Please select the eligibility criteria that correspond to the clinical trial below.
Title: Randomized, Embedded, Multifactorial Adaptive Platform Trial for Community- Acquired Pneumonia
Brief Summary: REMAP-CAP is a randomised, embedded, multifactorial, adaptive platform trial for community-acquired pneumonia.

The purpose of this study is to evaluate the effect of a range of interventions to improve outcome of patients admitted to intensive care with community-acquired pneumonia.

In addition, REMAP-CAP provides and adaptive research platform for evaluation of multiple treatment modalities in the event of a respiratory pandemic such as COVID-19.

REMAP-COVID is a sub-platform of REMAP-CAP that evaluates treatments specific to COVID-19 in the United States of America.


Options:
A: Inclusion Criteria:

* Age ≥ 65
* pneumonia at CT scan
* PaO2/FiO2 ≥300 mmHg
* Presence of one or more comorbidities (consider the list provided in Appendix A)
* Signed informed consent

Exclusion Criteria:

* Age \< 65
* PaO2/FiO2 \< 300 mmHg
* pending cardiopulmonary arrest
* refusal to blood product transfusions
* Severe IgA deficiency
* any life-threatening comorbidity or any other medical condition which, in the opinion of the investigator, makes the patient unsuitable for inclusion
B: REMAP-CAP PLATFORM INCLUSION CRITERIA:

1. Adult patient admitted to an ICU for severe CAP within 48 hours of hospital admission with:

   1. symptoms or signs or both that are consistent with lower respiratory tract infection AND
   2. Radiological evidence of new onset consolidation (in patients with pre-existing radiological changes, evidence of new infiltrate)
2. Up to 48 hours after ICU admission, receiving organ support with one or more of:

   1. Non-invasive or Invasive ventilatory support;
   2. Receiving infusion of vasopressor or inotropes or both

PLATFORM EXCLUSION CRITERIA:

1. Healthcare-associated pneumonia:

   1. Prior to this illness, is known to have been an inpatient in any healthcare facility within the last 30 days
   2. Resident of a nursing home or long term care facility
2. Death is deemed to be imminent and inevitable during the next 24 hours AND one or more of the patient, substitute decision maker or attending physician are not committed to full active treatment
3. Previous participation in this REMAP within the last 90 days

REMAP-COVID PLATFORM INCLUSION CRITERIA

1. Adult patients (≥ 18 years) admitted to hospital with acute illness due to suspected or proven pandemic infection.

REMAP-COVID PLATFORM EXCLUSION CRITERIA

1. Death is deemed to be imminent and inevitable during the next 24 hours AND one or more of the patient, substitute decision maker or attending physician are not committed to full active treatment
2. Patient is expected to be discharged from hospital today or tomorrow
3. More than 14 days have elapsed while admitted to hospital with symptoms of an acute illness due to suspected or proven pandemic infection.
4. Previous participation in this REMAP within the last 90 days

DOMAIN-SPECIFIC ELIGIBLE CRITERIA:

Each domain may have additional eligibility criteria. Refer to the study website for more information (www.remapcap.org).
C: Inclusion Criteria:

- Age ≥ 75 or age 65-74 with at least 1 of the following comorbidities: arterial hypertension, diabetes, obesity, chronic obstructive pulmonary disease, heart disease, chronic kidney disease

* Last 48 hours: (A)Axillary temperature ≥ 37.5oC or febrile equivalent, combined with (a) dry cough and/or (b) breathing difficulty and/or (c) odinophagia and/or (d) anosmia/dysgeusia and/or (e) any of the following symptoms: fatigue, anorexia, myalgias or rhinorrhea.
* Confirmed diagnosis SARS-Cov2 by RT-PCR
* Give Informed consent

Exclusion Criteria:

* Severe respiratory disease
* Cardiac insufficiency,
* Chronic renal failure,
* Primary hypogammaglobulinemias,
* Myelodysplastic syndromes,
* Chronic linfoproliferative syndromes,
* Monoclonal gammapathies,
* Known hypersensitibility,
* Active cancer,
* HIV, HBV or HCV infection,
* Chronic administration of immunosuppressants,
* Body transplant history,
* Chronic liver disease, Chronic lung disease with oxygen requirement.
D: Inclusion Criteria:

-

Recipient:

Severe COVID -19 infections defined as WHO Interim Guidance and the Guideline of Diagnosis and Treatment of COVID-19 of National Health Commission of China (version 5.0) with confirmation by real-time RT-PCR assay with severe disease i.e. meeting any 2 of the following criteria-

1. Respiratory distress, RR ≥30 beats/min
2. Oxygen saturation level less than 93% in resting state
3. Partial pressure of oxygen (PaO2)/oxygen concentration (FiO2) ≤ 300 mmHg.
4. Lung infiltrates \> 50% within 24 to 48 hours
5. Very sick (on ventilator) and patients with co-morbidities such as patients with known co-morbid diseases (COPD, CAD, CLD, CKD, cardiopulmonary disease-structural or valvular heart disease)
6. Patient presenting with multi organ failure or requiring mechanical ventilation.

Donor:

* Known case of recovered COVID-19 Infection, and
* Complete resolution of symptoms at least 28 days prior to donation or Complete resolution of symptoms at least 14 days prior to donation and negative results for COVID-19 either from one or more nasopharyngeal swab specimens or by a molecular diagnostic test from the blood, And Negative RT-PCR for COVID-19 on two sequential paired nasopharyngeal and throat specimens \> 24 hrs apart (WHO-CDC guideline).
* Donor Plasma after 2 negative tests and 2 weeks of remaining asymptomatic, without antibody titre \& presence of IgG/IgM antibodies to COVID-19 by serological as per manufacturers instructions. Donors negative for these will be deferred).
* Fulfill all criteria of donor eligibility for donor Plasmapheresis under the Drugs \& Cosmetics Act and Rules 1945, amended 11.03.2020.

Exclusion Criteria:

- Recipient

* Patients with age less than 18 years.
* Pregnancy
* Individual with HIV and Hepatitis
* Morbid Obesity BMI\>35 kg/m2
* Extremely moribund patients with an expected life expectancy of less than 24 hours.
* Failure to give informed consent from the patient or family members.
* Hemodynamic instability requiring vasopressors.
* Previous allergic history to plasma.

Donor:

* Donors age \< 18 \& ≥60 years old
* Do not fulfil all criteria of donor eligibility for donor Plasmapheresis under the Drugs \& Cosmetics Act and Rules 1945, amended 11.03.2020.
* Females who have been pregnant and previously transfused donors (to prevent TRALI).
* Donors who have taken steroids during treatment for COVID-19.

Answer: B