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At the beginning of April, after the first chaotic week of the lockdown announced by Prime Minister Narendra Modi, a request for blood from relatives of patients at a large corporate hospital in Delhi kept coming in to the Twitter handle @BloodDonorsIn started by entrepreneur Balu Nayar. The handle, started in 2008, has 1.2 million followers and coordinates requests from a network of 40-plus cities and towns.

The volunteer operating the handle for Nayar decided to call the number given as a contact to check. The man who picked up seemed disoriented. He had travelled from Jammu for his 37-year-old son’s kidney transplant early in March. The transplant had been done but complications had arisen and there was a nearly daily demand for blood and plasma.

“Within a couple of minutes, this elderly man was in tears," says the volunteer, who did not want to be identified. “He said he knew no one in Delhi and knew little about the lockdown because he was living in the hospital. But that week, doctors had asked him to organize blood because the blood bank was running out. He was not social media savvy but some of the others staying at the hospital with their patients had helped him. But no donors turned up. I felt very helpless myself at that moment because I had been getting distressed tweets all week from people who could not find donors."

The handle is used to receiving grateful shout-outs because social media has proved to be extremely effective in organizing blood donation. Now, police officials from cities across the country were tweeting to the handle for help—and it was unable to oblige.

Blood donation drives had been cancelled and donors were staying home for fear of infection, or just because they couldn’t reach a hospital. Social media helplines like @BloodDonorsIn, which help mobilize donors, found themselves helpless.

On 3 April, for the first time in the handle’s 12 years, Nayar pinned an appeal on top of the timeline: “There is an extreme shortage of blood across India during this Lock down. Please donate blood at your nearest hospital. Patient’s families can provide letter from the hospital to help you reach for donation. Also, requesting authorities to support."

State governments, hospitals and NGOs have issued similar appeals. On 31 March, Tamil Nadu’s department of health tweeted: “As of 16 March, 4,000 blood drives had been cancelled and the state had missed 130,000 donations. We are in a severe shortage." Around the same time, the Delhi government’s 1,700-bed Guru Teg Bahadur Hospital sent out an email requesting blood donation. The director of the blood bank offered to issue commuting passes for volunteers who wrote in to the email address provided, so they could come to the hospital to donate (an email I sent to the address on 6 April was opened within an hour but was unanswered at the time of writing). The Indian Red Cross Society, a branch of the International Red Cross and Red Crescent Movement, has an open request for blood donation in Delhi on its home page.

The nationwide lockdown has choked most supply chains, disrupting delivery of critical services and goods. Specialized drugs like immunosuppressants have not been available in some cities, in other places the absence of public transport means patients have to embark on arduous journeys to collect their medicines. Kerala, Rajasthan and Bihar have hit pause on their immunization drives. Immunosuppressants and vaccines are both life-saving interventions. But the need for blood can be both universal and immediate, for a range of life-saving treatments.

On 1 April, the Kolkata police “pledged" to donate 50 units of blood every day in a city that earlier seemed to always be on a blood donation drive. This means that an already overworked police force must also donate a certain quantum of blood to maintain bare minimum supplies.

Fifty units a day is a drop in the proverbial ocean. Bengal usually needs 2,400 units of blood daily, the state’s health department said in an interview to the Kolkata city edition of The Times Of India. With hospitals shutting outpatient departments, delaying “elective" surgeries and offering only emergency care, this has fallen to 800-1,000 units per day.

“The (donation) camps organized for the weekend of 22 March had to be cancelled (for the Janata curfew), “ says Pratik Dey, who is in charge of the blood bank at the Institute of Postgraduate Education and Medical Research, the largest government hospital in the city. “In regular times, there are seven-eight camps every weekend and even that is not enough to fulfil the demand in government hospitals. We have already gone two weeks without any camps, so you can imagine," he adds.

Most of India’s blood supplies, which include whole blood, plasma and platelets, come from donors who participate in camps or drives. The Supreme Court banned professional (paid) blood donation in 1996, although news reports and the government’s own reporting suggest that the practice continues.

Large private hospitals tend to ask patients’ families to organize blood for the units they consume. This category of donation is known as family or replacement donors and is actually discouraged by the World Health Organization (WHO) because it puts pressure on people who are already dealing with a health crisis. A 2010 WHO report indicated a higher prevalence of transfusion-transmissible infections in such cases.

Even in normal times, India falls short of 1.1 million units of blood annually, according to a 2018 report by the National AIDS Control Organization (Naco). The national demand was for 14.6 million units while the supply was 13.5 million units (interestingly, the report could account for only 11.1 million units of blood).

Another picture of what essential (non-elective) demand for blood looks like comes from this Naco report, which distinguishes among four kinds of demand—medical, surgical, obstetric and gynaecological and paediatric. Surgery accounts for only 28% of the demand for blood; most surgeries are said to have been delayed under the head of elective procedures. So it may be fair to assume that 72% of the demand would continue even during the lockdown, for emergencies such as gastrointestinal bleeding, births and complications with infants.

Why is the Bengal government reporting much lower demand than this 72%? Ground exigencies. Even those who need to go to hospital may be unable to make it because there is no transport. Free ambulance services are very limited, and paid services are often expensive, especially at a time like this.

“The Bengal government figure is an underestimate because they are going by the actual quantity of blood demand faced by hospitals," says Subhasri Balakrishnan, who works with the collective CommonHealth and is an obstetrician by training. “For instance, I know that a number of state governments have discontinued antenatal care during the lockdown, hence a lot of women who would be advised treatment for anaemia during pregnancy will not receive it. But if they haemorrhage during delivery, they will not get the blood they need.

“Even the term ‘elective surgery’ is hugely misleading. Would you call a transplant an elective surgery? Or a cancer surgery? You are already very sick, which is why you need those surgeries. The problem with a response focused on covid is that existing critical problems are being sidelined," says Dr Balakrishnan.

The only state that has narrowly averted this shortage for now is Maharashtra, which, in fact, has registered the highest number of covid-19 cases and deaths in the country. Blood supplies in the state were touching dangerously low levels at the end of February because many blood donation camps had to be cancelled owing to anxiety about the pandemic. The NGO Think Foundation, which organizes blood for thalassemia patients, was one of the organizations which alerted the state blood transfusion centre to the possibility of a shortage due to covid-19 fears ahead of the lockdown.

“We are lucky that our health minister (Rajesh Tope) understood and addressed a Facebook live session asking for blood donation," says Vinay Shetty, who works with Think Foundation. “Camps were organized every day from 25-31 March, following distancing norms. Blood banks issued e-permits to volunteers who signed up.

“Police are also aware that blood donation is an essential activity. Yet the same police force stopped one of our thalassemia patients from travelling by bus because they did not understand what it means. Messaging makes all the difference."

Sohini Chattopadhyay is a Kolkata-based journalist.

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