We are pleased that governments around the world have been proactive in attempts to minimize the impact of COVID-19. Hopefully, new social distancing measures and travel restrictions for high-risk regions will prevent the rapid dissemination of the virus. Many countries have called on residents to shelter in place, work remotely, and limit contact with the sick, immunocompromised, and elderly. As conscious global citizens, we should all be doing our part to be mindful of those around us and abide by medical recommendations.
Unfortunately, patients in need of bone marrow transplants cannot afford to wait, which means that registries around the world cannot afford to stop operating. In response to new border restrictions and shutdown procedures, the South African Bone Marrow Registry must use innovative thinking to ensure that our patients can still receive the lifesaving transplants they need. Because our work deals extensively with sick and immunodeficient patients and most of the time requires international travel for our stem cell couriers, it is particularly important that we are alert, adaptive, and abiding by important COVID-19 restrictions. Below, we outline the procedures we have put in place in the last several weeks in response to the virus.
SABMR’s Response to COVID-19
The SABMR and other registries around the world are rapidly modifying procedures to align with COVID-19 restrictions. Thankfully there is no evidence that COVID-19 can be transmitted via blood products or that stem cells are carriers of the virus, which means that even if a donor did unknowingly have COVID-19, neither the courier nor the patient receiving their stem cells should be at any increased risk. However, as a precaution, the SABMR has introduced new donation procedures. When possible, bone marrow collection will be delayed for four weeks if a donor has been overseas to a high-risk area or in contact with someone who has been exposed to or diagnosed with the virus.
Many of our donors for South African patients come from overseas, some of which are from high-risk COVID-19 countries. This means we must be extremely careful in planning the transfer of stem cells. With extensive flight cancellations worldwide, we are strategizing with the government and local and international transplant centres to get stem cells across borders without putting South African citizens at risk of COVID-19. To prevent exposure, couriers flying into South Africa from overseas will remain in the airport rather than delivering the product to the transplant centre. When the courier lands in South Africa, they will be assessed for symptoms of the virus, then an SABMR staff member will meet them at the airport and retrieve the stem cells. After the transfer is complete, the courier will immediately return to their country on the next flight without exiting the airport. Registries around the world, including Israel, Italy, Spain, and Australia, have instituted similar measures.
With this new procedure in place, the SABMR was granted clearance from the government to fly stem cells in and out of the country via courier. This was approved on March 24th by the South African Department of Health, the Department of Home Affairs, and the National Command Council.
Normally, stem cells are transported fresh from the donation centre to the transplant centre and transplanted to the patient in less than two days. This is done to ensure that the highest number of healthy cells are used in the transplant. But with travel restrictions and flight cancellations becoming more prominent as a result of COVID-19, the SABMR has recommended the use of another option: cryopreservation, or freezing, of the stem cells after they have arrived at the transplant center. In cryopreservation, stem cells are temporarily frozen on arrival and then unfrozen at the transplant centre about a week later.
The reason for this has to do with the process called conditioning. Conditioning is the preparation a patient must undergo in the week leading up to the transplant. Because conditioning involves vigorous chemotherapy, it is extremely dangerous to the patient’s health to undergo conditioning without an immediate transplant. If, for example, a patient has begun conditioning and a courier’s flight is cancelled and the transplant is delayed or cancelled, the patient is at extreme risk. Cryopreserving the stem cells means that the transplant centre can have the stem cells on hand before beginning the conditioning, rather than relying on all travel going as planned.
The SABMR is also postponing our 2020 Golf Day so that we are not putting attendees at risk. If you were registered for this event and have not been contacted, please contact Kamiel Singh at firstname.lastname@example.org.
Helping where we can
Moments like this allow us to reflect on how important physical health is to our quality of life, and how quickly one’s medical situation can change. Now is the time to show extra compassion for each other, especially those of us who are sick. We may not have a widespread cure for COVID-19 yet, but we do have a way to treat patients with blood diseases like leukemia and marrow failure: a bone marrow transplant. These life-saving treatments cure over 60% of recipients.
Sick and immunocompromised people are even more vulnerable to viruses like COVID-19, which makes our work that much more critical. Taryn Lipschitz, whose son Aaron received a bone marrow transplant in 2018 at the age of 3, explains just how common the fear of infection is for someone with a pre-existing illness. “When you have an immune-compromised child, the risks involved with being out and about are an everyday reality. This fear and anxiety are feelings we live with on a daily basis.”
Let’s use the COVID-19 crisis as a springboard for action to help those we can. There may not be much you can do right now to help those with COVID-19, but you can help patients with other serious diseases like leukemia by registering to be a bone marrow donor today.
Register to be a donor
Diseases don’t wait, and that’s why the SABMR and other registries around the world must continue to do our work even under the threat of COVID-19. And you can help! For most donors nowadays, stem cells are donated through a process called peripheral blood stem cell donation. It’s a virtually painless process that’s completed in about six hours and looks a lot like a simple blood donation.
If you’re between the ages of 18 and 45, register to be a bone marrow donor by contacting our office at (021) 447-8638 or email@example.com. The SABMR offers at-home sampling kits, available at many locations nationwide, with a free collection service. All it takes to register is a simple cheek swab. Sign up today!