BACKGROUND

A novel coronavirus (now named SARS-CoV-2, with the resulting illness named COVID-19) emerged in Wuhan, China in December 2019.  The World Health Organization (WHO) declared 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, COVID-19 initially displayed high mortality but low infectivity, with limited person-to-person transmission. However, the epidemic has quickly evolved to display lower mortality but higher infectivity with increasing and sustained person-to-person transmission. A particular feature of this epidemic has been the variety and extent of public health measures taken in different regions. While such measures no doubt decrease the risk that an infected HPC donor could progress to donation or even work-up assessment, they are also presenting major challenges in logistics and transport.  The rapid evolution of this 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 four (4) weeks after a donor’s return from an area with sustained local transmission of COVID-19. To identify countries with sustained local transmission, registries may refer to national health authorities and/or trans-national sources such as WHO and the European Centre for Disease Prevention and Control, ECDC.

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 if local quarantine requirements permit.

Risk assessment should be based on:


Geographical risk – donors residing in a risk area

To identify countries with sustained local transmission, registries may refer to national health authorities and/or trans-national sources such as WHO and the European Centre for Disease Prevention and Control, ECDC. Collection should be deferred for four (4) weeks after any contact with a person with confirmed COVID-19 infection (see below) and/or travel to another risk country (see above). In the absence of known contact with COVID-19, collection may be considered subject to careful risk assessment and local public health restrictions if the patient’s need for transplant is urgent, the donor is completely well and there are no suitable alternative donors.

Risk assessment should be based on:


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

Collection should be deferred for four (4) weeks after a donor’s last contact with a person with confirmed COVID-19 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 if local quarantine requirements permit, subject to careful risk assessment.

Risk assessment should be based on:


History of 2019-nCoV infection

Collection should be deferred for three (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 if local quarantine requirements permit.

Risk assessment should be based on:


Additional 2019-nCoV questions

Geographical risk:

Contact with 2019-nCoV:

History of 2019-nCoV infection:


RATIONALES

There has been some evidence of person-to-person transmission during the pre-symptomatic phase. Other coronaviruses (as noted above) have not displayed transmissibility via blood or hematopoietic progenitor cells (HPC), which suggests that the blood phase of coronavirus RNA is limited to the symptomatic phase. Even if this virus is not an infective risk for HPC, however, the quarantine/isolation requirements for at-risk people will likely make affected HPC donors unavailable for at least 14 days – the commonly accepted upper limit for COVID-19 incubation.

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


REFERENCES

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

WBMT: WBMT_COVID-19-2.pdf

ASTCT: https://www.astct.org/connect/astct-response-to-covid-19

EBMT: EBMT COVID-19 guidelines v.2 (2020-03-10).pdf

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

EUPHA: EUPHA statement on COVID-19.pdf

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.