Excellent article, Dr. Smith! I think you bring up some great points. Bottom line is that overall, and with rare exception, our nation's healthcare and political leaders have led poorly (to put it kindly) during the pandemic.

I participated in this study by ordering convalescent plasma for my hospitalized patients with Covid-19 and wondered myself why there wasn't a control arm. I suspect that it may be due to ethical concerns. There is known risk with administering a blood product to a patient including inadvertently transferring an infection or causing an adverse reaction. When administering convalescent plasma, a provider is suggesting the risks are outweighed by the potential benefits. However, just giving plasma that lacks antibodies to the novel coronavirus (what a control group would receive) really only carries risk without any reasonable chance for benefit which is likely why there was no control arm. In addition, donor plasma is a limited and expensive resource and therefore is not a good placebo.

While I think convalescent plasma probably has some benefit for critically ill patients early in their disease course, it is by no means a wonder-therapy. I was also disappointed at the FDA's approval based on the lack of convincing evidence. Dexamethasone, anticoagulation, diuretics, and proning are still our best tools at this point. For more on my experience the interested reader is welcome to look here:

https://medium.com/beingwell/what-i-learned-this-week-caring-for-hospitalized-patients-on-the-covid-19-unit-47e18e7ae52c

Husband, Father, Health and science writer, Interpreter of medical jargon, Hospitalist physician, Board certified in internal medicine and pediatrics

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