This is a Phase II study. This research study is being conducted to use convalescent donor plasma in seriously ill patients who have COVID-19.

This is an open label phase 2 trial assessing the efficacy and safety of anti-SARS-CoV-2 convalescent plasma in hospitalized patients with acute severe respiratory symptoms from COVID-19. Symptomatic patients with clinical or radiological interstitial COVID-19 pneumonia and within 21 days of onset of symptoms will be enrolled in 2 cohorts - an ICU cohort and a hospitalized non-ICU cohort.

Inclusion Criteria:

1. Age ≥ 18 years or older

2. Hospitalized as an in-patient with positive COVID-19 test by PCR

3. Presence of respiratory symptoms with any of severe features as below:

   • Respiratory Rate ≥ 24/min
   • Oxygen Support >3L/min by nasal cannula
   • New onset or worsening of respiratory symptoms with radiologic confirmation of bilateral ground glass opacities that cannot be attributed to another cause

4. Patient / HCPOA must agree to storage of blood specimens for future testing.

5. Patient / HCPOA is willing and able to provide electronic informed consent and comply with all protocol requirements. If patient is unable to consent due to incapacity, health care POA should be defined and able to consent for the patient.

6. Patients are allowed to receive all standard of care. Co enrollment in other clinical trials is permitted.

Exclusion Criteria:

1. FCBP with positive pregnancy test (mandatory)
2. Breastfeeding females
3. Receipt of pooled immunoglobulin (e.g. IVIG or other hyperimmune globulin products) in past 14 days. This does not apply to monoclonal antibodies .
4. Mechanical ventilation for > 14 days
5. Days from symptom onset >21 days
6. Expected survival < 72 hours
7. Contraindication to transfusion or history of prior reactions to transfusion blood products including any proven history of TRALI
8. Patients who were previously admitted to ICU cannot be enrolled in the non-ICU cohort. These patients could need ICU level care subsequently and at that time point could be considered for ICU cohort .

Patients were monitored for adverse events from the time of plasma infusion through the duration of their hospitalization, sometimes exceeding 60 days, through study completion.

Limitations: The plan was to infuse high titer plasma. All units were screened for SARS-CoV-2 antibody and were positive, but our blood bank was not able to provide specific titer information for each unit. We planned to monitor patients for up to 60 days post infusion, but once discharged pandemic concerns prevented follow-up.

Caveats: Inpatients were followed for duration of hospitalization, sometimes exceeding 60 days.