News reports over the past two days have given us some insight into the aggressive treatment being provided to the latest Chinese victim of the H5N1 virus. Her condition remains poor, despite the massive resources being applied.
Today, we are hearing they Chinese are attempting to create a serum from the blood of a recovered bird flu patient, and hope that it will help this current patient in her fight against the virus.
First the articles on her treatment, then some discussion.
A farmer who was confirmed on Tuesday to be infected with the deadly H5N1 strain of bird flu is still in a critical condition in hospital.
The 44-year-old woman, surnamed Li, is receiving medical treatment in Jian'ou City Hospital, said Xu Longshan, spokesman and chief of the Fujian Provincial Professional Panel for Prevention and Control of Human Infection of bird flu, on Friday.
According to Xu, the patient was found with inflammation on her left lung when she came to the hospital on Feb. 24, but her pneumonia symptoms developed quickly and she went into a coma the next day. A chest X-ray on Feb. 25 shows large shadows on her lungs.
As of Thursday evening, Li's body temperature and pulse had returned to normal, and her lungs and breathing appeared to be functioning better but she was still breathing with the help of a respirator, Xu said.
Doctors say Li is still in a critical condition and they are trying to boost her immunity to prevent further organic infection.
Over ten doctors and medical experts from local hospitals, and Beijing-based Chaoyang hospital and Ditan Hospital are trying to work out a detailed treatment plan to save Li, said Xu Yongxi, head of the hospital.
Policemen and hospital staff have been seen guarding the ward where the patient is staying and doctors are wearing thick, disinfected suits.
Obviously, Li's condition is grim.
The statement that doctors are trying to boost her immunity to prevent further organic infection is, apparently, a reference to the blood serum treatment reported today.
The farmer from East China's Anhui Province, who contracted the deadly H5N1 strain of bird flu last December but was later cured of the avian disease, was called in to donate his serum for treatment of another rural Chinese woman who was confirmed last month to have been infected of the same virus.
Xu Longshan, spokesman and chief of the Fujian Provincial Professional Panel for Prevention and Control of Human Infection of bird flu, told Xinhua Saturday health workers from Anhui Province Thursday escorted the farmer, identified by his surname as Li, to Fuzhou, capital of Fujian Province, where experts from the blood center affiliated to the Fujian Provincial Bureau of Health got serum from him the second day.
Li has returned back home.
"The serum was brought to Jian'ou on the same day, and so far, medical workers have carried out the first round of injection on the woman who was just confirmed of being infected of the lethal strain of the avian disease," said Xu.
"The method is new but is for sure to be of some effect in improving the woman's capability of fighting against new rounds of infection," said Xu, who admitted it would take some time before the woman could develop immunity of her own against the avian disease.
Either there is a mixup in the names in this article, or both patients have the same surname, Li. A trivial point, unless they are related.
As we've seen far too often, the course of illness with H5N1 is a rocky one. To date, roughly 60% of all known victims have died. Nearly all of those who have recovered have required extraordinary, and often heroic, measures during a prolonged hospital stay.
According to reports, Li has 10 doctors working on her case. She's been either in a coma, or on a respirator, since Feb 24th. It isn't stated, but no doubt she has received Tamiflu, and antibiotics, as they are standard treatments. Now, they are trying an experimental human serum.
Despite her grave condition, Li has an advantage that most people will not have during a pandemic. She is in a hospital, has multiple doctors seeing to her care, has received all of the standard treatments, has had a respirator, and will now receive an experimental treatment.
Should a pandemic erupt, after the first week or so, no one will receive that level of care unless they are a Head of State.
According to news reports, Li began to show symptoms on February 18th, was seen in a local clinic for a week before being transferred to the hospital, and she had pre-existing conditions that likely compromised her ability to recover.
All negative factors. Early, aggressive treatment with antivirals might have prevented her complications. Her pre-existing medical condition may be a serious factor, too.
But the fact remains, to date, 60% of all patients have died. Many have been young, and presumably healthy.
Doctors and scientists will be watching closely to see if this new human serum can bring Li back from the brink. A failure there would not discount the use of a serum, given her condition. But large scale use of a serum, even if it proved effective, is in doubt.
Harvesting serum antibodies from someone who has been vaccinated, or who has contracted a disease and recovered, is not a new idea. Recently Chinese scientists have suggested infecting horses with an attenuated (weakened) H5N1 and producing a serum.
The process is relatively simple. Once someone (or an animal) is able to produce antibodies, a quantity of blood can be removed and through a process called plasmapheresis, the blood cells are removed from the blood plasma. This is done by passing the blood through a special filter, or by using a centrifuge. The blood plasma will contain antibodies that could then be injected into people.
A serum could, theoretically, be used as either a treatment for someone already infected, or as a prophylactic, to prevent infection.
There are problems involved, however. It takes a large amount of blood product to produce a small amount of serum. Human donors would have to be screened for AIDS and Hepatitis, among other blood borne diseases. Horse serum is still used today, although sparingly, because of `serum sickness’, a reaction to the serum that can be fatal.
And lastly, a serum is not a vaccine. It confers a temporary immunity, not a permanent one. The effects of a serum would last a few weeks, and then another injection would be needed. With each new injection, the likelihood of a bad reaction increases.
While a serum might be produced and even used, it is unlikely to be available in any quantity, and it will have a substantial potential for side effects.
None of this is to suggest that the Chinese shouldn't try to use a serum. We are facing a grave, possibly devastating pathogen, and right now we need answers.
Hopefully, these early patients will provide them, so we will have greater success treating patients down the road.