COVID-19

Understanding the SARS-nCOV2 virus and COVID-19 disease || Thalassemia and COVID-19 || Bleeding disorders and COVID-19

Understanding the SARS-nCOV2 virus and COVID-19 disease

SARS-nCOV2 virus is a type of coronavirus causing a respiratory illness called COVID-19. This novel strain of coronavirus emerged in December 2019 and spread throughout the world. The novel strain is said to have originated from animals and mutated to cause illness among humans (zoonotic virus). In the past, may mutated viruses have jumped species from animals (bats, pigs, birds) to humans causing contagious outbreaks like bird flu, swine flu, Nipah virus.

In February 2020, the World Health Organization (WHO) came up with the official name COVID-19 for the disease caused by SARS-nCOV2 virus. CO is corona, VI is virus and D is disease. The term corona means crown and refers to the appearance of the virus with spiky proteins sticking out.

COVID-19 has resulted in a total infected cases of 244,458,032 and total of 4,964,302 deaths.

https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus
https://www.cdc.gov/coronavirus/2019-ncov/your-health/about-covid-19/basics-covid-19.html

Keywords:

SARS-nCOV2 virus, Coronavirus, Respiratory illness, COVID-19

The delta variant of SARS-nCOV2 was first identified in India in December 2020. It spread throughout the country before sweeping across the world. It is currently the main variant of the coronavirus.

The delta variant is believed to be twice as contagious as the previous variants and leads to a more severe form of COVID-19 requiring hospitalization. Unvaccinated people are more at risk and there is more morbidity and mortality in places with low vaccination rates.

Vaccination is the best protection against the delta variant. It is important to get both doses of the vaccine for it to be effective. While the vaccination may not fully prevent an infection, it definitely reduces the severity of the illness and prevents hospitalization and death.

https://www.yalemedicine.org/news/5-things-to-know-delta-variant-covid

The COVID-19 virus mainly spreads from person-to-person. This can happen in two ways:

  • Airborne transmission which happens because the virus stays in the air for up to 3 hours. It enters the lungs when an infected person has breathed out droplets and aerosols and it remains suspended in the air
  • Droplets or aerosols which are emitted when an infected person coughs, sneezes or talks. These droplets or aerosols spread the virus into the air from the nose or mouth of infected people. Any person within 6 feet of an infected person can inhale the infected droplets into their lungs
Keywords:

Droplets, Aerosols, Airborne transmission, Lungs, Suspended particles

The COVID-19 virus mainly spreads from person to person. This can happen in many ways:
  • Surface transmission is now being debated as it is not a common method of transmission. However, it is better to take precautionary measures like avoid surfaces which an infected person may have touched. Since the virus can live on surfaces like metals and plastic for up to 3 days, it is better to clean and disinfect all surfaces if an infected person is around
  • Fecal transmission is also being debated. Studies have indicated that the virus is present in the feces of an infected person. If anyone in your family is infected and you are using the same bathroom, makes sure to close the lid of the toilet bowl before flushing and use a mask in the bathroom
  • Since the virus can also spread from asymptomatic persons, it is better to take care with proper masking and distancing
  • Community spread occurs when people are unable to trace out how they got affected with the virus without really being in contact with an infected person
  • Delivered food, packages and groceries are unlikely to spread the virus. However, maintain the mandatory 6 feet distance from the delivery personnel and always use the mask. Wipe the packages with a disinfectant wipe to be on the safe side and clean any surface on which the packages were kept
  • It is a myth that COVID-19 is transmitted through water while swimming (World Health Organization). Maintain the mandatory 6 feet distance while swimming
  • Chances of COVID-19 spreading through shoes is low. However, if you have babies which are crawling on the floor at home it is better to leave the shoes at the home entrance

Read up more on COVID-19 myths and facts:

 
Keywords:

Droplets, Aerosols, Airborne transmission, Lungs, Suspended particles, Surface transmission, Fecal transmission, Asymptomatic persons, Community spread, Swimming

Typically, the virus manifests in COVID-19 within two to 14 days of exposure. A person infected with the virus is contagious at least two days prior to actual manifestation of symptoms and they remain contagious for 10-20 days depending on the severity of the illness.

On an average, the virus takes anywhere between 3-6 days from the day of exposure for symptoms to manifest. In the case of the delta variant, it can take anywhere between 3-14 days for the symptoms to appear.

https://www.who.int/health-topics/coronavirus#tab=tab_3

Keywords:

SARS-nCOV2 virus, COVID-19, Exposure, Delta variant

You can protect yourselves and others during the pandemic by taking some simple precautions:

  • Wear a mask in all public places whether indoor or outdoor. The mask must fully cover your nose and mouth
  • If you have visitors at home, make sure to mask up and ensure they also wear the mask
  • Maintain the mandatory 6 feet distance from others
  • Avoid crowds and badly ventilated places
  • Wash your hands frequently with soap and water (or sanitizer if running water is not available). Remember to wash thoroughly especially before eating or preparing food, after using the restroom, after handling your mask, after touching a sick person, after changing diapers and after touching animals
  • Don't touch your face, eyes, nose, mouth with unwashed hands
  • Clean frequently touched surfaces like door knobs, electric switches, mobiles, keyboards, kitchen counters, taps, tables and desks with clean water and soap. You can also use a disinfectant spray and then wipe it clean
  • Take the vaccine whenever it is available to you. Make sure you get both doses
  • Protect children who are not vaccinated with proper masking and hand washing
  • If there are seniors or people with medical conditions, make sure they get fully vaccinated and follow all the masking and washing protocols
  • Monitor your health and be aware of any changes. If you feel feverish, make sure to check and record your temperature
  • See a doctor immediately if you develop sore throat, cough, cold, fever, breathlessness, vomiting, diarrhoea or any other symptom of COVID-19

https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/prevention.html

COVID-19 is an infectious disease caused by the SARS-nCOV2 virus. It causes flu-like mild to moderate and in some cases severe symptoms. Most common symptoms include:

  • cough
  • fever
  • fatigue
  • loss of smell or taste

Less common symptoms are:

  • cold
  • sore throat
  • chills
  • headache
  • body pain
  • diarrhoea and stomach pain
  • nausea and vomiting
  • pink eye

Serious symptoms which require immediate emergency treatment are:

  • low oxygen saturation
  • breathing difficulty
  • chest pains
  • slurring of speech, loss of mobility and confusion
  • Around 15% of those with the COVID-19 disease may get severe bilateral pneumonia requiring hospital admission, oxygen administration and even ventilation. The virus also causes severe inflammation in the lungs damaging the cells and tissues which line the air sacs.
  • Those people above the age of 65 and those with co-morbidities like diabetes, hypertension, cardiovascular disease, chronic kidney disease, chronic liver disease, autoimmune conditions, hemoglobinopathies or other orphan diseases which affect immunity are more at a risk of the severe form of COVID-19 with pneumonia.
  • Healthy individuals with mild symptoms can be treated at home with home isolation and medications. Those with more serious symptoms and other co-morbidities must seek immediate medical help.

https://www.who.int/health-topics/coronavirus#tab=tab_3

https://www.mayoclinic.org/diseases-conditions/coronavirus/symptoms-causes/syc-20479963

https://www.webmd.com/lung/covid-19-symptoms#1

Keywords:

SARS-nCOV2 virus, COVID-19, Oxygen saturation, Bilateral pneumonia, Ventilation, Lungs, Inflammation, Co-morbidities, Diabetes, Hypertension, Cardiovascular disease, Chronic kidney disease, Chronic liver disease, Autoimmune conditions, Hemoglobinopathies, Orphan diseases

The gold standard diagnosis for COVID-19 is the molecular Real-Time PCR (polymerase chain reaction) test to confirm if the person is positive for the virus. The RT-PCR test also indicates the viral load. The test involves a nasopharyngeal swab (sample from the nose and throat). This test is the most preferred one for those who already present with active symptoms and those who have come into close contact with infected people.

The other option is the antigen test which is inexpensive, faster and easier-to-use at the point of care. This test uses an immunoassay to detect the presence of the viral antigen which indicates a current infection. The test involves a nasopharyngeal swab (sample from the nose and throat) and turns out the results within 30 minutes.

Another class of tests which diagnose past infection is the antibody or serology test. This test detects the presence of SARS-nCOV2 antibodies which are developed in the body to fight off the infection. The antibodies appear after the person has been infected or vaccinated between 1 to 3 weeks of exposure or vaccination. The antibody tests should not be used to test for current infection.

For active infections with symptoms, along with an RT-PCR or a rapid antigen test, a lung CT is also indicated in case the test shows up as negative despite the person presenting with symptoms.

https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/testing.html

https://www.cdc.gov/coronavirus/2019-ncov/lab/resources/antigen-tests-guidelines.html

https://www.cdc.gov/coronavirus/2019-ncov/testing/serology-overview.html

Keywords:

COVID-19, Real-Time PCR (polymerase chain reaction), Nasopharyngeal swab, Antigen test, Antibody test, Serology, Lung CT-scan

Though there is no cure for COVID-19 as such, a range of therapies are used to keep the damage minimal. Antibiotics may be used only to prevent secondary infections and as such are not effective against viruses.

The FDA has approved an antiviral drug remdesivir for hospitalized cases in adults and children above the age of 12.

Several monoclonal antibody medications are used to reduce inflammation. The US National Institutes of Health (NIH) recommends the use of dexamethasone (a steroid) for people who are hospitalized and on oxygen or mechanical ventilation. If this drug is unavailable, other corticosteroids like prednisone or hydrocortisone may be used.

Supportive care may involve:

  • use of antipyretic medications
  • pain relievers
  • cough medications
  • fluids (including IV fluids)
  • rest
Keywords:

COVID-19, Antibiotics, Secondary infections, FDA, Antiviral drug, Remdesivir, Inflammation, Dexamethasone, Corticosteroids, Prednisone, Hydrocortisone

General references:

https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus

https://medlineplus.gov/covid19coronavirusdisease2019.html

Coronavirus and Pneumonia - https://www.webmd.com/lung/covid-and-pneumonia#1

Coronavirus disease 2019 (COVID-19) -https://www.mayoclinic.org/diseases-conditions/coronavirus/diagnosis-treatment/drc-20479976

https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/prevention.html

In India, we currently have 3 vaccines approved by the Ministry of Health and Family Welfare and the regulatory bodies. These are:

  • Covishield by AstraZeneca
  • Covaxin by Bharat Biotech
  • Sputnik by Gamaelya Research Institute, Russia

The approved vaccines are safe and have been rolled out throughout the country. In India, all persons above the age of 18 are eligible to take the vaccine. You can go to your nearest vaccination centre (government or private) and take the vaccine after producing your Aadhaar card or any other valid photo ID card which will be linked to your vaccination certificate.

People who have already been infected with COVID-19 can also take the vaccine safely 14 days from the resolution of all symptoms.

People with co-morbidities like cancer, diabetes, hypertension, cardiovascular illness, kidney or liver disease are in the high-risk group and must take the vaccination as soon as possible.

The vaccines may produce side effects like fever, headache, body pain, nausea, vomiting and diarrhoea which resolves by itself within 1 or 2 days.

If you have any specific allergy, talk to your clinician before taking the vaccination and be prepared with precautionary measures.

https://www.unicef.org/india/coronavirus/covid-19/faq

https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/is-the-covid19-vaccine-safe

Until the COVID-19 pandemic wanes and case count decreases, it is safest to stay home and minimize outside visits and contacts. Here are some simple pointers to staying physically active:

  • Studying or working from home means we are constantly at the computer. You may experience a lot more episodes of neck pain, back pain, shoulder pain and eye strain. Remember to take frequent breaks. Say after every 30 minutes, get up and walk around for 5 minutes. Stretch your body and drink lots of water, buttermilk, coconut water and other hydrating drinks. Splash your eyes with cold water or use eye drops like Refresh Tears® if your ophthalmologist has prescribed it
  • Make time to help with cleaning and cooking. Remember that during the lockdown period, many households and apartments have forbidden outside help from coming in, so pitch in and help those who are engaged in cooking and cleaning. All that bending and stretching is good for our physical bodies!
  • It is understandable that the daily walk or jog may be unsafe now and with parks and playgrounds closed there are no options. If you a treadmill at home, time to dust it down and use it! Try to walk around as much as possible at home. Either indoors or in your home compound or apartment premises. Make sure you mask up properly if you are walking in the apartment premises. See if the terrace can be utilized for walking. Instead of using the elevators, use the stairs. Climbing up and down is a great weight bearing exercise and will do good to your bones
  • Eat a balanced diet including sufficient daily protein, vitamin B12, vitamin C, calcium, micro nutrients, fibre, optimal fat and minimum carbohydrates. Choose nourishing foods like soups, stews, dals, khichdi, colourful salads, fruit smoothies, yogurt and other protein-rich dishes. Keep hydrating yourself frequently with glasses of tepid (not cold) water
  • Being cooped up at home, we tend to overdo the digital screens which results in eye strain and dry eyes. Make sure you take a long digital break every day. Put away the laptops, tablets and mobiles. Pick up a book, magazine or newspaper and read or just walk around and relax. You need at least 7-8 hours of daily sleep so put away those screens before bed time
Keywords:

Physical, Well-being, Pandemic, Balanced diet, Protein, Vitamin B12, Vitamin C, Calcium, Micro nutrients, Fibre, Optimal fat, Carbohydrates

The pandemic and the lockdowns across the country has forced people to stay indoors and study or work-from-home. Families have to adjust with each other and find the right space to continue their study or work. Being cooped in together is not easy and it is observed that tempers run high due to frustrations. It is not unusual to see family dynamics changing during these tough times.

Here are some simple pointers for psychological well-being:

  • Spend some time with the family on a daily basis. Make it a family breakfast, lunch, tea or dinner. At least once a day
  • Stay connected with family and friends through phone calls
  • Contextual depression during these times is not unusual. Talk about your feelings to people close to you. For all you know, they may as well be feeling the same!
  • Don’t immerse yourself too much in TV news with reports of daily deaths and other struggles. Be aware of the situation but don’t get overwhelmed
  • Whenever you find yourself sinking into a chain of negative thoughts; get up and walk around, talk to people in the family, pick up the phone and call a friend, watch a funny movie or a cartoon program, go outdoors and breathe the fresh air or just think of the good times in the past and visualize it all coming back again
  • Try to stay positive and visualize a future free of COVID-19. Avoid listening to all doomsday predictions. Mute the notifications on WhatsApp or other social media groups spreading fear
  • Worrying is not going to change a thing so you might as well stop worrying and focus on staying safe
  • Seek help from a mental health expert if you feel things are getting out of hand and you are getting too overwhelmed with negativity and depression. There is absolutely nothing wrong in getting help
Keywords:

Psychological, Well-being, Pandemic, Frustrations, Lockdown period, Stress, Family, Digital break, Negative thoughts, Mental health expert

 

Thalassemia and COVID-19

The SARS-CoV2 virus has created specific challenges and risks for people with blood disorders as it affects the respiratory system.

While blood disorders are not directly linked to respiratory diseases, the presence of co-morbidities such as current hepatitis B and C infections, HIV, chronic liver disease, cardiac complications, diabetes can lead to severe complications if the patients are infected with COVID-19. This is clearly the case in those patients who do not have access to optimal therapy and multidisciplinary care.

Thalassemia patients who have undergone splenectomy and sickle cell disease patients with asplenia or hyposplenism are at a risk of bacterial infections which can further lead to fatal sepsis events. If infected with COVID-19, these patients are at an increased risk of serious secondary bacterial infections.

In a position statement on COVID-19 and thalassemia by the Thalassaemia International Federation (2020); Farmakis, Giakoumis, Angastiniotis and Eleftheriou have classified thalassemia patients into three risk groups:

  • Group A with moderate risk
  • Group B with high risk
  • Group C with highest risk

Please check out your risk group based on the criteria outlined in the table and accordingly follow the guidelines to keep yourself safe from COVID-19.

Risk Group Criteria for risks Guidance (to be followed to stay safe)
Group A has moderate risk Thalassemia patients with:
  • optimal transfusion with a pre-transfusion Hb of 9.5-10.0g/dL for at least the past 3-4 years
  • optimal iron chelation with serum ferritin less than 2000 mg/L for the past 3-4 years
  • No splenectomy
  • No comorbidities
Can safely go to school/college/work with COVID-19 safety measures like double masking, distancing, sanitizing and hand washing
Group A has a high risk
Thalassemia patients with 2 or more of the following risks:
  • suboptimal transfusion with a pre-transfusion Hb of 8.0-9.0g/dL for at least the past 3-4 years
  • suboptimal iron chelation with serum ferritin more than 2000 mg/L to 4000 mg/L for the past 3-4 years
  • splenectomy
  • comorbidities like diabetes, other endocrine issues, cardiac issues, chronic liver disease, HIV, Hepatitis B or C and other respiratory complications

Can safely go to school/college/work with COVID-19 safety measures like double masking, distancing, sanitizing and hand washing.

Minimize contact with people to avoid infection risk

Group C has the highest risk
  • sickle cell disease
  • suboptimal transfusion with a pre-transfusion Hb of less than 7g/dL for at least the past 3-4 years
  • severe iron overload with serum ferritin more than 4000 mg/L for the past 3-4 years
  • comorbidities like diabetes, other endocrine issues, cardiac issues, chronic liver disease, HIV, Hepatitis B or C and other respiratory complications
  • splenectom

    Avoid going to school/college/work. Work from home or study at home. Minimize contact with people except those at home. Avoid large gatherings.

    Strictly follow COVID-19 safety measures like double masking, distancing, sanitizing and hand washing.

    Follow these measures even after the pandemic is declared over in the country for at least 6 months.

     
    Medically reviewed by:
    • Dr. Tulika Seth

      Clinical hematologist and Professor of Hematology
      All India Institute of Medical Sciences

    • Dr. JS Arora

      Hematologist and Thalassemiologist
      General Secretary
      National Thalassemia Welfare Society and Federation of Indian Thalassemics

    Reference:

    Farmakis, Dimitrios, Anastasios Giakoumis, Lily Cannon, Michael Angastiniotis, and Androulla Eleftheriou. "COVID‐19 and thalassaemia: A position statement of the Thalassaemia International Federation." European Journal of Haematology 105, no. 4 (2020): 378-386. Accessed on 31 May 2021 from https://onlinelibrary.wiley.com/doi/10.1111/ejh.13476

    Keywords:

    SARS-CoV2 virus, Thalassemia, Blood disorders, Respiratory system, Co-morbidities, Hepatitis B, Hepatitis C, HIV, Chronic liver disease, Cardiac complications, Diabetes, Splenectomy, Sickle cell disease, Hyposplenism, Bacterial infections, Sepsis, Transfusion, Iron chelation

    • The SARS-CoV2 virus has created specific challenges and risks for people with blood disorders as If a person with thalassemia presents with symptoms of cough, fever, fatigue or other symptoms related to acute respiratory illness, it is essential to test for COVID-19 as well as rule out other respiratory diseases.
    • If the test is COVID-19 positive, the treating physician should be fully briefed about the person's medical history and current care plan with thalassemia. The treating hematologist should be immediately kept informed
    • In people with other thalassemia-related comorbidities, the treating physician should stay in touch with them and brief them about the patient's condition
    • If the person currently has or has had hepatitis B or C or HIV; the COVID-19 treatment should be tailored accordingly to avoid severe side effects in the liver
    Medically reviewed by:
    • Dr. Tulika Seth

      Clinical hematologist and Professor of Hematology
      All India Institute of Medical Sciences

    • Dr. JS Arora

      Hematologist and Thalassemiologist
      General Secretary
      National Thalassemia Welfare Society and Federation of Indian Thalassemics

    References:

    Farmakis, Dimitrios, Anastasios Giakoumis, Lily Cannon, Michael Angastiniotis, and Androulla Eleftheriou. "COVID-19 and thalassaemia: A position statement of the Thalassaemia International Federation." European Journal of Haematology 105, no. 4 (2020): 378-386. Accessed on 31 May 2021 from https://onlinelibrary.wiley.com/doi/10.1111/ejh.13476

    Keywords:

    Thalassemia, Cough, Fever, Fatigue, Acute respiratory illness, Hematologist, Comorbidities

    Dr. J.S Arora from the National Thalassemia Welfare Society (NTWS) presented an informative session on COVID-19 vaccines for people with thalassemia. We have summarized the important points, DO's and DON'Ts to be followed:

    • Please drink lots of water before and after the jab
    • If you have pain at the vaccination site and fever, you can take Meftal tablets
    • Take the vaccine 5-6 days before or after blood transfusion
    • Before you get the vaccination, try to do a complete blood count (CBC), liver function test (LFT), kidney function test (KFT), lipid profile and fasting blood glucose
    • If you have diabetes, make sure your blood glucose levels are in control before you go for the jab
    • If you are taking BP medicine only at night, then take one extra dose in the morning on the day of vaccination
    • Those with high total cholesterol with high LDL, make sure you take your statins and Aspirin 75mg regularly and continue for at least 2 weeks after 2nd dose of vaccination
    • Those with cardiac abnormalities ensure you take your regular medicines and consult your cardiologist before vaccination.
    • If you have undergone splenectomy, check your platelet count and if above 5 lakhs start Aspirin 75 mg before 1st dose of vaccination and continue for at least 3 weeks after 2nd dose of vaccination
    • Vaccine is safe for those with HIV, hepatitis B and hepatitis C
    • Allergies or severe anaphylaxis after vaccinations may be due to the adjuvants/excipients/other compounds used in making of vaccine and not due to the active ingredient. If you have had a history of an immediate (in less than four hours) or severe allergic reaction to polyethylene glycol (PEG) or polysorbate 80 in the vaccine, ensure the clinic/hospital has adrenalin injections to counter any severe reaction
    • Those with a history of general allergies should take their antihistamines like cetirizine/levocetirizine/fexofenadine with Montelukast a day before the vaccination, one hour before vaccination and once a day for next three days
    • Asthmatic patients should not stop their medicine. Take one extra dose of Montelukast with antiallergic medications and inhaler one hour before vaccine.
    • For those who are on corticosteroids (like Wysolone) or immunosuppressive drugs, consider talking to your hematologist and immunologist if you can take a short drug holiday from these drugs as these suppress antibodies and can interfere with the vaccine's efficacy in producing antibodies
    • Those on Thalidomide should stop thalidomide one week before vaccination to at least 3 weeks after 2nd dose of vaccination and continue aspirin 75mg
    • Patients with a mildly lower platelet count around 1,00,000/mm3 do not need extra precautions, however if the platelets are very low then do consult your doctor before vaccination
    • Continue iron chelation as usual. However, do not take iron chelation if you get fever. Show a doctor as soon as possible and follow their advice
    • Non-Transfusion Dependent Thalassemia (NTDT) patients and splenectomised patients also to follow same precautions as stated above for thalidomide
    • Girls on hormone therapy or oral contraceptive. Either stop the treatment for 2-3 months or start aspirin 75mg daily from one week before 1st dose to 3 weeks after 2nd dose
    • Those on anti-coagulation therapy should continue their medication

    The COVID-19 vaccines provide adequate protection against the virus. Even among those who contracted the virus after the vaccination, the vaccine prevented complications and reduced the need for hospitalization.

    Remember that even after you get your shot you still need to follow measures like masking, hand washing and sanitizing and avoiding crowds.

    Medically reviewed by:
    • Dr. Tulika Seth

      Clinical hematologist and Professor of Hematology
      All India Institute of Medical Sciences

    • Dr. JS Arora

      Hematologist and Thalassemiologist
      General Secretary
      National Thalassemia Welfare Society and Federation of Indian Thalassemics

    Keywords:

    Vaccination, Pain, Fever, Blood transfusion, Iron chelation, Complete blood count (CBC), Liver function test (LFT), Kidney function test (KFT), Lipid profile, Fasting blood glucose, High total cholesterol, Statins, Cardiac abnormalities, Splenectomy, HIV, Hepatitis B, Hepatitis C, Anaphylaxis, Polyethylene glycol (PEG), Polysorbate 80, Adrenalin injections, Antihistamines, Cetirizine, Levocetirizine, Fexofenadine, Montelukast, Asthmatic, Corticosteroids, Wysolone, Immunosuppressive drugs, Thalidomide, Non-Transfusion Dependent Thalassemia (NTDT) patients, Hormone therapy, Oral contraceptive, Anti-coagulation therapy, Platelet count

    According to the Joint United Kingdom (UK) Blood Transfusion and Tissue Transplantation Services Professional Advisory Committee's guidelines, blood donation after COVID-19 can happen as listed:

    • donors confirmed positive with COVID-19 can donate after 28 days of symptom resolution
    • donors not tested at all but with COVID-19 symptoms can donate after 28 days of symptom resolution
    • donors who have developed upper respiratory tract symptoms but tested negative for COVID-19 can donate after 14 days of symptom resolution
    Medically reviewed by:
    • Dr. Tulika Seth

      Clinical hematologist and Professor of Hematology
      All India Institute of Medical Sciences

    • Dr. JS Arora

      Hematologist and Thalassemiologist
      General Secretary
      National Thalassemia Welfare Society and Federation of Indian Thalassemics

    Reference:

    https://www.transfusionguidelines.org/document-library/documents/jpac-position-statement-sars-cov-2-covid-19-march-2021-pdf/download-file/JPAC%20Position%20Statement%20SARS-%20CoV-2%20COVID-19%20-%20March%202021.pdf

    Keywords:

    Blood donation, Symptom resolution, Donors, Symptoms, Upper respiratory tract, Negative

    • According to the National Blood Transfusion Council (NBTC) guidelines in India dated 5th May 2021, blood donors may donate blood 14 days after receiving the first or second shot of the vaccine. Blood donors have to conform to all other health norms for blood donation.
    • The Thalassemia International Federation (TIF) has issued a position statement stating that people who get the SARS-CoV-2 vaccines (which do not contain live viruses) can donate blood 7 days after the vaccination. Donors will have to be healthy and should not develop any symptoms of COVID-19 in the interim waiting period of 7 days.
    Medically reviewed by:
    • Dr. Tulika Seth

      Clinical hematologist and Professor of Hematology
      All India Institute of Medical Sciences

    • Dr. JS Arora

      Hematologist and Thalassemiologist
      General Secretary
      National Thalassemia Welfare Society and Federation of Indian Thalassemics

    Keywords:

    National Blood Transfusion Council (NBTC), COVID-19 vaccine, Blood donors, COVID-19 symptoms, Interim waiting period

    A US study titled "Minipool testing for SARS-CoV-2 RNA in United States blood donors" by Bakkour, Saa, Groves, Montalvo, Germanio et al., found that the risk of transmission of SARS-CoV-2 through blood transfusion was highly unlikely.

    They tested for COVID-19 in nearly 18,000 pools of donated blood collected between March to September 2020 from 6 US metropolis regions and found only 3 samples positive for coronavirus. The 3 samples had a very low viral load and clearly could not be transmitted to the person receiving the blood transfusion.

    The study is in line with the finding of the Thalassemia International Federation (TIF) which indicated that there is no data suggesting transmission of COVID-19 through blood transfusions.

    Medically reviewed by:
    • Dr. Tulika Seth

      Clinical hematologist and Professor of Hematology
      All India Institute of Medical Sciences

    • Dr. JS Arora

      Hematologist and Thalassemiologist
      General Secretary
      National Thalassemia Welfare Society and Federation of Indian Thalassemics

    References:

    https://thalassaemia.org.cy/news/us-study-covid-19-does-not-pose-a-threat-to-blood-and-transfusion-safety/

    Bakkour, Sonia, Paula Saá, Jamel A. Groves, Leilani Montalvo, Clara Di Germanio, Sonja M. Best, Eduard Grebe et al. "Minipool testing for SARS-CoV-2 RNA in United States blood donors." Transfusion. Accessed on 1 June 2021 from https://pubmed.ncbi.nlm.nih.gov/34046906/

    Keywords:

    Blood transfusion, Risk, Transmission, Donated blood, SARS-CoV-2

     

    Bleeding disorders and COVID-19

    Having a bleeding disorder does not pose any greater risk than what the general population faces. However, those people may have other co-morbidities like HIV, hepatitis B or C, chronic liver disease, diabetes, asthma or high blood pressure which may put them at risk of serious COVID 19 infections. In such cases, you should choose to work from home or study from home and strictly follow all the general guidelines like frequent hand washing, sanitizing, masking and social distancing.

    Medically reviewed by:
    • Dr. Tulika Seth

      Clinical hematologist and Professor of Hematology
      All India Institute of Medical Sciences

    • Dr. JS Arora

      Hematologist and Thalassemiologist
      General Secretary
      National Thalassemia Welfare Society and Federation of Indian Thalassemics

    In general, COVID-19 itself does not lead to more bleeding episodes than usual. However, if you develop a severe cough there is a greater risk of having throat, lung and head bleeds. In such cases, you must keep your hematologist informed and take prophylactic measures.

    Medically reviewed by:
    • Dr. Tulika Seth

      Clinical hematologist and Professor of Hematology
      All India Institute of Medical Sciences

    • Dr. JS Arora

      Hematologist and Thalassemiologist
      General Secretary
      National Thalassemia Welfare Society and Federation of Indian Thalassemics

    Please continue your factor therapy as usual. If you are going to a hospital or treatment centre, follow the standard precautionary guidelines.

    Medically reviewed by:
    • Dr. Tulika Seth

      Clinical hematologist and Professor of Hematology
      All India Institute of Medical Sciences

    • Dr. JS Arora

      Hematologist and Thalassemiologist
      General Secretary
      National Thalassemia Welfare Society and Federation of Indian Thalassemics

    A joint guidance statement has been issued by the World Hemophilia Federation (WHF), European Association for Haemophilia and Allied Disorders (EAHAD), European Haemophilia Consortium (EHC), and U.S. National Hemophilia Foundation (NHF) clarifying that COVID-19 vaccines are recommended for people with bleeding disorders.

    Salient points include:

    • The vaccine should be given as an intramuscular injection with the smallest gauge needle preferably 25-27 gauge
    • Apply pressure to the vaccination site for at least 10 minutes to stem the bleeding from the injection
    • Keep checking for any swelling at the injection site
    • Any allergic reaction should be reported immediately (fever, warmth, redness, itching, rash, shortness of breath or swelling in the face)
    • Those with a history of allergies to polyethylene glycol (PEG) should discuss with their primary clinician and choose a vaccine without PEG
    • For those with moderate to severe hemophilia, the vaccine should be given after administering FVIII or FIX injections
    • Those with a basal FVIII or FIX level above 10%, no hemostatic precautions are required
    • Those who are on emicizumab (with or without inhibitor) can take the intramuscular vaccine any time without hemostatic precautions
    • Those with Type 1 or Type 2 von Willebrand disease (VWD) should check their baseline von Willebrand factor (VWF) and ristocetin cofactor (RiCof) and use medications like DDAVP (desmopressin) and tranexamic acid before taking the vaccine. Those with Type 3 VWD should be given a VWF-containing injection before the vaccine jab
    • All those with rare bleeding disorders like thrombocytopenia and other platelet disorders must be vaccinated. Those on anticoagulants should get the prothrombin time test within 72 hours before the vaccine to check for INR (international normalized ratio). If the results are normal, they can safely go for the vaccine
    • There are no contraindications of the vaccine to therapies used in the bleeding disorders
    • Treatment of HIV, hepatitis B or C do not contraindicate the vaccine
    • Vaccines are not contraindicated for those on immunosuppressive drugs like cortisone

    The European Medicines Agency (EMA) Pharmacovigilance Risk Assessment Committee (PRAC) has been investigating isolated cases of blood clotting in cases that occurred across the globe. The PRAC reiterated that these are isolated cases and the benefits of COVID-19 vaccine outweighs the miniscule risks.

    Following the link between the AstraZeneca COVID-19 vaccine and the unusual blood clotting reactions, the European Regulatory Authority investigated 169 cases of blood clots in the brain and 52 cases of blood clots in the abdomen (among the 34 million vaccinated) and suggested the risk estimate to be 1 in 153,000 for thromboembolic events.

    As compared to the general population, people with bleeding disorders are not at a higher risk for these rare reactions to the vaccine. Therefore, people with bleeding disorders must get the vaccine whenever it is rolled out.

    Medically reviewed by:
    • Dr. Tulika Seth

      Clinical hematologist and Professor of Hematology
      All India Institute of Medical Sciences

    • Dr. JS Arora

      Hematologist and Thalassemiologist
      General Secretary
      National Thalassemia Welfare Society and Federation of Indian Thalassemics

    References:

    https://hemaware.org/mind-body/managing-bleeding-disorder-during-pandemic-answers-6-common-questions-about-covid-19

    COVID-19 vaccination guidance for people with bleeding disorders. Guidance from the World Federation of Hemophilia (WFH), European Association for Haemophilia and Allied Disorders (EAHAD), European Haemophilia Consortium (EHC), and U.S. National Hemophilia Foundation (NHF). Published December 22, 2020

    EMA, ISTH, WHO and many countries recommend benefit of COVID-19 vaccination outweighs risks. World Federation of Hemophilia, European Haemophilia Consortium. April 12, 2021

    Keywords:

    Hemophilia, Comorbidities, HIV, Hepatitis B, Hepatitis C, Asthma, Chronic liver disease, High blood pressure, Throat, Lung, Head, Bleeds, Hematologist, Prophylactic, Factor therapy, Intramuscular injection, Allergic reaction, Polyethylene glycol (PEG), FVIII, FIX, Hemostatic precautions, Emicizumab, Inhibitors, von Willebrand disease (VWD), Ristocetin cofactor (RiCof), DDAVP (desmopressin), Tranexamic acid, Thrombocytopenia, Platelet disorders, Anticoagulants, Prothrombin time test, INR (international normalized ratio), Immunosuppressive drugs, Cortisone, Blood clots, AstraZeneca COVID-19 vaccine



     

    Helplines
    Testing and vaccination centres
    Others