In the last text that Dr. Michael Leonard sent before COVID-19 attacked his body and forced him to go on a ventilator, he reassured his wife of 32 years.
“I’m coming home,” wrote Leonard, a 68-year-old anesthesiologist and businessman from Evergreen.
“He promised me that,” Meg Leonard said. “I’m just hanging on to that.”
And now, Michael’s chances of coming home and keeping his promise look even better. He remains on a ventilator in the ICU at UCHealth University of Colorado Hospital.
But, day by day, he is improving.
Dark days, an infusion of antibodies and moments of hope
Doctors don’t know exactly why Michael appears to be rebounding, but last week, he became the first person in Colorado and one of the first in the U.S. to receive what’s known as “convalescent plasma.” The plasma contains antibodies from a donor who contracted COVID-19, recovered, and donated that plasma to the blood donor center at Children’s Hospital Colorado. The main Children’s Colorado campus is right next door to University of Colorado Hospital on the Anschutz Medical Campus in Aurora and medical experts at the two facilities frequently work closely together.
The anonymous donor, the team at Children’s Colorado and Michael’s doctors and nurses all hope that the infusion of antibodies may have helped strengthen Michael’s immune system, giving him greater ammunition to fight COVID-19.
Update: ‘Huge’ milestone: Colorado’s first convalescent plasma recipient leaves ICU after 34 days on a ventilator
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The treatments are experimental and Michael also might have received other experimental medications that are part of clinical trials, including a medication called sarilumab, which is typically used for people with rheumatoid arthritis. So, doctors won’t know for sure how much the plasma helped as compared to other treatments Michael has received.
Before getting COVID-19, Michael was healthy and active and loved skiing, hiking and fishing.
He runs a health care consulting company called Safe and Reliable Healthcare, and he had been traveling extensively for about two weeks across the country to hospitals in large cities before returning home to Evergreen in mid-March.
Meg said Michael started coughing almost immediately. His cough worsened, then Michael started running a fever, and eventually struggled to breathe. At his doctor’s urging, Meg took her husband to University of Colorado Hospital two weeks ago and hasn’t been able to see him since.
There were some very dark days as Michael declined fast. His family and his team feared they were losing him. In recent days, however, there have been some powerful moments that have given the Leonards hope.
A chaplain has set up calls over an iPad with Michael, Meg, their son, Matthew, and daughter, Dr. Molly Leonard, who is a surgical resident in Salt Lake City. Molly recently learned some exciting news. A nurse held the iPad up to Michael’s ear.
“Molly is pregnant and the other day, she found out that’s she’s having a girl,” Meg said. “She said, ‘Dad, I want you to know that you’re going to have a granddaughter.’ It looked like his eyebrow lifted up. That was a pretty lovely moment. I feel like he knows we’re there with him.”
Saving critically ill patients and reducing the need for precious ventilators
In the absence of any cures now for COVID-19, medical experts in Colorado are hoping to give convalescent plasma from COVID-19 survivors to as many hospitalized patients as they can.
“Right now, we want to treat the very sick patients, but if we can ramp up our supply, our goal would be to provide plasma for patients who are sick enough to be hospitalized, but who have not progressed to needing ventilators. That’s the ultimate goal,” said Dr. David Beckham, an infectious disease specialist who studies viruses in a lab he runs at the University of Colorado School of Medicine.
Beckham and researchers at his lab study viruses similar to coronaviruses called flaviviruses. They include common viruses like West Nile, Dengue, tick-borne encephalitis, Zika virus, and now are working in the laboratory with the SARS-CoV2 virus which causes COVID-19.
Beckham has joined a team of infectious disease and blood bank experts around Colorado who are now creating a network of sites throughout the state where people who tested positive for COVID-19 in recent weeks — and have recovered — can donate their plasma.
For now, donors must have received a positive result from a COVID-19 test. Of course, tests in Colorado and around the U.S. have been in very short supply. But, it’s possible that within weeks, people who believe they had the illness, but recovered at home and never were tested, will also be able to donate their plasma.
Beckham is racing to create a test at his University of Colorado lab over the next several days that will be able to determine how powerful a donor’s antibodies are.
Different people who contracted COVID-19 will develop different amounts of antibodies that vary greatly in their potency. Interestingly, Beckham said that people who had mild cases of COVID-19 might actually have the fiercest antibodies. With better tests, he’ll get much better information about people’s antibodies.
Once Beckham and the team in his lab create the test, they will work with hospital and industry laboratories to test potential plasma donors who never got a test for COVID-19, but who were fairly certain they had the illness. The new plasma test will enable people who think they had COVID-19, but were never tested, to step up, donate their plasma and help critically ill patients like Michael.
“There’s a lot of hope for the community,” Beckham said. “This is something that you can rapidly get up and running as a potential therapy until we have more advanced treatment approaches down the road.”
The concept of using convalescent plasma is an old one that was used during the 1918 flu pandemic and more recently to try to help patients suffering from Ebola, the H1N1 flu and SARS, an earlier type of coronavirus.
Michael’s family asked about the possibility of getting convalescent plasma exactly when Dr. Kyle Annen, Medical Director of Transfusion Services and Patient Blood Management at Children’s Hospital Colorado, was fielding calls from COVID-19 survivors, who wanted to donate their plasma.
Very small study in China showed 5 of 5 patients survived
Dr. Mary Berg, Medical Director of Transfusion Services at University of Colorado Hospital, called Annen to see if the Children’s Colorado blood bank could provide convalescent plasma. And the answer was “yes.”
“It’s my job to be optimistic. That’s why we’re doing this,” said Berg. “There is promise from giving this convalescent plasma.”
One study of five critically ill patients suffering from COVID-19 in China, found that all five improved after receiving convalescent plasma.
“This is a very small study, but if we can do more plasma transfusions, hopefully we’ll have people on ventilators for a shorter period of time. And maybe we can get plasma for people sooner so we can prevent them from having to get ventilators. And hopefully, we will not run out of ventilators.”
Plasma transfusions don’t work for every infection or every patient, but with broad efforts across the U.S. to solicit plasma donors, medical experts here expect to learn many lessons about whether convalescent plasma can help people who are critically ill with COVID-19.
Children’s Colorado first to collect COVID-19 plasma, others ramping up fast
Additional patients have since received convalescent plasma both at University of Colorado Hospital and at other Colorado hospitals. And, blood centers, including Children’s Hospital, Vitalant, St. Mary’s Medical Center in Grand Junction and the UCHealth Garth Englund Blood Center in Fort Collins are quickly ramping up to collect convalescent plasma from eager donors. Kaiser Permanente Colorado also plans to set up donor sites.
Dr. Annen was the first to collect COVID-19 plasma in Colorado. She had heard about the idea of giving convalescent plasma to COVID-19 patients in early March, when Colorado reported the state’s first official case of the new coronavirus.
Then about two weeks ago, just around the time Michael had to be hospitalized, officials at the Food and Drug Administration (FDA) issued new guidelines for giving convalescent plasma to COVID-19 patients.
Annen started working on protocols right away. Even though children have fared better than adults, Annen knew convalescent plasma would be critical for patients throughout Colorado. She wanted her center to collect plasma to support hospitals throughout Colorado and ultimately, throughout the region.
Right around the time that Annen began figuring out a system for accepting plasma, Berg called seeking plasma for Michael. Annen found a donor who had previously tested positive for COVID-19 and had been symptom-free for at least 14 days and who met all the other requirements. She and her team arranged for the donor to come in last week. The donor took another test, and this time, tested negative for COVID-19, meaning the donor was no longer infectious.
The test results came back within hours, and the staff members at Children’s Colorado collected the plasma. Then, they had to fly a sample to a centralized facility in Dallas for FDA required testing, to guarantee that that the plasma didn’t have any other infectious agents. The report came back late at night that the blood was safe. And one of Annen’s staffers raced into the blood bank at 1 a.m. to finish the paper work so the center could get the plasma out the door as quickly as possible. The moment it was ready, a courier from University of Colorado Hospital raced over to Children’s Colorado, collected the plasma and brought it back to Berg’s blood center at University of Colorado (which does not have a donor center). Berg and her team then processed the plasma and rushed it to Michael’s team in the ICU.
He received about 400 ml or two units of plasma. Each donor can supply 3 units of plasma at the most. So, two donors can provide enough plasma for three patients.
“I am so excited,” said Annen, who is also an assistant professor at the University of Colorado School of Medicine. “This is so important to the community. I really feel like we are making a difference.”
She looks forward to assisting with clinical trials that can help prove whether convalescent plasma helps COVID-19 patients.
Annen welcomes more donors and has heard from hundreds of people who were never tested for COVID-19, but who are eager to donate as soon as they can.
“We would love to have people reach out to us. We are trying to schedule people (for donations) as quickly as we can,” Annen said.
COVID-19 hits patients with infections and organ failure
Berg said Michael is typical of some COVID-19 patients who become critically ill and need as much help as possible.
“It started with coughing, fever and chills, then progressed to him being short of breath,” she said. “The disease continued to progress and he needed to be intubated and put on a ventilator. His lungs failed. A bacterial infection snuck in and he was going into renal failure.”
On top of the infection itself, COVID-19 can cause severe inflammation.
“It’s like a car engine is running and your body hits the gas to rev up the engine when you have an infection. The gas pedal gets hit, the engine goes into overdrive, and it’s much more gas than you need. And the brakes don’t work,” Berg said.
For people suffering severe problems like this, convalescent plasma may provide some help.
“Every hospital that knows anything about convalescent plasma wants to have it,” Berg said.
In some parts of the country, where doctors are overwhelmed and in crisis, like New York and New Orleans, there’s little time to get a program up and running to do the plasma transfusions. But, Berg said the team effort in Colorado has been excellent.
“We have a lot of proactive people here. It was seamless,” Berg said. “We hope we can help others at smaller hospitals get the convalescent plasma easily too.”
Plans to sit on the deck someday and to become a plasma donor
The Leonard family is incredibly grateful for the help they’ve received.
Meg used to work as a public health nurse. She knows how sick her husband has been. She knows not to expect miracles.
“It’s just baby steps,” she says, her voice cracking with emotion. “It takes a long time for people who have COVID to get off of a ventilator.”
Meg is ready to wait.
She and Michael met through a friend who happened to be a patient of Michael’s many moons ago when he was practicing in Boston. He was her anesthesiologist for a minor procedure. As she woke up, they were chatting. Michael shared some of his interests in mountain climbing. He planned to leave soon to work at a clinic in Nepal. Meg’s friend insisted that Michael needed to meet Meg, who had just returned from a trip to Nepal. Meg and Michael got to know each other for months through letters and phone calls. Then, they went together to work in Nepal, were soon married and enjoyed a lovely life together until the infection attacked Michael’s body and the Leonards came face-to-face with a global pandemic.
“I’ve never been through anything more difficult,” Meg said. “It’s been really hard, not being able to be with him or hold his hand or talk to him.”
At the same time, she has been struck by the kindness of people and the selflessness of Michael’s medical team.
“This experience shows you how lovely people are and how much we need each other,” Meg said.
She and her son both became sick with what they believe were mild cases of COVID-19. Both have had to isolate themselves. But now that Michael has received convalescent plasma, Meg sees an upside to having become infected herself.
She may soon be able to donate her own plasma and help bring life to another person who is suffering.
“I hope they’ll let me do that. I’d just love for someone else to benefit. I would love to help out,” Meg said.
Once Michael is home and safe and sound, Meg is even thinking of volunteering to work as a nurse again in an ICU or somewhere else where she might be needed.
For now, she dreams of the day when she and Michael can enjoy the simplest of pleasures: sitting outside on their back deck, looking out into the forest and sipping a glass of wine. Until then, she must love her husband from afar.
“I’m sending him all my energy and my thoughts and prayers,” she said. “When we talk to him, we just tell him we love him. We want him to get better. Just hang on and fight hard.”