Photo: Obi Onyeador/Unsplash
The social media is inundated with requests from users around India for information about oxygen cylinders and hospital beds. But there isn’t nearly as much information available about the effect India’s COVID-19 epidemic has had on supplies of the tissue that disseminates oxygen through our body: blood.
The Centre has announced that everyone older than 18 years can receive COVID-19 vaccines from today, May 1. This is the same demographic group that includes most of the country’s blood donors. The National Blood Transfusion Council (NBTC) recently issued an order saying a person can’t donate blood “28 days post-vaccination after the last dose of COVID-19 vaccination”.
This deferral period of 28 days is considerably longer than what other regulatory bodies around the world need, and experts have also questioned it.
The same order requires people who have received Covaxin to wait at least 56 days to donate blood, and those who received Covishield, up to 70 days. Given that packed red blood cells have a shelf life of 42 days and platelets of just seven days, the order has understandably become a cause for concern.
The WHO estimates that a country requires blood units equal to 1% of its population – a standard India has probably not met, even before the epidemic kicked off. There has also been a steep decline in the units of blood collected and in the number of blood camps since the national lockdown that began in March 2020 – despite an NBTC advisory recommending that donation services continue with precaution.
The reasons for the decline aren’t mysteries. Much like with newly emerging infectious diseases of the past, people have been wary of visiting crowded hospitals or blood collection camps for fear of contracting COVID-19. Lockdown guidelines have largely shut down colleges and offices as well – formerly popular sites at which to organise blood donation drives – for over a year.
And thanks to stringent new guidelines to prevent a person with symptomatic COVID-19 (and travel history and recent contact with someone who tested positive) from donating blood, deferral rates have spiked.
India imports most of the reagents it uses in blood banking, so disrupted supply chains have disrupted their availability as well.
Thus far, this shortage in blood supply has been somewhat offset by the drop in blood requirements (including due to postponement of elective surgeries and reduction in road traffic accidents).
However, India still needs blood to help patients with thalassemia, anaemia and blood malignancies, among others. It’s notable that blood shortage disproportionately affects women, as postpartum haemorrhage is one of the most common preventable causes of maternal death.
Perhaps the shortage of blood units during the epidemic can prompt the authorities to rethink some laws and policies.
On April 5, 1999, the Indian government amended the Drugs and Cosmetics Act 1940 to ban unbanked directed blood transfusion (UDBT). In this procedure, blood is taken directly from a donor and given to the patient. The ban meant that the blood would have to be banked or stored first, after being properly grouped and checked for HIV, hepatitis B, etc.
However, the UDBT ban cuts off one way to make up for blood shortage. This practice is still legal in many parts of the world, including in the US. Re-legalising it in India, but requiring healthcare workers to retain the safety protocols, could help save lives, especially in rural areas where banked blood is often unavailable.
We can also compensate for the increased deferral rates of potential blood donors due to anti-COVID measures by tackling other reasons for deferral. In India, for example, reasons for rejection of a potential donor include “men having sex with other men” and “getting a tattoo and/or a piercing”. Given that all donated blood is screened for diseases irrespective of a donor’s history, relaxing or doing away with deferral periods for such reasons is unlikely to negatively affect recipient safety.
Wider adoption of practices like maintaining a ‘rare blood group donor registry’, pooling the resources of transfusion centres and/or first using the blood whose expiration date is earliest are likely to improve resource allocation.
Ultimately, it’s important that we keep blood donation services running smoothly, and we need policies in turn to protect the people running these places. For example, they should have access to PPE, psychological support and an environment where they can safely self-report the symptoms of upper respiratory tract-like infections.
These workers could also have periodic sessions on ‘information, education and communication’, in which they’re brought up to date on the latest standard operating procedures.
Meanwhile, those eligible to donate blood (eligibility criteria here) should strongly consider donating before they receive a COVID-19 vaccine dose.
Sumedha Sircar is an intern-doctor at KMC Manipal and consults for Suicide Prevention India Forum. She is dedicated to learning about sociodemographic determinants of health and science communication.