The world is facing a situation never before seen on this magnitude-the emergence of a new virus which, because of the ease and magnitude of travel between nations and the highly virulent nature of the virus, has, in less than 6 months, affected all countries and significantly changed life as we know it everywhere.
As we move toward developing and having the systems for widespread testing for the virus and for its antibodies and begin the process of utilizing apheresis both to collect plasma from recovered patients and, using plasma exchange to treat some of the non -responders, this journal will focus on bringing our readers information on practice and concerns in different parts of the world. We encourage the submission of articles and letters to the editor as the information gained in some countries, particularly those with early onset of the infection, will be vital to others. Please let us hear from you.
In this issue, we have 3 articles addressing different aspects of the pandemic. The first, by Amiral, Visaac and Seghatchian, describes Covid-19 activation of hemostasis and immune reactions and askes the extremely important question as to whether an autoimmune - reaction is contributing to the delayed severe complications in certain patients. There are some extremely important points raised in this paper, particularly the question of allo or autoantibodies.
The second paper, by Brown and McCullough, considers the use of convalescent plasma from recovered patients for the treatment of patients as does the third paper, by Seghatchian and Lanza. This is a procedure with considerable precedence having been used as early as the Spanish-American war and then routinely, for many years to produce Rh immune globulin and more recently, in the SARS epidemic. Many centres are setting up to do this and there are guidelines, such as from the AABB, on principles to follow. In this regard, readers will note the concern about the the development of autoimmunity expressed in the Amiral paper. So, it is clear that there will need to be careful assessment to ensure that we collect the “good” antibodies and no harmful ones.
And, what about using PE in (young) patients who are on a ventilator but not responding? This would reduce the cytokines and help with the thrombotic complications. This approach is supported by some of the sepsis literature and is worth a try!
Again, we welcome submissions on this topic and will keep you to date on the evolution of this never before experienced global medical emergency.