Getting Creative but Remaining Rigorous, and Scientific, in Responding to a Pandemic

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Apparently, I have missed an anniversary.

Almost exactly 10 years ago, when we were in the midst of the last pandemic, I published my very first scholarly first-author paper – Convalescent transfusion for pandemic influenza: preparing blood banks for a new plasma product? The basic idea of this paper is that I and coauthors Patricia Brunker and Paul Ness would review a concept that had been around for a while – that you could take certain blood products from people who had recovered from a disease like the Swine Flu (or Ebola, or SARS) and use it to treat people who were sick – potentially very sick – when there wasn’t another available medical countermeasure that seemed to be working. But one of the things that I and my coauthors highlighted was that there would be risk associated with this kind of intervention, and that you would need to study it. This idea is back in the limelight, and I hope it will be taken seriously.

Emergency situations like a pandemic call for reconsidering some of our standards for testing for safety and efficacy. But that doesn’t mean that they shouldn’t exist. We are in a situation with few data points on what medical interventions work, and we’ll soon run low on the ability to provide supportive care to all who need it. I was heartened to see some pushback from leading national minds on the current administration’s fixation on very preliminary studies for how to medically intervene for COVID-19. Now, maybe these studies will really end up working – or maybe we will in fact use the blood sera of recovered patients to treat those in need. But we need to intervene when we have a reasonable body of evidence, not from one study here or there. That doesn’t mean researching for the sake of research when people are at high risk of death from COVID-19. We need to understand how well new potential treatments work, as well as the risks. To go back to the convalescent transfusion idea – one of the major risks is Transfusion Related Acute Lung Injury. Obviously, we’d like to learn how to minimize that risk given the issues with Acute Respiratory Distress Syndrome in COVID-19 patients. Even good ideas are just that – ideas – until we can know, and show, that they are safe and effective.

With the entire world mobilized to create medical interventions against COVID-19, I expect we’ll see a lot of interesting charts or tables in the next several weeks. And I hope that most of them pan out. I hope that most of these studies give us an arsenal with which we can fight COVID-19. We’re going to need it. But I do hope that replication becomes the name of the game – not replication of the disease, but replication of evidence to fight it.

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JP Leider
Jonathon P. (JP) Leider, PhD, is an independent consultant in the public health and health policy space, as well as a Senior Lecturer at the University of Minnesota and Associate Faculty at the Johns Hopkins Bloomberg School of Public Health. He has active projects and collaborations with foundations, national public health organizations, public health researchers and academics, and public health practitioners. His current projects focus on public health systems, the public health workforce, and public health finance. He holds a PhD in Health Policy and Management from the Johns Hopkins Bloomberg School of Public Health.

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