“This has just been an incredibly big lift,” says Goodhue of the push to get all their blood centers ready to collect convalescent plasma. “It’s coming up a little more slowly than we anticipated.”
Jed Gorlin, vice president at Innovative Blood Resources, a network of blood centers in several states including New York, Nebraska, and Minnesota, says it took three weeks just to get the new labels printed properly. Getting a root canal would be less painful, he says, and they’re all trying to be extra careful. “It’s easy to mix stuff up,” says Gorlin. “The amount of paranoid checking that happens with this process … it does add extra time.”
But the biggest issue isn’t the computer systems or labels. As with so many other coronavirus stories, it all comes back to testing. “The testing issue is the largest problem,” says Claudia Cohn, chief medical officer for AABB, an international association of blood centers, hospitals, and transfusion services.
There is a lot of debate about the accuracy of the blood titre tests available now to determine whether a person’s blood contains SARS-CoV-2 antibodies. This has been a chief problem for efforts to run mass serosurveys determining what percentage of the population has been infected. Instead, in order to give plasma, potential donors must have a positive diagnostic swab test that proves they’ve been infected. (Unlike a blood antibody test, diagnostic tests use a fluid sample collected from a sick person’s nose or throat to search for the virus’s genetic material, a sign of a present infection.) Otherwise, doctors can’t be sure that plasma has the antibodies patients need.
But since many people never received a test, they are automatically ineligible. “Things are moving in the right direction,” says Cohn, referring to antibody tests that are making their way to the public. But, she says, “I’m sure that it’s frustrating for donors that want to help.”
Donors also have to be symptom-free for 28 days before they donate, to ensure the virus is out of their system. They also have to qualify as blood donors, which means they have to meet a number of requirements including not having hepatitis and not having traveled to a country with malaria for at least the past year. “It’s been difficult to get donors in who check all those boxes at this time,” says the Red Cross’s Goodhue, who expects to see a surge of donors in the coming weeks.
There’s no hard data on how many volunteers are being turned away right now, but Eduardo Nunes, vice president of Quality, Standards and Accreditation at AABB, says that anecdotal reports from centers show that lots of people are stepping forward but that only a “very small number of folks are making it all the way through the process.” In Kansas City, Jed Gorlin estimates that as many as half of convalescent plasma donors aren’t eligible.
And collection has been uneven across the country. In some places like New York City, where over 140,000 Covid-19 cases have been confirmed, there are simply more eligible donors than in places like Minnesota or Nebraska, where the wave of infections hasn’t yet hit. “We’re now starting to stock inventory,” says Gorlin, which will be distributed to new hot spots. “This is because New York had such an absurdly large number of cases. It’s not true in other parts of the country.”
In normal times, these centers have a system for distributing blood products to areas that need them. After serving their local needs, their staffers will send blood to affiliates in other cities. If there’s still surplus, they’ll distribute to other centers that are outside of their network. But right now, there just isn’t enough convalescent plasma to go around. “We have about 90 patients with Covid in our hospital right now,” says Cohn, who is also the director of the Blood Bank Laboratory at the University of Minnesota Medical School. “Only one donor has been collected in our region.”
Without enough convalescent plasma, and without clear guidelines about dosage or when the treatment is most effective, blood centers and hospitals are also being forced to make some challenging ethical decisions about who gets treated. The Mayo Clinic, which is organizing clinical trials for hospitals across the United States, has some established protocols for patients who want to receive plasma: They have to be over 18, to have a positive diagnosis for Covid-19, to be admitted to the hospital with a severe or life-threatening infection, and to consent to the treatment. But the clinic doesn’t provide many guidelines about who should get the plasma first and leaves it up to hospitals to get ahold of plasma from their local suppliers.