Decades-old treatment may be ‘major tool’ in saving COVID-19 patients, SC doctors say

Debra Allen feels lucky to be alive, back at home in St. Matthews with her husband, Ed, and her two cats.

Just weeks ago, the 65-year-old librarian was one of the sickest COVID-19 patients at Lexington Medical Center, her doctors said. The novel coronavirus ravaged her body in mid-March. Her heart and lungs, overwhelmed by the virus and a simultaneous bout of pneumonia, started shutting down. Her risk of dying from the invisible disease increased.

Jeff Bennett, 68, was also caught off-guard by the illness. In a matter of days, the West Columbia resident and landscaper went from feeling healthy with no known underlying conditions to being hospitalized and unable to breathe without a ventilator. His blood oxygen level and blood pressure were dangerously low, his lungs appeared in a scan to have “ground glass” — a tell-tale sign of infection in some COVID-19 patients.

For both patients, and at least another half dozen gravely ill people, Lexington Medical Center doctors turned to an old treatment sometimes used for other life-threatening infections: therapeutic plasma exchange.

The results were astounding, the doctors said.

Within days, Allen and Bennett started feeling stronger, their lungs more full of air, they told The State. Both attribute their dramatic, rapid recoveries to the therapy, which flushes out the blood and replaces it with fresh plasma.

Unlike convalescent plasma therapy, which relies on blood donated by recovered COVID-19 patients, the plasma treatment Lexington Medical Center performed used blood plasma from healthy donors — no need to have had COVID-19. Over the course of three days, the tainted blood is removed and new blood is filtered in through a catheter in the neck or groin.

Lexington Medical Center doctors said the therapy is “labor-intensive” for bedside nurses, especially while wearing uncomfortable personal protective equipment. But the results have made ICU nurses “energetic” about the treatment, critical care physician Dr. Phillip Keith said.

Of the eight severely ill COVID-19 patients the hospital’s Intensive Care Unit physicians treated with therapeutic plasma exchange, five fully recovered, the doctors said. Two initially improved after receiving the new plasma — they could breathe without ventilators — but they later succumbed to second waves of the virus, they said. The eighth patient was recuperating in the hospital on May 12.

All of the patients had profound infection, or sepsis, and multiple organ failure, according to the physicians. Most severe COVID-19 patients have also been in acute respiratory distress. All of the patients had continued deteriorating despite other aggressive treatments, they said. And many had marked improvement after receiving the plasma therapy.

“This appears to be a major tool” to help some very sick COVID-19 patients, Dr. Matthew Day said.

Day is one of a group of Lexington Medical Center doctors who authored an editorial about the possibility that therapeutic plasma exchange could work for life-threatening COVID-19 infections, as it had worked in the past on bacterial and fungal infections.

Since their editorial was published in a critical care journal on April 2, Keith, Day and Chief Medical Officer Dr. Brent Powers said doctors and researchers from across the country have reached out to them to collaborate. They are hoping to begin trials to see if therapeutic plasma exchange is truly effective in septic COVID-19 patients with multi-organ failure.

Although there is no “magic bullet” when it comes to treating the COVID-19 virus, plasma exchange has been around for decades and has been shown to help with blood clotting and inflammation caused by other serious infections, the doctors said. In conjunction with other treatments, such as the promising antiviral drug remdesivir, plasma exchange could help physicians “buy time” for patients with a high risk of dying, they said.

For Allen and Bennett, receiving therapeutic plasma exchange meant being able to go home to their families after more than two weeks alone in the hospital.

“This is the longest we’ve been apart in the 39 years that we’ve been married,” Ed Allen said.

Debra Allen said she feels better than she has in years. The virus caused her to develop congestive heart failure but her heart function recovered within two weeks after treatment, Keith said. Although she was never placed on a ventilator — “My husband says it’s because I’m stubborn” — she was still extremely ill, more so than even she realized.

“Being within the experience, your perspective is different. Nobody ever said anything about how bad I was,” she said. “Possibly I did come close to dying with this thing, but now, it makes me realize what a serious thing it was that I went through.”

Bennett, a father of two daughters, has worked with a therapist since he returned home to rebuild his strength and help blood oxygen levels get back to normal. Sometimes, when he takes walks or sleeps, his levels dip low again. But he can breathe alone, a major improvement from when a machine filled his lungs for him in the hospital.

“Somehow God wasn’t ready for me yet and he gave me a second chance,” he said.

His wife, Camisa Bennett, is a nurse at Lexington Medical Center. Her medical knowledge was double-edged when faced with her husband’s illness, she said. She could understand what doctors — her colleagues — said about Jeff Bennett’s condition and explain it to family members, but she also knew that COVID-19 is unpredictable, and things could always take a turn for the worse.

At home, quarantined for 14 days after her husband was diagnosed, Bennett called the hospital every two hours during the day and FaceTimed her husband when she could. They whispered I-love-yous and tried to get their affairs in order in case Jeff Bennett didn’t recover.

Although she works in health care, Bennett said she didn’t understand until then how emotionally taxing the COVID-19 pandemic could be. One afternoon, she was at work. The next, she was driving her husband to the same hospital’s emergency room. She wouldn’t see him again in person for weeks.

“I even took a Facebook selfie photo, like, ‘Oh it’s Friday. I made it through another week,’” she said. “I had no idea that when I got home I’d be faced with this the very next day. It just all happened so fast.”

This story was originally published May 12, 2020 at 10:53 AM with the headline "Decades-old treatment may be ‘major tool’ in saving COVID-19 patients, SC doctors say."