We’ve all been racking our brains trying to figure out when and how it will be safe to relax the stay-at-home directives and begin our slow return to normal. In our city, it appears our COVID-19 infection rate and hospital admission rate has crested and now plateaued over the last 10 days. We came close, but never exceeded hospital capacity in terms of beds, ventilators, or personal protective equipment. Our social distancing measures did their job. The fear now is that relaxing those measures too soon could send the infection rate back up.
The problem in answering the question of when we can re-open is that there simply isn’t a clear answer. There is no quantitative measure of readiness. We’ve checked one box – the number of new infections are under control.
Maybe we need to turn the question around. When will we – you and I – feel safe going back work? Riding mass transit? Sending our kids to school? Eating at a restaurant? The answer to those questions different. It is when the risk of infection is slim to none. Fortunately, there are ways to quantitatively measure that and at least estimate the risk. But we first need to know who has had COVID-19.
In theory (but still a BIG question mark), people with COVID-19 antibodies should have immunity to the virus and should be free to roam about the world without fear of becoming infected or spreading it to anyone else. Unless you were tested, clinically diagnosed, and have recovered from COVID-19, there is no way of knowing if you have antibodies. That is unless you receive an antibody test.
Currently, there is no widespread access to these tests. Some community testing has taken place as part of research. One study, touted by the Governor of New York today, showed that as many as 14% of New York residents have COVID-19 antibodies. Until we know who and how many people in the wider community are immune, we can never truly gauge just how safe it is to return to the outside world.
This is where a practical approach is needed, and a practical solution may exist. There may be an opportunity for widespread antibody testing, by utilizing a network of blood testing sites that already exists in communities across the country right now. The American Red Cross.
You see, the Red Cross is the non-profit organization that provides disaster relief and coordinates blood donation campaigns across the country in preparation for those disaster situations. It provides US hospitals with about half of the nation’s blood supply. If you’ve ever seen a poster for a blood drive, the Red Cross was probably involved. The have staff, volunteers, and donation sites in every state if not every city.
The Red Cross is also the organization currently taking the lead in identifying donors as part of its COVID-19 convalescent plasma program. As I mentioned earlier, individuals who have recovered from COVID-19 have antibodies in their blood that not only make them resistant to future infections, but their blood can also be used as a treatment for other patients with severe COVID-19 symptoms. There is now a major campaign to recruit recovered COVID-19 patients (with a documented positive COVID-19 test) as plasma donors, with the potential to save many lives as the coronavirus crisis continues. The challenge has been identifying enough donors.
Another challenge being faced by the Red Cross, and by hospitals around the country, is a severe blood shortage caused by COVID-19. Many blood drives have been canceled and donors are canceling scheduled donations due to stay-at-home directives.
There is an opportunity to address three major issues by utilizing The American Red Cross: 1) identifying plasma donors for COVID-19 treatment; 2) increasing donations and the nation’s blood supply; and 3) widespread community testing for COVID-19 antibodies.
This would be a nationwide campaign by the American Red Cross – a national blood drive, so to speak – with the promise of testing never-diagnosed, even asymptomatic donors for active COVID-19 virus or COVID-19 antibodies. The Red Cross has to test these blood samples for pathogens anyway before they are made available to patients. In the process, we would also be identifying much needed convalescent plasma donors and providing a much needed boost to the US blood supply.
It’s a win-win-win-win. We get tested. The Red Cross gets blood. Hospitals get plasma. Public health officials get the elusive COVID-19 data we need to re-open the country.
The major question is capacity. Does the Red Cross have enough personnel, supplies, testing kits, donation sites, etc. to manage the donor “demand” while adhering to social distancing guidelines? By-appointment-only donation appointments could help mitiage this. Also, many community locations could be utilized or re-purposed for blood drives. If my old high school auditorium could handle it, then so can many other places. This makes the testing process more practical and way more scalable than if it required a doctors appointment and an in-office blood draw. (Don’t forget medical insurance).
The US is fortunate to have an organizational like The American Red Cross, with blood drawing and testing infrastructure in place in nearly every community in the country. This presents a unique opportunity to tap into this supply (no vampire pun intended) to help bring our country closer to re-opening, by generating real-world quantitative data on infection risk in our local communities. And along with blood type, the Red Cross could include COVID-19 antibody status right on our donor cards.
There is still a lot we don’t yet know about COVID-19 immunity, like whether the presence of antibodies means there is no longer a risk of re-infection. Or if there needs to be a certain amount of antibody to achieve immunity. Or how long immunity of any kind actually lasts. There are also questions about the reliability of antibody tests – like are they specific to COVID-19 and not capturing the presence of other coronovirus antibodies? Thus, at this moment in time, antibody test results are not informative for determining individual risk or for decision making on the scale of communities looking for indicators of when it will be safe to “reopen.”
For more on the subject of testing and its implications, see my post: