1. Epidemiology and Global Health
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Convalescent plasma use in the USA was inversely correlated with COVID-19 mortality

  1. Arturo Casadevall  Is a corresponding author
  2. Quigly Dragotakes
  3. Patrick W Johnson
  4. Jonathon W Senefeld
  5. Stephen A Klassen
  6. R Scott Wright
  7. Michael J Joyner
  8. Nigel Paneth
  9. Rickey E Carter
  1. Department of Molecular Microbiology and Immunology, Johns Hopkins School of Public Health, United States
  2. Department of Quantitative Health Sciences, Mayo Clinic, United States
  3. Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, United States
  4. Department of Cardiology, Mayo Clinic, United States
  5. Department of Epidemiology and Biostatistics and Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, United States
Research Article
Cite this article as: eLife 2021;10:e69866 doi: 10.7554/eLife.69866
4 figures, 1 table and 6 additional files

Figures

Figure 1 with 1 supplement
Doses of COVID-19 convalescent plasma (CCP) distributed in the USA by the American Red Cross and American Blood Centers (dashed) and total COVID-19 cases in the USA reported in Our World in Data (OWID) database (solid).

The vertical black line marks August 23, 2020, when the US Food and Drug Administration (FDA) announced that Emergency Use Authorization for CCP in the USA. The vertical gray line marks April 4, …

Figure 1—figure supplement 1
Correlation of convalescent plasma distribution and usage within the Expanded Access Program (EAP).

Shown is the progressive increase in the number of convalescent plasma units distributed in the USA and convalescent plasma units used in the EAP. Data between April 6 and August 23, 2020, are …

Doses of COVID-19 convalescent plasma (CCP) per hospital admission (red) and mortality calculated as deaths per hospital admission (green) using Our World in Data (OWID) database.

To account for time between admission to death, deaths from 2 weeks after admission are used to calculate mortality. The vertical line marks August 23, 2020, when the US Food and Drug Administration …

Figure 3 with 3 supplements
Correlation of mortality (death per admission) and COVID-19 convalescent plasma (CCP) doses per admitted patients using the Our World in Data (OWID) database.

Correlation analysis yields a Pearson’s correlation coefficient of −0.518 (p=0.0024). The black line represents a linear model regression with an R squared of 0.268.

Figure 3—figure supplement 1
A series of linear regressions and Pearson’s correlation tests comparing weekly reported deaths to new weekly hospital admissions, offset by various numbers of weeks to identify the length of lag between admission and death of patients using Our World in Data (OWID) database.

y-Axis values reflect the parameter of each gray box throughout the shifted weeks. Correlations peak at 2–3 weeks shifted, suggesting the lag time between admission and reported death is roughly 2 …

Figure 3—figure supplement 2
Mortality from COVID-19 by quintile of percent of admissions receiving COVID-19 convalescent plasma (CCP).

Regression analysis for the quintiles revealed R = 0.5 and p=0.03.

Figure 3—figure supplement 3
Investigation of high age group mortality.

The shifted mortality is compared to the percent of hospitalized patients 65+ each week as reported by the Centers for Disease Control (CDC). There is no significant correlation between the two …

Figure 4 with 1 supplement
Estimated (Est.) deaths under modeled scenarios of COVID-19 convalescent plasma (CCP) using Centers for Disease Control (CDC) database.

Panel A presents the longitudinal observed (dashed line) and modeled number of deaths under three scenarios for CCP over the study period (August 3, 2020 to February 22, 2021) that included 356,534 …

Figure 4—figure supplement 1
Replicated cumulative excess deaths analysis per Our World in Data (OWID) database for scenario 1 (orange).

Maintained plasma transfusion rate from October to November throughout period, scenario 2 (blue): 50% transfusion rate throughout period, and scenario 3 (red): 0% transfusion rate throughout period. …

Tables

Table 1
Estimated number of excess deaths due to transfusion hesitancy.
Time periodTransfusion rateNumber of admissionsDeathsMortality rateExpected deaths if mortality had remained at 18.16%Excess deaths in the low transfusion periodExcess deaths per 1000 admissions
High utilization ( September 21, 2021 to November 8, 2021)42.59%257,42446,74718.16%46,747
Low Utilization (November 9, 2021 to March 22, 2021)27.43%1,344,463270,01920.08%244,14825,87119.2

Additional files

Source data 1

Centers for Disease Control (CDC) analysis data.

Summarized data of hospitalizations and deaths, from CDC data.

https://cdn.elifesciences.org/articles/69866/elife-69866-data1-v2.xlsx
Source data 2

Blood banker distribution data for plasma units.

https://cdn.elifesciences.org/articles/69866/elife-69866-data2-v2.xlsx
Supplementary file 1

Mortality of COVID-19 in US COVID-19 convalescent plasma (CCP) efficacy studies.

https://cdn.elifesciences.org/articles/69866/elife-69866-supp1-v2.docx
Supplementary file 2

Data from and calculations for excess mortality from COVID-19 convalescent plasma (CCP) hesitancy based on the Centers for Disease Control (CDC) database.

https://cdn.elifesciences.org/articles/69866/elife-69866-supp2-v2.docx
Supplementary file 3

Excess death calculations based on Our World in Data (OWID) database.

https://cdn.elifesciences.org/articles/69866/elife-69866-supp3-v2.docx
Transparent reporting form
https://cdn.elifesciences.org/articles/69866/elife-69866-transrepform-v2.docx

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