Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

Background: Many patients with COVID-19 have been treated with plasma containing anti-SARS-CoV-2 antibodies. We aimed to evaluate the safety and efficacy of convalescent plasma therapy in patients admitted to hospital with COVID-19. Methods: This randomised, controlled, open-label, platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]) is assessing several possible treatments in patients hospitalised with COVID-19 in the UK. The trial is underway at 177 NHS hospitals from across the UK. Eligible and consenting patients were randomly assigned (1:1) to receive either usual care alone (usual care group) or usual care plus high-titre convalescent plasma (convalescent plasma group). The primary outcome was 28-day mortality, analysed on an intention-to-treat basis. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936. Findings: Between May 28, 2020, and Jan 15, 2021, 11558 (71%) of 16287 patients enrolled in RECOVERY were eligible to receive convalescent plasma and were assigned to either the convalescent plasma group or the usual care group. There was no significant difference in 28-day mortality between the two groups: 1399 (24%) of 5795 patients in the convalescent plasma group and 1408 (24%) of 5763 patients in the usual care group died within 28 days (rate ratio 1·00, 95% CI 0·93–1·07; p=0·95). The 28-day mortality rate ratio was similar in all prespecified subgroups of patients, including in those patients without detectable SARS-CoV-2 antibodies at randomisation. Allocation to convalescent plasma had no significant effect on the proportion of patients discharged from hospital within 28 days (3832 [66%] patients in the convalescent plasma group vs 3822 [66%] patients in the usual care group; rate ratio 0·99, 95% CI 0·94–1·03; p=0·57). Among those not on invasive mechanical ventilation at randomisation, there was no significant difference in the proportion of patients meeting the composite endpoint of progression to invasive mechanical ventilation or death (1568 [29%] of 5493 patients in the convalescent plasma group vs 1568 [29%] of 5448 patients in the usual care group; rate ratio 0·99, 95% CI 0·93–1·05; p=0·79). Interpretation: In patients hospitalised with COVID-19, high-titre convalescent plasma did not improve survival or other prespecified clinical outcomes. Funding: UK Research and Innovation (Medical Research Council) and National Institute of Health Research

The Sikhs of Northern California: A Socio-Historical Study

The Sikhs, a socio-religious group historically located in the Punjab region of northwestern India, began large-scale immigrations to North America in 1907. By 1910 they had settled throughout the State of California where they have continuously resided for nearly three quarters of a century. This study examines and analyses the social adaptations of these Sikh migrants, dividing their history into two eras. The first period consists of their initial immigration until the Independence of India in 1947, a period characterized by restrictive laws which resulted in nearly twenty-five years of cultural and physical decline. The second period has been termed the Reconstitution of Sikh society and deals with the period from 1947 to 1975, during which the resumption of contact with India led to a reversal of earlier social trends. The first four chapters document and analyse the effects of fluctuating immigration laws, international politics, and the Ghadar Party, restrictive and discriminatory state and federal legislation, and the all-male nature of the first four decades of California Sikh society. The fifth chapter is a discussion of the cultural compatability and the social effects of Sikh-Mexican unions which occurred in the late 1920\u27s through the 1950\u27s as Sikhs sought American partners after the Barred Zone Provision of 1917 closed legal immigration from India. Chapters VI and VII outline the main features of the Reconstitution of Sikh life in rural California from the resumption of immigration in 1947 under the Luce-Celler Quota system to 1975, particularly as it was manifested in the Northern Sacramento Valley Sikh community in Yuba City-Marysville. Based on fifteen months of fieldwork, these chapters contrast the once tenuous social and economic positions of the \u27pioneer\u27 Sikhs with the substantial changes occurring after 1950, including the rapidly expanding population growth after the 1965 liberalization of U.S. immigration laws. Ethnographic and immigration data on the volume and characteristics of the recent Sikh arrivals is provided as well as the composition of household units, analysis of the Yuba City gurdwara (Sikh temple) as a socio-religious institution, and a discussion of changing value structures within various segments of the community. By every indices, the Sikhs of California have been undergoing a reconstitution, including adoption of increasingly orthodox religious practices and attitudes, reestablishment of arranged-marriages and maintenance of group endogamy, general adherence to behavioral and sex role models of South Asian origin, and the use of the family networks for economic and other corporate goals. The study documents how, after living for a half-century under many legal and social disabilities, the Sikhs of California began a reassertion of their ethnic and religious identities. This trend continued and accelerated through the late 1960\u27s and 1970\u27s until, in some rural areas of the state, there has been an almost total reconstitution of Punjab Sikh society and culture. The study finally suggests that the Sikhs will continue to adapt to the political and economic demands of American society while exercising their right to follow their cultural and religious heritage and will continue as a minority group which makes minimal concessions to American social customs