By James Shea

Last March, as he lay in a hospital bed at VCU Medical Center, Billy Brooks thought COVID-19 would kill him. That didn’t happen, and Brooks credits an experimental treatment for saving his life.

Brooks was the first COVID-19 patient at VCU Health to receive convalescent plasma — a treatment in which the plasma of someone who’s recovered from COVID-19 is transfused into someone who’s still sick. The hope is that the antibodies in the donor plasma will attack the coronavirus.

At the time, Brooks had been in a medically induced coma for 14 days and was on a ventilator. Doctors had struggled to combat his high fever and breathing difficulties, and they hoped the convalescent plasma would help.

“My fever subsided shortly after they gave me the treatment, and I started to come around,” Brooks said. “Then they began waking me up, and I could hear what they were saying. I would respond with headshakes. I absolutely believe it played a role in me getting better.”

Transfusions aren’t new

Convalescent plasma has a long history in treating viruses, said Dr. Jeffrey Donowitz, a pediatrician at VCU Medical Center who specializes in infectious diseases. During the 1918 pandemic as well as recent outbreaks of Ebola, doctors transfused convalescent plasma into patients, with good results. Researchers saw the treatment as a possible option for the novel coronavirus.

“This idea of taking blood products from someone who has recovered and giving them to somebody who is actively sick is not new at all,” said Donowitz, who played a key role in bringing the treatment to VCU. “It has been tried in one form or another throughout medical history.”

As he began reading on COVID-19 and previous coronavirus outbreaks, including SARS and MERS, Donowitz found preliminary evidence suggesting convalescent plasma treatments might treat the novel coronavirus. The challenge was clearing the regulatory hurdles, including special permission from the FDA, and acquiring plasma containing the required antibodies.

Mayo Clinic had established an Expanded Access Program with the FDA to serve as centralized oversight for the use of the investigational product, with hospitals around the country using their program.  Donowitz filled out the application, and VCU joined the first wave of hospitals in the United States to use the treatment.

Infected at work

A registered nurse, Brooks works at different hospitals in the region. He was infected while working in a COVID unit at a hospital outside Richmond. Brooks had volunteered for an overnight shift so a pregnant nurse could take the night off. He worked with four different COVID patients that night.

“I volunteered because I didn’t want her to get sick,” Brooks said.

A few days later, Brooks was mowing his lawn and started to feel ill. His temperature read 101. He wasn’t sure he had COVID-19, but a test a few days later revealed that he did.

At first Brooks had mild symptoms, but two weeks later, he had a high fever and difficulty breathing. He considered going to a local hospital near his home but decided he could get the best treatment at VCU Health.

“They are a teaching hospital and would be able to try the newest stuff for treating COVID,” Brooks said.

He was transported by ambulance to VCU Health and admitted to the ICU. “I wasn’t nervous until the following day, when I couldn’t breathe,” Brooks said. “Being a nurse, I knew I was either going to be in respiratory arrest or cardiac arrest.”

Locating the plasma wasn’t easy

Brooks was put on a ventilator to help him breathe, but he continued to struggle. His family pressed the hospital to try anything, even experimental treatments.

VCU was already authorized to give convalescent plasma under the Expanded Access Program, but the challenge was obtaining donated convalescent plasma. VCU Health, like many hospitals, relies on blood banks for its blood products. It can’t, on its own, find people in the community with the COVID-fighting antibodies.

“Getting the blood product was actually harder than I would have liked,” Donowitz said. “It was not that easy.”  Given the limited number of donors and the high demand for COVID convalescent plasma nationwide, it took 10 days to obtain a unit.  “Those were the early days,” Donowitz added.  “Things are much better now. We can usually give it the same day.” He stressed the continued need for donation from recovered COVID-19 patients. 

Brooks’ recovery was unexpected. Convalescent plasma seems to work best when given early. Brooks, however, was already extremely ill.

Donowitz stresses that data on convalescent plasma therapy is promising but mixed. By the end of October, VCU had administered 130 units of convalescent plasma to COVID patients. About 86,500 doses had been administered through Mayo Clinic’s Expanded Access Program. Researchers should have a better sense of the treatment’s effectiveness within the next few months.

The road to recovery

Brooks had a long road to recovery. He had spent two weeks on a ventilator and a month in the hospital. Once off the ventilator, he couldn’t walk and had difficulty speaking.

Brooks returned home in May, but his recovery was challenging. His body was worn down from fighting. He began physical and occupational therapy at home, then continued with outpatient therapy until early August.

Brooks went back to work in October, taking an assignment at a hospital in North Carolina. He told the facility he wouldn’t work with COVID patients.

“I don’t want to work around those patients until I feel comfortable again,” Brooks said. “I need to let my body heal.”

A large number of COVID-fighting antibodies were detected in Brooks’ blood, so he became a donor, too. He hopes to help others similarly struck down by the virus.

Happy with VCU Health

“I was really impressed with my doctors and the nurses,” Brooks said. “They did everything possible to save my life. … Even one of the administrators came by every day and checked in on me. There were a lot of people pulling for me.”

Since Brooks’ transfusion, the FDA has authorized the use of convalescent plasma for emergency use. The next person in need won’t have to wait as long as Brooks. VCU Health has doses of the plasma ready and waiting for future patients.

For more information on COVID-19, please visit our COVID-19 news center.