Everything You Wanted to Know About Donating COVID-19 Antibodies

If you’re a survivor of COVID-19, your blood might be pretty valuable right now.

Across the country, doctors and researchers are using the blood products from people who have recovered from the novel coronavirus to treat patients who are severely ill. About 300,000 people in the U.S. who no longer show symptoms of COVID-19, and the Food and Drug Administration—as well as the Mayo Clinic and CSL Plasma—have urged that more donations are needed to meet overwhelmingly high demand during a global crisis that has exhausted public health resources.

If you have recovered from COVID-19, here’s what you need to know about donating.

Plasma is one of four main components of blood. Blood is made up of platelets, red blood cells, white blood cells, and plasma, the last of which refers to the nonliving, liquid part of blood. Ace Robinson, director of the Center to End the Epidemics at the National Minority AIDS Council, said that a vial of donated blood is like a glass of lemonade, where the “sugar and the lemon fall to the bottom, and then above, it will be more clear.” “The part that’s clear, that's your plasma,” he told VICE.

Robinson added that this straw-colored fluid isn’t just “unused liquid.” Plasma is critical to the body’s immune response because it contains antibodies, which is why it’s “been all over the TV recently and why so many people are talking about it.”

Convalescent plasma is the blood fluid of someone who has recovered from an infection and therefore likely contains relevant antibodies—in this case, for COVID-19.

Antibodies are proteins in blood that are created by the immune system to help fight off disease. They attach themselves to infectious material and “flag it” as a “foreign invader so that white blood cells can attack and kill the infection,” explained Sarah Henn, chief health officer at Whitman-Walker in Washington, D.C.

In the case of COVID-19, Henn said that antibodies have started to be used to treat patients who have not yet developed antibodies themselves or do not have enough antibodies in their immune system to recover. “The thought is that by giving someone those antibodies, it will allow them to better fight the infection because those antibodies will attach to the virus and allow their own white blood cells to attack and kill those cells,” Henn told VICE.

Donations of COVID-19 antibodies can be used in several different ways. For instance, in a four-month clinical trial at Penn Medicine, patients will receive transfusions of up to 500 mL of convalescent plasma, often distributed through multiple doses.

Convalescent plasma is also being used to develop vaccines for the novel coronavirus. Although the biotechnology company Moderna recently announced that a vaccine trial is headed into phase II of testing, the nation’s leading infectious disease expert, Anthony Fauci, has warned that it could be 12 to 18 months before a COVID-19 vaccine is readily available.

It is currently unknown whether a transfusion of COVID-19 antibodies can help fight off the novel coronavirus. Studies published in the National Academy of Sciences and Journal of the American Medical Association suggest some early success in transferring plasma from COVID-19 survivors to those who are severely ill, but health experts say more research on the subject is needed before conclusions can be drawn, especially because the virus is so new.

Researchers remain hopeful based on previous success with using convalescent plasma to treat infectious disease, said Alyssa Ziman, medical director of the clinical laboratories at the Ronald Reagan UCLA Medical Center. The treatment dates back to 1891 and was used during the 1918 flu pandemic, the 2002 SARS epidemic, and the Ebola outbreak in 2014.

“We know from history that we have used convalescent plasma for different illnesses,” Ziman told VICE. “They've been used with measles, and we use them with hepatitis B more in a prophylactic sense. Antibodies can be a powerful therapeutic tool.”

The Red Cross requires convalescent plasma donors to be at least 17 years of age, weigh more than 110 pounds, and generally be in good health. On its website, the emergency relief organization also states that all applicants must “have a prior, verified diagnosis of COVID-19,” but says they must be “symptom free and fully recovered from COVID-19.”

Most donation centers mandate that COVID-19 survivors be asymptomatic, meaning they show no symptoms of the novel coronavirus, for at least 14 days before giving convalescent plasma, but requirements vary somewhat. The Jefferson Blood Donor Center in Philadelphia, Pennsylvania, for example, asks that individuals who have been asymptomatic for fewer than 28 days provide a “repeat negative COVID-19 test.

Potential donors who meet qualifications should contact their local community blood center, hospital, or nearest medical center to inquire about convalescent plasma donations. Those who are unsure about how to locate these institutions can refer to databases established by the American Association of Blood Banks, Vitalant, and the Plasma Protein Therapeutics Association, or fill out a donation form with the American Red Cross, which directs qualified applicants to the nearest participating facility.

Hospitals and medical centers that are currently accepting convalescent plasma from COVID-19 survivors include Mount Sinai in New York City, Hoxworth Blood Center in Cincinnati, and the UCLA Medical Center and Cedars Sinai in Los Angeles. Colleges like the University of Washington, University of San Francisco, and Tufts University in Medford, Massachusetts, are also conducting trials on COVID-19 antibodies.

Gay and bisexual men must refrain from same-sex sexual contact for three months before they are permitted to donate COVID-19 plasma, according to new recommendations released by the Food and Drug Administration in April. But as VICE previously reported, it could be months before many donation centers update their systems and donation guidelines to adhere to the regulations. That means men who have sex with men are often being held to an outdated policy requiring them to abstain from sex for 12 months before donation.

Henn urged the FDA to reconsider guidelines that place outdated restrictions on gay and bisexual men based on decades-old fears that they will transmit HIV through the blood supply. She said the presence of HIV in the blood can be easily detected within days through pooled blood testing, in which lab technicians “take small samples from multiple donors and check for the virus.”

“If it turns up positive at all, then you can go back and test each sample,” she said. “We have very accurate ways of testing for HIV that are much better than asking someone about their sexual activity.”

Policies on whether individuals can donate plasma after getting a tattoo vary by donation site. Ziman said UCLA’s guidelines are that donors who went to a licensed tattoo parlor have to wait until the tattoo is “fully healed with no signs of infection” at the time of donation. Those who did not get a tattoo from a licensed artist will be subject to additional restriction in the state of California, however.

“If your buddy gives you a tattoo in his garage, you're deferred for 12 months,” she said, noting the increased likelihood of transmitting infection to a vulnerable patient whose immune system may not be prepared to fight it.

People who have had symptoms of COVID-19—such as fever, dry cough, diarrhea, and a flu-like illness—can request an antibody test through their doctor, or they can order a test through companies like LabCorp using an independent physician service. The Red Cross is offering its own tests for potential donors of convalescent plasma, but they are not available for members of the general public.

Antibody tests may not work for everyone, however. For individuals who didn’t show symptoms during their illness, Ziman said the likelihood of the test “being a true positive will go down” because it’s not clear if asymptomatic individuals develop detectable antibodies to COVID-19.

“For people that are just looking to be tested to see, ‘Was I exposed?’ the tests may not provide them with valuable information,” she said.

Asa Radix, director of research and education at Callen-Lorde, said that not enough time has passed for a COVID-19 antibody test to be developed that meets the standards of FDA approval. “It usually takes a while before the FDA approves a test because you have to be able to show that the test is valid and reliable,” Radix told VICE.

But due to the urgency of COVID-19, the FDA has approved production of antibody tests for emergency use authorization (EUA). Under EUA guidelines, companies are still required to share data with the FDA regarding the efficacy of their tests.

Although Radix said oversight of the more than 200 available COVID-19 antibody tests “hasn’t been as rigorous” as it might be under more typical circumstances, Henn encouraged anyone who does get a test to make sure it has been EUA approved. “That way you know that the FDA has reviewed data that supports the efficacy of the test so that the test you’re getting back has some meaning to it,” she said.

Generally, there are no specific requirements for what donors are asked to do before coming in to give convalescent plasma. Donation centers will likely require that you wear a mask due to COVID-19 health and safety guidelines. (It’s best to call one’s local center and ask whether there are additional specifications.) Experts suggest that individuals make sure to get a full eight hours of sleep before donation day, that they’re well-hydrated, and that they eat a full breakfast.

Ziman suggested avoiding “fatty foods” in the days leading up to donation. She said that several years ago In-N-Out Burger, a West Coast fast-food chain, opened across the street from the UCLA donor center, and suddenly many of the plasma samples they began receiving “looked like milk.”

“It wasn’t yellow,” she said. “It was really fatty. The challenge is it interferes with the ability for us to test for HIV, HCV, and HPV. If we don’t have those test results, we can’t use the blood for transfusion.”

Prior to donation, individuals will be asked to complete a donor history questionnaire, which is intended to verify that they are a suitable candidate to transfer convalescent plasma with low risk to the recipient. Questionnaires typically have about 50 questions regarding things like pregnancy, travel history, and any behaviors that may be considered high-risk, such as intravenous drug use.

Afterward, individuals will undergo a short physical followed by an assessment of their red blood cell count in order to determine that they are not anemic. This will be followed by temperature, blood pressure, heart rate, and respiratory rate checks, as well as a weigh-in to confirm the donor meets the 110-pound minimum requirement.

Should the donor appear to be a solid candidate to donate convalescent plasma, the donation will take about an hour. The individual will stay seated with a blanket to stay warm until a medical professional removes the needle and applies a bandage. Under California law, the donor must wait for an additional 15 minutes before leaving the blood center to ensure there was no adverse reaction to donation.

Donors are generally discouraged from lifting heavy weights or engaging in strenuous exercise for the next 24 hours, and it is generally advisable to maintain good hydration.

Henn said that the overall health risks from donating convalescent plasma are “very small,” but there are some considerations that donors should keep in mind. “If you're donating a larger volume of plasma, you can get low calcium levels related to that, which is part of the reason it’s good to eat before donation, particularly to eat some foods that are high in calcium,” she said.

Yes. According to its website, the Red Cross requires that donors wait 28 days to donate a second round of convalescent plasma, but there are no restrictions on how many times an individual may donate.

Public health authorities strongly encourage individuals who are not able to donate convalescent plasma to consider giving other blood products. Whole blood donations take no more than 15 minutes to process, while platelet donations can take anywhere from an hour to 90 minutes. These contributions are critical after the Red Cross reported the cancellation of 2,700 blood drives in March alone, resulting in the loss of an estimated 86,000 donations.

It’s estimated that just one blood donation can save up to three lives, whether that’s a COVID-19 patient or anyone else who needs critical care. “People can still help out a lot of patients,” Ziman said. “It is an amazing gift that people can give. This is a time where our community really needs to come together and support each other.”