PROPORTION AND CHARACTERISTICS OF COVID-19 SUSPECTS AMONG BLOOD DONORS IN NORTHERN TANZANIA

BACKGROUND, CONTEXT AND NEEDS The emergency of the Sar-Cov-2 about 5 months ago found most places in the world to be unprepared for this unprecedented crisis. The result is a significant increase of number of infections and the corresponding mortality associated with it. By mid of April, 2020, its estimated that more than 2,094,725 people have already been infected with more than 135,562 (6.5%) deaths, and only 520,930 (24.8%) who have recovered. Tanzania is not an exception with the number of infections and deaths keeping on increasing. Due to its notorious nature of transmission, the pandemic has expressively affected the economical, social and political decisions of the communities at large and individuals in particular. This aspect has seriously affected the struggle to have a continuous supply of adequate and safe blood and blood components. Several strategies have been recommended by the World Health Organization (WHO) so as to ensure availability of adequate and safe blood as well as ensuring the safety of blood donors, blood recipients and staff of Blood Transfusion Service (BTS), during an infectious disease emergency (WHO 2019, WHO 2020). These strategies have been widely applied during blood donation in different settings during this pandemic (Chang et al. 2020, Xiaohong et al. 2020). Some of these strategies include screening for fever for all potential blood donors and appropriate use of personal protective equipment (PPEs) such as masks, gowns and sanitizers as well as frequent hand washing with soap and clean water. Others include maintaining social distance of 1 to 2 meters, reduction of waiting time for blood donors, as well as introducing additional screening questions to exclude donors who have/had a recent positive SAR-Cov-2 infection or had an exposure to a patient who had a positive SAR-Cov-2 diagnosis. Transmission of SAR-Cov-2 through blood transfusion is theoretically possible (Chang et al., 2020) but no objective evidence has yet been obtained (references). This does not eliminate the crucial need of strict screening for SAR-Cov-2 and immediate disposal of infected blood before its use(references). With the current SAR-Cov-2 pandemic, Tanzania has introduced the WHO recommended measures on its blood collection protocol so as to reduce the risk of transmission of the disease. Due to reduced capacity of testing for SAR-Cov-2 and reduced awareness and willingness for testing, the active involvement of BTS in early detection of SAR-Cov-2 suspects among blood donors, and to defer them from blood donation and refer them to get appropriate care is crucial. The practice will help prevent the spread of SAR-Cov-2 and reduce the burden of the disease. This study will determine the proportions and characteristics of those deferred from blood donation due to potential or valid exposure to SAR-Cov-2. It will also highlight the potential magnitude and impact of SAR-Cov-2 in the general population and specifically the blood donors. STUDY AIMS AND RESEARCH QUESTIONS RESEARCH QUESTION What is the proportions and characteristics of patients deferred due to being suspects of SAR-Cov-2 during blood donation in Northern Tanzania? SPECIFIC OBJECTIVES 1. To determine the proportion and characteristics of blood donors deferred due to fever 2. To determine the proportion and characteristics of blood donors deferred due to history of travel to COVID-19 area in the past 28 days 3. To determine the proportion and characteristics of blood donors deferred due to exposure to COVID-19 infected patient in the past 28 days 4. To determine the proportion and characteristics of blood donors deferred due to COVID-19 infection in the past 28 days 5. To determine the proportion of blood units discarded after the blood donor becomes SAR-Cov-2 suspect after a blood unit has already been donated STUDY DESIGN AND METHODOLOGY DESIGN A cross-sectional study whereby all blood donors who donated blood after the commence of the study will be included for analysis STUDY SETTINGS AND POPULATION The study will involve blood donors who donated blood during the study period from July 2020 to June 2021, in Northern Tanzania. VARIABLES Predictor /Independent variables: Age, sex, place of domicile, type of blood donor (voluntary, family replacement, first time or repeat). Outcome /Dependent variables: Being suspect or confirmed case of SAR-Cov-2 infection STUDY PROCEDURES All blood donors will undergo routine demographic and medical screening to establish their eligibility for blood donation. But before this a special SAR-Cov-2 screening will be done using a special designed questionnaire form. All suspected individuals will be deferred from blood donation and referred to the appropriate health care facility for further investigations and management. Those screened negative in all screening procedures, will be allowed to donate blood, but a follow up phone call will be made to each donor after 3 days to rule out a diagnosis of SAR-Cov-2 infection to the blood donor. If the blood units will still be in the BTS premises the blood units will be discarded, but if the blood units will have been transferred to the health facility for use, information will be sent immediately to the relevant health facility authority. ETHICAL CONSIDERATION Ethical clearance will be sought from National Institute of Medical Research (NIMR) -National Health Research Ethical Committee or Kilimanjaro Christian Medical University College-Clinical Research Ethical Committee. Permission from MoH and NBTS authority to conduct the study will also be sought. Blood donors' data will be kept confidential, and privacy will be strictly observed throughout the study. APPROACH TO MAXIMIZE IMPACT OF THE RESEARCH OUTPUTS The following activities will be done to maximize the impact of the research outputs: • The manuscript will be prepared and submitted for publication in an international journal • Findings will be presented to staff of the National Blood Transfusion Services (NBTS) and the Ministry of Health for further discussion and improve the way forward when needed. The aim is to improve availability of safe and adequate blood so as to improve health. • Findings will be presented at the Academic Forum of the Kilimanjaro Christian Medical University College (KCUMCo), and a copy be kept in the KCMUCo library, to increase awareness on the topic to research community EXPECTED OUTCOMES The study will help us estimate the magnitude of the burden of Coronavirus infectious outbreak on availability of adequate and safe blood. It will also help us to characterise the blood donors suspected of Coronavirus infection/exposure. This will inform us on the way forward to tackle the problem. REFERENCES Chang L, Zhao L, Gong H, Wang Lunan, Wang L. Severe acute respiratory syndrome coronavirus 2 RNA detected in blood donations. Emerg. Infect Dis 2020 Jul; 26(7). Le Chang, Ying Yan, Lunan Wang. Coronavirus Disease 2019: Coronavirus and Blood Safety. Transfusion Medicine Reviews 21 February 2020 WHO, 2019. Protecting the Blood Supply During Infectious Disease Outbreak WHO, 2020. Maintaining a safe and adequate blood supply during the pandemic outbreak of coronavirus disease (COVID-19). An Interim guidance Xiaohong Cia, Min Ren, Fenghua Chen, Liliang Li, Hang Lei, Xuefeng Wang. Blood transfusion during the Covid-19 outbreak. Blood transfus. 2020 March; 18(2):79-82 MY ROLE IN THE PROJECT : PRINCIPAL INVESTIGATOR