A new initiative is matching covid-19 patients with plasma donors

On 30 May, Adwitiya Mal’s in-laws, both aged 60-plus, began to show symptoms of covid-19. They tested positive a day later and were advised home isolation. “After a week, my mother-in-law started to get better but my father-in-law’s situation started to deteriorate. His blood oxygen levels and pulse dropped," says Mal. “He said he wanted to go to the hospital. And when someone like him—an army man, built like an ox—says they need to get admitted, you know it’s serious."

Once he was admitted to Max hospital, Saket, Delhi, he needed to be moved to the ICU, and as his condition worsened, doctors advised plasma therapy. Over the next three-four days, the family put out posts on Facebook and sent messages on WhatsApp, speaking to over 250-300 potential donors. “We have seen extremes of human nature in this process—a donor who volunteered to donate plasma who, despite not being well-off, spent his own money to get a blood test, pay for transport and so on and yet refused to take any money from us," says Mal. “The other extreme was people saying ‘paise aap transfer kar do, hum kal aayenge (transfer the money and we will come tomorrow).’ And I couldn’t really blame them, everybody’s hard up these days," says Mal.

The donor they homed in on proved to be ineligible—she was pregnant. They had to start the entire process all over again. By the time they traced a donor four days later, the hospital too had found one. Mal’s father-in-law got the plasma transfusion, and when this was combined with two rounds of the antiviral Tocilizumab over two days, his health began to improve. A few days later, he was back home and had tested negative for SARS-CoV-2.

Around the same time, Mal’s childhood friend Mukul Pahwa’s uncle too tested positive for covid-19 in Delhi. Though his uncle did not need plasma therapy, Pahwa, a London-based software consultant, had been in touch with Mal through the ordeal of hunting for a suitable plasma donor for his father-in-law.

Potential plasma donors and patients can register on the Dhoondh.com website for a match.

The two decided to create a technology-based solution to make the process easier for others in a similar situation. They invested around $3,000 (around ₹2.27 lakh) from their savings. It took them four days, from 7-11 June. Pahwa would spend the days working, and the nights, coding. By 12 June, Dhoondh.com was live, ready to connect potential plasma donors with patients—both parties register on the website for a match.

“We needed to do it now not because we are in a competitive market but because it’s a problem that needs to be solved immediately," says Pahwa. “I live in London and I have seen what’s happening with covid-19 in the last few months. This helps to solve a problem that we faced, for other people who might need it too."

They were right. Within 72 hours, they had over 12,000 hits and 1,100 people, both patients and donors, had started filling in forms. By 15 June, the number of patients registered was close to 150, the number of donors stood at 190. Pahwa, who has been working on websites and apps for decades, says a response like this at such an early stage is unprecedented.

IS PLASMA THERAPY EFFECTIVE?

Clinical trials for convalescent plasma therapy only began in India in May—though the treatment is allowed outside controlled trials if hospitals adhere to Indian Council of Medical Research (ICMR) guidelines. The plasma of a recovered, healthy donor—ideally 14-28 days after the first negative test post infection—contains antibodies that help fight the virus if transfused in a sick patient.

Swapneil Parikh, a research fellow at the molecular lab in Mumbai’s Kasturba Hospital, which has joined ICMR trials on the use of plasma therapy, explained its efficacy in an interview with Mint published on 9 May. “Recently, for SARS and MERS, plasma therapy was effective—when we say effective, it’s based on small, poorly powered studies. Nothing in the form of widespread clinical trials. But there are two concerns," said Dr Parikh. “The first, immunity against SARS-CoV-2 may not be just related to antibodies but might be due to special white blood cells called T-cells; plasma therapy is based on the assumption that immunity is mainly due to antibodies. Secondly, some laboratory evidence with SARS has shown immune enhancement of infection." While this is speculative, it does raise some concerns about the potential harm of plasma therapy, said the doctor.

The Dhoondh founders are clear that they are not involved in the medical aspect of the process. Their job is to connect prospective donors to patients whose doctors may have recommended the treatment. Once that is done, it is for the doctors to assess and decide procedures.

Still, Mal and Pahwa have two doctors—cardiologist and physician Hari Om Gupta and gynaecologist and laparoscopic surgeon Kanika Gupta—providing support and advice on the criteria donors must meet. They must, for instance, not have any co-morbidities, the blood groups must match, and they must meet the stipulation on time-frame post recovery.

Over the first three-four days, the founders, along with Mal’s wife Kanupriya, a few friends and volunteers connected candidates manually. They would call prospective donors, take consent for forwarding their details to a patient, and match the two if all the requirements were met.

One such donor was a 40-year-old professional from Gurugram who chooses to remain anonymous. He tested positive for covid-19 on 26 May, was rushed to hospital in Delhi and recovered in 10 days. “I was not home for my birthday and my son was crying as he watched me leave. When I came back, it was like I was given a new lease of life and I wanted to do whatever I could to help others who may need it." He received the link to Dhoondh on a WhatsApp bikers’ group he’s part of and signed up immediately: “I received the passcode and a call and was told that I would be eligible as an active donor after a few days."

COVERING ALL BASES

Pahwa says he has been particular about data privacy. While India is yet to pass a comprehensive law on this, it is largely ethics that dictate how websites such as these ought to deal with data—particularly information as sensitive as medical history. “Essentially, what they need to do is follow a process of data protection even though there is no data protection law," explains Apar Gupta, lawyer and executive director of the Internet Freedom Foundation (IFF), an organization that works for digital liberties. “They need to ensure the information they are gathering is through a process of consent, which means not only telling a person what information they are gathering and what use they are putting it to but also ensuring that it is not put to any other use for which consent has not been sought in advance."

Working with lawyers to make sure these standards are met, Pahwa has released a privacy policy on the website, informing candidates about how their data will be handled and the option of removing it or revoking consent. “Please note that any such information may have been processed and/or shared with relevant third parties to facilitate matching of donors with recipients by such stage, but will not be used for any future matching," the platform’s data policy reads.

Pahwa and Mal managed the back-end work themselves—only putting in automation measures to match candidates when they believed the process was ethically sound and strongly encrypted. Within the first three days, they had over 100 attempts to breach the servers—each one was foiled. Scaling up is inevitable, say the founders, since it’s already happening without marketing. They don’t plan on monetization just yet but going forward they do have volunteers on board to help connect recipients to donors and provide engineering support.

What takes precedence, however, is reach and accessibility. “We are looking to make the platform available in different regional languages, that is the first thing we will do. By the end of this week, we will ensure it is available in Hindi," says Pahwa, who hopes to translate the page into other languages eventually.

Mal adds, “We really don’t know what will happen next, all we know is we want to help as many people as possible." Dhoondh, with a heart as its logo and its call to action—“Ready to help save a life?"—is a reflection of just that.