key: cord-0808154-56s37zhm authors: Lee, CK title: Impact of Severe Acute Respiratory Syndrome (SARS) on Blood Services and Blood in Hong Kong in 2003 date: 2020-05-20 journal: Transfus Med DOI: 10.1111/tme.12698 sha: d7ca954c4725c359ab356a7d33a2b4cc563e3590 doc_id: 808154 cord_uid: 56s37zhm The current global pandemic of COVID‐19 due to the novel coronavirus SARS‐CoV‐2 is causing considerable loss of life and enormous social and economic disruption. Here, we describe the response of the blood service, the impact on blood donation and the effects on the blood supply in Hong Kong posed by the earlier SARS epidemic in 2002 and 2003. The infection, like SARS‐CoV‐2 was highly contagious through droplet transmission. In the 2003 SARS epidemic in Hong Kong, donor and staff safety was secured by using stringent infection control measures to protect both donors and staff from contacting the virus. All the donors were requested to wear face masks within the donation venue and use an alcohol‐based hand rinse. The donors' body temperature was checked before donation and staff's body temperatures were checked daily. The safety of the blood supply was secured by a donor deferral policy for 4 weeks following contact with a confirmed or suspected case of and a post‐donation call‐back system. Despite scheduling mobile donation sessions and a decrease in donors attending blood donor centers, the blood supply was maintained as there was a 12.8% reduction of the demand of blood and only a 16.9% reduction in the blood donation. Lessons learnt during the epidemic may help preparation for future epidemics and provide a basis for understanding the pathogenesis, laboratory diagnosis and role of coronaviruses in transfusion medicine. These are continuing problems as coronavirus epidemics may recur with future impact on blood collection and blood donation screening. This article is protected by copyright. All rights reserved. In the 2003 SARS epidemic in Hong Kong, donor and staff safety was secured by using stringent infection control measures to protect both donors and staff from contacting the virus. All the donors were requested to wear face masks within the donation venue and use an alcohol-based hand rinse. The donors' body temperature was checked before donation and staff's body temperatures were checked daily. The safety of the blood supply was secured by a donor deferral policy for 4 weeks following contact with a confirmed or suspected case of and a post-donation call-back system. Despite scheduling mobile donation sessions and a decrease in donors attending blood donor centers, the blood supply was maintained as there was a 12.8% reduction of the demand of blood and only a 16.9% reduction in the blood donation. Transfusion safety is ever challenging as new diseases or risks appear from time to time. Despite the availability of modern sophisticated laboratory testing to better detect those important viral infections, there is still the inevitable limitation due to the possibility of a donor transmitting infection through blood in the window period of infection, when the blood contains infectious pathogens but the biomarkers of infection are undetectable. Therefore, health history enquiry remains an important part of donor screening to exclude those donors who may be at risk to themselves or pose a risk to the blood supply. The health history enquiry covers a broad range of Accepted Article not to travel to Hong Kong, until the time when the epidemic was controlled, and Hong Kong was been taken out of the infected area. As SARS is highly contagious infection and transmitted through droplets, stringent infection control measures were required to protect both donors and staff from contacting the virus. From the donor side, educational materials on SARS infection and prevention were put up at the entrance of the collection clinics to remind all prospective donors. All the donors were requested to wear face masks within the donation venue. Moreover, alcohol-based hand rinse was available to all donors so that they could have their skin disinfected before handling their face masks. Body temperature checking was also introduced for every blood donor as part of donor eligibility criteria. The staff were required to attend infection control course on SARS and constantly updated on the latest developments. Protective measures such as wearing face masks were mandatory within the donation venue and laboratory area. To be in line with the donor, staff were required to have their body temperature taken before reporting for duty every day. Regarding facility management, the frequency of the cleaning schedule was increased over and above the normal routine to further reduce the risk of contamination. As SARS was a newly identified viral infection, the understanding of its natural history was relatively limited. Based on the previous case histories, it was estimated This article is protected by copyright. All rights reserved. Accepted Article that the incubation period was between 2 to 10 days. Laboratory diagnostic evaluation was based on testing for the virus by RT-PCR from the secretions from upper respiratory tract and paired serological titres by immunoflorescence study. Therefore, the policy to combat SARS in blood safety had to be focused on donor deferral policy and post donation call back system. The BTS had implemented donor deferral policy to temporarily defer prospective donors who had close contact history with patients who suffered from confirmed or suspected SARS. The initial policy was a two-week deferral followed by an enquiry into the donor's health status and risk exposure. It was then modified to a four-weeks deferral policy and reassessed when the donor came again for blood donation. During this period, a total of 57 donors were deferred because of their contact history (Table 1) . Moreover, all the donors were reminded to report to the BTS if they experienced any SARS-related symptoms within one month after their donations. Table 2 The BTS also followed the WHO recommendation to implement a donor deferral policy for those donors who recovered from confirmed or suspected SARS This article is protected by copyright. All rights reserved. (http://www.who.int/csr/sars/guidelines/bloodsafety/en/) (accessed 30 th April 2020) though very few donors belonging to this category came back to donate. SARS had resulted in many significant changes in the health care service in Hong Kong. There was an influx of many SARS patients into hospitals in Hong Kong (e.g. cases from Amoy Garden) and an outbreak of SARS infection in health care workers 6 and therefore a switch in the normal health care provision was made as the battle against SARS developed. For the blood supply, the change in the health care had resulted in a 12.8% reduction of the demand of blood ( Figure 1 ). However, the impact of SARS on society and hence the willingness to come forward for blood donation was also significant. There This article is protected by copyright. All rights reserved. A major outbreak of severe acute respiratory syndrome in Hong Kong A cluster of cases of severe acute respiratory syndrome in Hong Kong Identification of a novel coronavirus in patients with severe acute respiratory syndrome A novel coronavirus associated with severe acute respiratory syndrome The epidemiology of severe acute respiratory syndrome in the 2003 Hong Kong epidemic: an analysis of all 1755 patients Coronavirus as a possible cause of severe acute respiratory syndrome The authors acknowledge the staff and donors that continued to work to meet the transfusion demand of the patients at that time, and grateful to the valuable comments and advice made by Professor David Roberts. This article is protected by copyright. All rights reserved.Accepted Article