The case of the National Hellenic Blood Transfusion Center:
From victim of the pandemic to the front line of defense against it.
In mid-April and in the heart of this year’s Orthodox Easter –one of the most bizarre Easters Greece has ever experienced– the National Hellenic Blood Transfusion Center found itself accidentally playing a strategic role in the control of the coronavirus diffusion in Greece.
“When COVID-19 appeared, the discussion started, in first place, because the blood donation was affected. There was a fear about the transmission of the virus –about whether it can be transmitted through transfusion or not. That’ s always an issue that perplexes blood donors because they erroneously assume that either the donor or the recipient might be infected. So, in that phase, we made campaigns aiming to the transfer the blood transfusion procedures outside the hospitals,” explains Dr Stamoulis, hematologist and scientific director of the Hellenic National Blood Transfusion Center.
From March 23rd, heavy restrictions in mobility had been imposed, introducing the first phase of the lockdown that would last until May 4th. During this period, Greeks were allowed out of their homes only for merely essential reasons: work, medical reasons and urgencies, food supplies, and dog walk.
“From my point of view, the measures have been to the right direction, so that people who were flocking the hospitals would be reduced. However, the blood transfusion system suffered a collateral damage because it lost blood donors. This happened because Greek donors have some specific features; the 35% of them is what we call ‘donors from the immediate environment of the recipient’. Therefore, while this measure brought a result by having saved the blood reserves that would be used in the surgeries, it also created a pause in the flow of the blood transfusions. So, the National Hellenic Blood Transfusion Center had to be more actively involved by organizing the external blood transfusion actions. We asked the collaboration of the municipalities and people indeed responded to the calls,” says Dr Stamoulis.
Yet, the NHBTC, apart from having to resolve such a crucial side-effect of the pandemic as severe blood shortage, ended up having been summarily assigned an unexpected mission.
As Dr Stamoulis explains “in issues of healthcare, in general, the Blood Transfusion sector is engaged as a last resource. It is not the first field where a country bases its public health strategy. This happens only on two occasions: on the occasion that the problem involves blood, whereon the necessary measures are taken, or on the occasion that a government has run out of tools and is trying to muster all healthcare entities. On the other hand, the Blood Donation procedure functions on a very industrial logic by conducting massive controls and making scheduled blood transfusions. It has the know-how to work outside the urban centers and to codify the samples, which are both essential procedures in the case of a pandemic as well”.
This expertise has been proved to be indeed efficient as the progressive lifting of the restrictive measures would not have been possible without a tool of massive control. However, it was nothing more than a coincidence that brought the NHBTC in the frontline against COVID-19.
“We had already published a call for the purchase of blood control machinery in 2018, which was completed in 2020. The winning manufacturing company had provided the device that we finally purchased with two extra channels for analysis. It wasn’ t COVID-19 that they had in mind that time –actually it was a provision addressed to Hepatitis E, that was still spreading in Europe, and to Babesia, a widely diffused parasite in the US. The Hellenic National Blood Transfusion Center always ensures a second machine because during summertime here in Greece we deal with the West Nile virus, an epidemic whose extent is always hard to estimate. Probably, the company was already oriented to the Wu-Han pandemic, since they had created their first experimental COVID-19 reagents and had send them to German scientific laboratories for testing. The German response was positive, accompanied by the suggestion that this is a good platform for molecular controls used in blood transfusion that could be also useful in case of pandemic. This happened in January of this year. To be honest, when I read this suggestion, I was sceptical, because in our field this kind of indications are not accidental,” points out Dr Stamoulis and he recounts the details of the immediate developments: “In mid-March, the machinery receives FDA’ s approval for the COVID-19, which makes it the only approved automatic platform by that moment. In an attempt to find reagents for the control of the virus, the Greek Ministry of Health gets notified about the existence of this equipment in our premises, and informs us that we may be involved in the control, and shortly afterwards sanctions our involvement with a legislative act”.
Within a few days, a special room was prepared in the premises of the NHBTC to ensure that all the necessary standards are provided for the safety of the laboratory team, as well of the rest of the center’s employees. The whole endeavour started idly, with isolated controls of specific patients and suspicious cases, but gradually the sample collection began expanding in increasingly larger scale. The samples, so far, come from the targeted samplings conducted by the National Public Health Organization in nursing homes, orphanages, ports, ships on quarantine, as well as from operations conducted by the General Secretariat for the Civil Protection that include, among others, controls in Roma camps and flight passenger groups arriving at the Greek airports from abroad. The NHBTC has issued and distributed barcodes for all operations across Greece. The collection of samples is taking place daily, until noon, and the lab controls are being conducted each afternoon till the evening. Dr Stamoulis describes the way his team works: “It is exactly because we ignore the behaviour of the virus –we are not sure, for example, whether the conservation duration of the samples affects the result, we begin to control the material immediately. By now, our preparation time has been minimized to about half an hour, and once the samples enter the platform, the results can be ready within three and a half hours approximately. New data are continuously emerging. Therefore, when we deal with an ambiguous health record or clinical manifestation, even in the case of a negative sample, we suggest a verification control after four days”. And he further explains what this procedure entails: “What we make is molecular control, we trace the RNA of the virus. This is useful only if someone has the infection that very moment; it does not give a “commemorative image” about whether the donor of the sample has been in the recent past infected by COVID-19. At a certain moment, when the “positive” donor will become “negative”, they will have an antibody test, and then it will become clear what has elapsed. We will probably take a part also in the antibody control, again because we function under this “industrial” logic. The rest of the available reagents in Greece are of course also of high quality, yet of lower capability”.
When asked about his personal account of the last three months, Dr Stamoulis says:
“All along the line, things advanced rapidly. We were all taken by surprise. The virus itself was not known, neither was its infectiveness. New facts are constantly arising, and we all keep on learning. It has been something unprecedented. In any case, pandemics happened always in the history of humanity. What Europe now pays for is the privatization of the healthcare systems. NHBTC’ s story is what it means to be present at the right moment. We had the access to the reagents, and we had the know-how and the organizational infrastructure from the collective controls that we make. Without those elements, without the experience of the complex conduction of the blood transfusion, even the machinery itself would have been useless. As far as governmental management is concerned, what has saved Greece is the fact that the whole system has learnt how to work with those ‘unseen heroes’, those two-three people who work with great self-sacrifice in every healthcare unit and entity.”