseph Ordog : recent aticle stated that neutralization efficiency by convalescent sera for recent nCoV-19 is moderate, while for previous SARS is high

link: https://www.cell.com/action/showPdf?pii=S0092-8674%2820%2930229-4

I had recommended hyperimmune gamma globulin produced from the blood of patients recovered from Covid-19, more purified than just the convolescent plasma. It does not require cross matching or blood typing, there is little chance of a reaction, and it is administered intramuscularly in much smaller volumes. Initially, the plasma is next best choice. For both, the donor and blood must be checked for transmissible pathogens.

In today's lead article in JAMA It worked very well.

I think YES !

https://www.medrxiv.org/content/10.1101/2020.03.22.20040758v1

This discussion, as well as the two previous, were combined into one article that was published in JAMA last month. Thank you for your help and support.

We have used Stem Cell cultures to produce various product that greatly benefitted patients with chemically induced immune deficiency, including ALF and hyperimmune gamma globulins. If you can isolate the specific sequence now and mass produce it, that would be great.

What do you think of thymosin, maybe attach it to Fab fragments? Coming out in Lancet next week.

Here is the official response from JAMA July 10, 2020:

Here is how and why the vaccine is slow: A modified quote from JAMA today July 10, 2020:

Prevention and Vaccine Development COVID-19 is a potentially preventable disease. The relationship between the intensity of public health action and the control of transmission is clear from the epidemiology of infection around the world.25,101,102 However, because most countries have implemented multiple infection control measures, it is difficult to determine the relative benefit of each.103,104 This question is increasingly important because continued interventions will be required until effective vaccines or treatments become available. In general, these interventions can be divided into those consisting of personal actions (eg, physical distancing, personal hygiene, and use of protective equipment), case and contact identification (eg, test trace-track-isolate, reactive school or workplace closure), regulatory actions (eg, governmental limits on sizes of gatherings or business capacity; stay-at-home orders; proactive school, workplace, and public transport closure or restriction; cordon sanitaire or internal border closures), and international border measures (eg, border closure or enforced quarantine). A key priority is to identify the combination of measures that minimizes societal and economic disruption while adequately controlling infection. Optimal measures may vary between countries based on resource limitations, geography (eg, island nations and international border measures), population, and political factors (eg, health literacy, trust in government, cultural and linguistic diversity). The evidence underlying these public health interventions has not changed since the 1918 flu pandemic.105 Mathematical modeling studies and empirical evidence support that public health interventions, including home quarantine after infection, restricting mass gatherings, travel restrictions, and social distancing, are associated with reduced rates of transmission.101,102,106 Risk of resurgence follows when these interventions are lifted. A human vaccine is currently not available for SARS-CoV-2, but approximately 120 candidates are under development. Approaches include the use of nucleic acids (DNA or RNA), inactivated or live attenuated virus, viral vectors, and recombinant proteins or virus particles.107,108 Challenges to developing an effective vaccine consist of technical barriers (eg, whether S or receptor binding domain proteins provoke more protective antibodies, prior exposure to adenovirus serotype 5 [which impairs immunogenicity in the viral vector vaccine], need for adjuvant), feasibility of largescale production and regulation (eg, ensuring safety and effectiveness), and legal barriers (eg, technology transfer and licensure agreements). The SARS-CoV-2 S protein appears to be a promising immunogen for protection, but whether targeting the full-length protein or only the receptor-binding domain is sufficient to prevent transmission remains unclear.108 Other considerations include the potential duration of immunity and thus the number of vaccine doses. Coronavirus Disease 2019 (COVID-19)—Epidemiology, Diagnosis, and Treatment Review Clinical Review & Education jama.com (Reprinted) JAMA Published online July 10, 2020 E9 © 2020 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ by Gary Ordog on 07/10/2020 needed to confer immunity. More than a dozen candidate SARSCoV-2 vaccines are currently being tested in phase 1-3 trials. Other approaches to prevention are likely to emerge in the coming months, including monoclonal antibodies, hyperimmune globulin, and convalescent titer. If proved effective, these approaches could be used in high-risk individuals, including health care workers, other essential workers, and older adults (particularly those in nursing homes or long-term care facilities). Thank you and stay safe; Gary Ordog, MD

August 23, 2020: "President Trump Announces FDA Authorization of Convalescent Plasma Treatment for COVID Patients" today. This is what I recommended, the Gamma Globulin portion which is what is required, over 6 months ago. Please note, this has been recommended for almost a century (e.g. Read the book Arrowsmith, although fiction based upon a true story, also recommends and uses this type of ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,treatment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,.

Example

August 29, 2020 Update on Vaccine: Finally, an expedited discussion on the "Fast-Tracking" of the vaccine; prior to the ending of the Phase three trials. Messing up the perfect research trials, but perhaps, life is more important than the perfect research trial. (cf Arrowsmith; Sinclair Lewis; please re-read this great novel, one of my favorites!!)

@ Gary Joseph Ordog , for convalescent plasma, there are precautions that should be taken into account. https://www.trasci.com/article/S1473-0502(20)30241-X/pdf

The point is, the HLA level of the convalescence pts., which is high e.g. in ever gravid women, should be think as a prerequisite

G-Ordog replied on Wed, 09/02/2020 - 17:27 Doctors Guide Alerts, after NIH Statement. The message appears to be obvious, that is, use it earlier, some time before the patient is so sick that he/she needs the ventilator. The statistical improvement in mortality was 100% when used earlier. Thank you. Gary Ordog, MD.

@ Gary Joseph Ordog "The message appears to be obvious, that is, use it earlier, some time before the patient is so sick that he/she needs the ventilator. The statistical improvement in mortality was 100% when used earlier "

Yes. before cytokine storm happens, as conv plasma only eliminate the virus, and do not repair damaged organs,

FEBRUARY 4, 2021

IVIG plus methylprednisolone linked to more favourable fever course in children with multisystem inflammatory syndrome

Treatment with intravenous immunoglobulin (IVIG) and methylprednisolone, compared with IVIG alone, was associated with a more favourable fever course in multisystem inflammatory syndrome in children (MIS-C), according to a study published in the Journal of the American Medical Association. In addition, the combination therapy was also associated with less severe acute complications, including acute left ventricular dysfunction and hemodynamic support requirement. 

A total of 106 children, with a median age of 8.6 years, who fulfilled the World Health Organization definition of MIS-C were included in this retrospective cohort study which started on April 1, 2020, with follow-up ended on January 6, 2021. More than half (52%) of the children were female. The primary outcome was treatment failure, defined as persistence of fever for 2 days after the introduction of initial therapy or recrudescence of fever within 7 days after the initial therapy. Meanwhile, secondary outcomes included second-line therapy, hemodynamic support, acute left ventricular dysfunction after first-line therapy, and length of stay in the pediatric intensive care unit (PICU).

Of the children, 34 received IVIG and methylprednisolone while 72 received IVIG alone. The dosage of IVIG was 2 g/kg for all patients. Among children in the IVIG and methylprednisolone group, 30 received methylprednisolone at 0.8 to 1 mg/kg every 12 hours (maximum of 30 mg for 12 hours) for 5 days, while the 4 remaining children received a bolus of 15 to 30 mg/kg/d of methylprednisolone for 3 days.

Overall, 3 of 34 children (9%) in the IVIG and methylprednisolone group while 37 of 72 (51%) in the IVIG alone group did not respond to treatment. When 32 children in the IVIG and methylprednisolone group were propensity-score matched with 64 children in the IVIG alone group, the researchers found that treatment with IVIG and methylprednisolone was associated with a lower risk of treatment failure (absolute risk difference, −0.28 [95% confidence interval (CI), −0.48 to −0.08]; odds ratio [OR], 0.25 [95% CI, 0.09 to 0.70]; P = 0.008). 

Similarly, IVIG and methylprednisolone therapy, compared with IVIG alone, was also significantly associated with lower risk of use of second-line therapy (absolute risk difference, −0.22 [95% CI, −0.40 to −0.04]; OR, 0.19 [95% CI, 0.06 to 0.61]; P = 0.004), hemodynamic support (absolute risk difference, −0.17 [95% CI, −0.34 to −0.004]; OR, 0.21 [95% CI, 0.06 to 0.76]; P = 0.01), acute left ventricular dysfunction occurring after initial therapy (absolute risk difference, −0.18 [95% CI, −0.35 to −0.01]; OR, 0.20 [95% CI, 0.06 to 0.66]; P = 0.007). The duration of PICU stay was also significantly shorter among those treated with IVIG and methylprednisolone compared with those on IVIG alone (median, 4 vs 6 days; difference in days, −2.4 [95% CI, −4.0 to −0.7]; P = 0.005). 

“MIS-C is the most severe pediatric disease associated with severe acute respiratory syndrome coronavirus 2 infection, potentially life-threatening, but the optimal therapeutic strategy remains unknown,” wrote Naïm Ouldali, MD, Université de Paris, Paris, France, and colleagues. 

“Corticosteroid use is currently one of the few validated therapeutics in severe respiratory adult forms of COVID-19. The findings in the current study suggest that corticosteroids may also be beneficial in MIS-C, possibly acting systematically as a potent inhibitor of SARS-CoV-2–induced inflammation,” the authors noted. “Combined with findings of studies reporting MIS-C cases in young adults, there may be common pathways between severe respiratory adult forms of COVID-19 and MIS-C.”

“Additional studies are warranted to understand the mechanisms underlying a possible corticosteroid effect in MIS-C and in severe forms of COVID-19,” the authors added. 

Reference: https://jamanetwork.com/journals/jama/fullarticle/2776054SOURCE: Journal of the American Medical Association. Finally, confirmation of therapy that I have successfully used in the Emergency department for 40 years. Thank you. Gary Joseph Ordog, MD.