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BACKGROUND

A novel coronavirus (currently named 2019-nCoVlater named SARS-CoV-2, with the resulting illness named COVID-19) emerged in Wuhan, China in December 2019.  WHO declared late 2019, with WHO declaring a global health emergency on 30 January 2020, and a number of blood and tissue donor guidelines have been issued - largely based on previous guidelines for SARS-CoV and MERS-CoV. Like SARS and MERS, 2019-nCoV displayed high mortality but low infectivity in the early weeks, with limited person-to-person transmission.  However, the epidemic quickly changed to display lower mortality but higher infectivity with increasing evidence of sustained person-to-person transmission. Various public health measures taken at a local or national level are likely to aid and/or complicate donor assessment, while the rapid evolution of the epidemic demands a precautionary yet flexible approach to suitability guidelines.

AT VERIFICATION TYPING OR WORKUP

Geographical risk – donors returning from a risk area

Collection should be deferred for 4 weeks after a donor’s return from a 2019-nCoV risk area. If the patient’s need for transplant is urgent, the donor is completely well and there are no suitable alternative donors, earlier collection may be considered subject to careful risk assessment.  Risk assessment should be based on:

  • When the donor left the risk area.
  • Which cities the donor visited.
  • Any contact with a person with pneumonia or the novel (2019-nCoV) coronavirus.

Contact with 2019-nCoV – donors who report contact with a confirmed case

Collection should be deferred for 4 weeks after a donor’s last contact with a person with confirmed 2019-nCoV infection. If the patient’s need for transplant is urgent, the donor is completely well and there are no suitable alternative donors, earlier collection may be considered subject to careful risk assessment.  Risk assessment should be based on:

  • The last date of contact.
  • The nature of the contact.
  • The results of any testing for 2019-nCoV.

History of 2019-nCoV infection

Collection should be deferred for 3 months after recovery. If the patient’s need for transplant is urgent, the donor is completely well and there are no suitable alternative donors, earlier collection may be considered subject to careful risk assessment.  Risk assessment should be based on:

  • The date of full recovery.
  • The duration and severity of illness.
  • The date and result of the most recent test for 2019-nCoV.

Additional 2019-nCoV questions

Geographical risk:

  • China, the first country affected by 2019-nCoV, already carries risk for malaria and dengue fever. Therefore any existing protocols that are in place to capture geographical risk for China should be modified to trigger a 2019-nCoV deferral.
  • If other countries are affected, further modification of travel questions will be required.
  • Strict quarantining and travel restrictions, while they are in place, will tend to minimise the need for a specific travel question.

Contact with 2019-nCoV:

  • Likewise, the application of public health measures will make it unlikely that a donor will reach VT or WU stage without being isolated. By the time such measures are withdrawn, it is possible that the risk from 2019-nCoV will have diminished.
  • Therefore a specific “2019-nCoV contact” question may be unnecessary.

History of 2019-nCoV infection:

  • A donor who has recently recovered from 2019-nCoV seems very likely to report this in response to general health questions at VT or WU, as public health follow-up is likely to be diligent.
  • Therefore a specific “recent 2019-nCoV infection” question may be unnecessary.

RATIONALES

While 2019-nCoV is new and not yet well understood, early guidelines have been based on previous guidelines for SARS-CoV and MERS-CoV with conservative adjustments based on early evidence:

  • Similarity to SARS-CoV suggests the possibility of prolonged post-infection viraemia; hence a 3-month standard deferral period has been recommended by bodies like ECDC.
  • ECDC recommends a 3-week deferral period after contact or geographical exposure. Considering early indications of an incubation period of up to 14 days, WMDA recommends a 4-week deferral period to conservatively double the longest expected incubation period.
  • There is already limited evidence of person-to-person transmission during the pre-symptomatic phase. This justifies the deferral of symptomless donors who report recent geographical risk or contact.

With limited numbers and a rapidly evolving epidemic, individual cases should ideally be assessed in consultation with infectious disease and/or public health experts.

REFERENCES

WHO: . The epidemic has since spread to all populated continents, with a global pandemic declared on 11 March 2020.

Public health measures against the COVID-19 pandemic have varied widely in strategy and success around the world.  Travel restrictions in particular are presenting major challenges in logistics and transport for donated haemopoietic progenitor cells.  Meanwhile there remains no evidence that SARS-CoV-2 is transmissible via blood or HPCs from a healthy donor lacking symptoms of COVID-19.



REFERENCES

WHO: https://www.who.int/emergencies/diseases/novel-coronavirus-2019

ECDC: https://www.ecdc.europa.eu/en/publications-data/risk-assessment-outbreak-acute-respiratory-syndrome-associated-novel-1

EBMT: https://www.ebmt.org/covid-19-and-bmt

COVID-19 is presenting major logistical challenges in managing and assessing HPC donors and in collecting and transporting HPC products.  WMDA has developed a publicly-available resource page at https://share.wmda.info/x/Yj6OF.