Voluntary blood donation: challenges in COVID-19 pandemic—Indian scenario

The World Health Organization declared the outbreak of COVID-19 as a Public Health Emergency of International Concern on 30^th January, 2020, and a COVID-19 pandemic on 11^th March, 2020 (1). As of 6^th July 2020, more than 11.56 million cases of COVID-19 have been reported across the globe, resulting in more than 536,786 deaths; more than 6.53 million people have recovered (2).

This pandemic has resulted in development of severe panic and fear among the people for their safety and survival. Many countries have enforced lockdown to all activities leading to the postponement or cancellation of many sporting, religious, political, and cultural events. Nationwide all schools, colleges and universities have been closed. Misinformation about the virus has been circulated through social media and the mass media.

These factors have seriously affected one significant area of healthcare delivery—availability of adequate quantities of safe and quality blood in the Blood Centres across the country. More than 80% of the nation blood supply comes from voluntary non-remunerated blood donors (VNRD), who through their altruistic act keeps the shelves of the Blood Centre filled up with blood units throughout the year. Ever since the lockdown has been announced in the country from 25^th March 2020 onwards, all movements of citizens have come to a standstill. All the educational institutions, industries, social organizations, IT sectors are closed down across the country. Outdoor blood donation camps are mainly organized by these sectors. Suddenly without any prior arrangements, blood donation came to a grinding halt. The situation became worse with no blood donation camps being organized, no people were willing to visit blood center for donation and many healthcare workers were put into quarantine. With a large number of populations being affected with COVID-19 and many of their family members and close contacts going for either institutional or home quarantine, the population of eligible blood donors is also shrinking. This is a matter of big concern for National blood supply.

Availability of blood and blood products remain one of the bottlenecks in getting back to normalcy in clinical work of the hospitals, especially for people needing regular blood transfusion on account of blood disorders such as Thalassemia, Sickle Cell Anemia, Hemophilia, etc. Obstetric patients, Cancer patients and others in dire need, such as victims of accidents, need blood products on a daily basis during the pandemic period.

Blood Center operates normally round the clock regardless of the pandemic. It is crucial that healthy people continue to donate blood so that needy patients can have access to the blood products they need. Many hospitals have stopped undertaking elective surgical cases which accounts for maximum blood utilization. These have resulted in outdating of several units of blood and blood components like platelets which has a short storage life. Blood Centers have no other option beside collecting blood from replacement donors, which may compromise on the quality of blood during this pandemic period. But they are very few in numbers which cannot meet the daily requirement.

Testing of blood donors for COVID-19 is not mandatory as per national guidelines. Till today no cases of blood-borne COVID-19 infections have been reported. But it is essential that Blood Donors must be completely well, without any symptoms.

Unfortunately, Blood Centers have been forced to cancel blood donation events during the pandemic because of a lack of suitable premises, closure of organizations, unwillingness of people to venture out for blood donation and of course the impending lockdown.

During the pandemic, people will not be able to donate blood if they are symptomatic, because blood centers will not allow donors with symptoms of a cold into the donation area.

One of the situations is that highly debatable is whether the blood donor should wear face masks and protective gloves before entering the donation site and throughout the donation process.

It is advisable that face masks and protective gloves must be removed when entering the donation centre. Removal of face mask helps to identify the blood donor during the blood donation and also help the donor to drink as recommended before and after the donation. The more often a person touch the mask, the greater is the chance that mask itself can spread potential viruses.

Protective gloves must also be removed when donor arrive at the donation centre. Washing or sanitising hands when donor arrive, before drinking coffee, and when donor leave is an effective way to prevent the potential risk of infection via the hands.

In such a grievous situation prevailing throughout the nation, the best alternative is the use of Blood mobiles which can go to the doorstep of willing regular voluntary blood donors house to collect blood from them. Blood Centers should process all collected units into blood components so that proper clinical use of blood can be ensured.

Care about the safety of blood donors during this pandemic situation is very important to gain confidence from the blood donors. Blood Donation camps as well as in-house blood donation needs to change some practices at blood donation sites.

• Only blood donors are allowed to enter the donation area;
• No children or accompanying person should be allowed to enter the donation site during this pandemic;
• Blood donors should be checked upon arrival to confirm that they do not have any fever like symptoms;
• If donors have any symptoms of fever, cough, cold, they will not be able to donate blood;
• Donor must wear face masks (compulsory) and protective gloves (optional) when they arrive at the donation site;
• Each donor is directed to wash or disinfect their hands upon arrival with sanitizer;
• Strict restrictions will be enforced to limit the number of people attending the blood donation premise at same time;
• A distance of at least one metre should be kept from other donors attending the donation area;
• Level of cleaning at blood donation premise has to be increased;
• Blood Center staff should stay at home if they have any fever like symptoms;
• It is essential that only healthy people continue to donate blood.

Change in criteria for eligibility of blood donors

• If donor do not have fever or any symptoms of COVID-19, they can donate blood;
• If donor were diagnosed with COVID-19 which was either mild, asymptomatic and placed in-home quarantine, they need to get a complete recovery certification from health authorities before donating blood. A severe infection that has required hospital treatment results in a 3-month deferral time from the date of full recovery;
• Also, a close contact with a patient with corona virus infection confirmed by laboratory tests (family member, person in the same household) or if donors are health care personnel caring for these patients, will result in a 14-day deferral from blood donation;
• Blood centre will not allow donors with symptoms of a common cold into the donation area, so during the pandemic donors will not be able to donate blood.

National Blood Transfusion Council, Ministry of Health and Family Welfare has issued guidelines on 25^th March 2020 to Blood Transfusion services to collect blood in view of COVID-19 pandemic (3).

Though the Blood Transfusion Services in India is facing a big challenge in this COVID-19 pandemic, with the active support from Government machineries, Organizers of voluntary blood donation camps, registered regular voluntary blood donors and above all the blood centers are taking all initiatives to ensure safe blood supply to the needy patients in this time of crisis.

Acknowledgments

Funding: None.

Footnote

Provenance and Peer Review: This article was commissioned by the editorial office, Annals of Blood. The article did not undergo external peer review.

Conflicts of Interest: The author has completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/aob-20-54). The author has no conflicts of interest to declare.

Ethical Statement: The author is accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

References

1. Scaling up COVID-19 Outbreak Readiness and Response in Camps and Camp Based Settings. World Health Organization, March 2020.
2. Available online: https://www.worldometers.info/coronavirus/
3. Guidance Document-National Blood Transfusion Council. Ministry of Health and Family Welfare, June 2020.