Pratima Mukherjee is in dire need of four units of AB-positive blood. The 31-year-old resident of a village near Kharagpur, in West Bengal, has cancer and requires regular blood transfusions, but the lockdown ordered by the central government following the COVID-19 pandemic has made this difficult. Biswajit Pandit, her brother, has visited multiple blood banks in Kharagpur and Kolkata, but has been unable to procure blood. “The extension of the lockdown till the beginning of May will make it even more difficult,” he told me.
Ashok Singh, a native of Darbhanga in Bihar, is undergoing dialysis and required two units of A-positive blood on 12 April. “The blood bank at the Darbhanga Medical College hospital is shut because the entire system has reoriented towards COVID-19,” Prabhakar Kumar, his son-in-law, told me. “The others that I tried insisted that the blood must be procured fresh from his relatives.” Singh’s son and another relative donated a unit each. He had a dialysis appointment at Delhi’s All India Institute of Medical Sciences on 21 March, but had to postpone it once the janata curfew was announced for the following day. The family had to settle for treatment at a private hospital in Darbhanga.
Kiran Kumar, a resident of Ongole in Andhra Pradesh, needs a unit of blood for his niece, who is about to deliver a child. “She needs A-negative, which is a rare group in any case, and the lockdown makes it more difficult,” he said. “We went to three blood banks, but didn’t find any.” He has circulated the details on social media, hoping someone will help.
Blood transfusions are necessary for people with diseases such as thalassemia and cancer, as well as for procedures such as kidney transplants and certain kinds of deliveries. While the nationwide lockdown—initially for 21 days and then extended for another 19 days—has reduced the demand for blood, due to a major reduction in traumatic injuries such as road accidents, it has become more difficult to procure blood for those who need it.
With the entire medical system geared for the fight against the coronavirus, non-essential surgeries and procedures have been put on hold. Donors stay at home, and the number of blood-donation camps has plummeted. According to the National Health Mission’s e-Rakt Kosh database, the number of camps fell from 606 in January to 369 in March, and only 81 in April. The number of blood donations fell from 38,207 in February to 7,981 in April.
On 25 March, anticipating the difficulties of collecting blood amid the lockdown, Dr Shobini Rajan, the director of the National Blood Transfusion Council—the apex body for formulating policy regarding blood transfusions—released a letter providing guidance for blood-transfusion services. The letter noted that no cases had been reported of the coronavirus being transmitted through transfusions. “Individuals are not at risk of contracting COVID-19 through the blood donation process or via a blood transfusion, since respiratory viruses are generally not known to be transmitted by donation or transfusion,” Rajan wrote.
Nevertheless, the NBTC’s accompanying recommendations asked blood-donation centres to exclude donors who have either been confirmed as infected with the coronavirus, or are at risk due to their travel history or proximity to infected people. They asked for physical distancing of at least one metre between individuals to be enforced at donation sites, for hand hygiene and cough etiquette to be followed, and for used protective equipment, such as gloves, masks and caps, to be disposed of safely. While calling for “regular repeat voluntary donors” to be “encouraged to come for blood donation at sites convenient to them,” Rajan recommended that donors be called “in a staggered manner such that crowding and mass gathering is avoided and social distancing is maintained.” If someone comes back within 14 days of donating blood and says that they are experiencing COVID-19 symptoms, or that they have been diagnosed as infected—or even if a close contact of theirs has tested positive for the coronavirus—she added, any unutilised blood collected from them “should be recalled and discarded.”
This has not allayed fears, however. “Normally, young people form the bulk of blood donors, but since they are not stepping out, the supply of blood has gone down,” Deepak Ladhdha, who manages the blood bank at the Ram Snehi Hospital in Bhilwara, a city in Rajasthan, told me. The fear extends to staff at blood banks. Dr Zarin Bharucha, the chairperson of the Federation of Bombay Blood Banks, told me that the 48 blood banks affiliated to the federation help each other meet shortfalls. However, the pandemic has deterred blood-bank workers from making such exchanges. “Some people are so afraid of coming out that, in spite of blood banks willing to provide vehicles, they are staying put indoors,” Bharucha said. “What can be done about that?”
“Before the lockdown, we used to collect nearly seventy to a hundred units of blood daily,” Dr Vanshree Singh, the director of the Indian Red Cross Society’s blood bank in Delhi—one of 69 IRCS blood banks across the country—told me. “The demand was also high, because there were surgeries and transplants, but now those have been postponed and only emergency surgeries are taking place.” She said the demand for blood has fallen by about half. “We are collecting forty to fifty units daily, which is sufficient for the present.” The Delhi chapter of the IRCS, which used to hold four blood-donation camps a day, has only held five camps in April.
Dr Indira Hasija, who is in charge of the blood bank at the general hospital in the Haryana town of Jhajjar, told me that demand for blood had fallen to a third, from about fifteen units a day to five. “There is no point in procuring extra blood during the lockdown, because it expires in 35 days,” she said. “If there is more blood, then we will have to dispose of it as biomedical waste.” The blood bank, which has a capacity of 400 units, would usually stock up to three hundred units at a time, she added, but only has a hundred units at present. Dr Sanjay Gupta, who succeeded Rajan as the NBTC director on 1 April, told me that while Assam and other northeastern states are experiencing a shortfall in blood, states such as Maharashtra and Karnataka are meeting the demand.
The Federation of Indian Blood Donor Organisations has added a video message on its website. In the video, Jitendra Kumar, the FIBDO treasurer, appeals to people to donate blood and promises to help them. “We will do the pre-donation counselling telephonically, and try to fix an appointment with the blood bank,” he says.
“There is a fear in everyone’s mind that going out may not be good for them,” Biswaroop Biswas, the general secretary of the FIBDO, told me. Biswas, who is based in Kolkata, said that the Kolkata police has decided to contribute 50 units of blood every day from among its ranks throughout April to tide over the shortfall. “Right now, West Bengal needs 1,100 units on average per day, whereas the normal demand is twenty times greater,” he said, adding that the priority should be ensuring that thalassemia patients, people on dialysis and pregnant women have access to blood transfusions. “I am worried about what will happen next month when the lockdown opens but blood supply is not back to normal levels.”