Liquid Gold at the End of the Rainbow: What the COVID-19 Pandemic Has Done for MSM Blood Donations

Simone Nabors
Nov 21, 2021
3 min read

At the height of the first wave, the plasma from recovered COVID-19 patients was in high demand. A treatment known as plasma-derived therapy was introduced from the antibodies present in the plasma of those who had recently recovered from COVID. This plasma could be donated and used as a treatment for someone actively battling the virus (1). Due in part to its color and value, this plasma became colloquially known as “liquid gold,” but what happens when this gold is found at the end of a rainbow?

For men who have sex with men (MSM), donating their potentially lifesaving plasma isn’t as simple as walking into a donation center. As of April 2, 2020, the Food and Drug Administration’s policy on blood donations requires a deferral period of 3 months “for a man who has had sex with another man during the past 3 months” (2). To clarify, this means that any MSM who wish to donate their blood, including those who are in long-term, monogamous relationships, must remain celibate for 3 months prior to donation. This is an update from their previous lifetime and 12-month bans.

Relative to its history, this policy revision may seem like the final frontier in tackling the antiquated blood bans on the LGBTQ+ community. In September of 1985, the FDA implemented a lifetime ban on blood donations from “male donors who have had sex with another male, even one time, since 1977” (2). This was in response to the AIDS epidemic sweeping the country, which was particularly prevalent in the MSM community. For the next 30 years, gay men were entirely prohibited from donating blood. It wasn’t until 2015 that this lifetime ban was reduced to a 12-month deferral period for MSM. This meant that after the June 2016 terror attack at Pulse night club in Orlando, gay men were turned away from their local blood donation centers (3). While blood banks were calling for urgent donations, these men were told that they would have to remain celibate for 12 months before they could help anyone, let alone those in their community who needed blood immediately. Despite pressure from medical professionals and lawmakers, this policy remained in effect until April of 2020.

Even now, as we face a national blood shortage with 32% of community blood centers having only enough blood for 1 day or less (4), the 3-month deferral period remains in effect. Organizations are working day and night to convince Americans to donate blood, but there is an entire demographic group willing and able to donate blood who are forbidden from doing so. Not only is this ban harming patients in dire need of blood and plasma donations, but it is continuing to stigmatize the LGBTQ+ community. When we focus on who someone is having sex with rather than the safety surrounding those sexual experiences, we perpetuate the sense of otherness that is all too familiar to the queer community.

In terms of using the plasma of recovered COVID-19 patients as a treatment for active cases, a 3-month ban still prevents hospitals from collecting this plasma at a time when antibodies are at their highest. It is now known that levels of antibodies decrease exponentially in the months following recovery (5), meaning that, by the time MSM have fulfilled their 3-month deferral period, their plasma is not nearly as useful as it once was.

As we move forward in this battle for equal access to blood donation, there are many questions, and answers fall few and far between. With tests designed to detect HIV within 11 days of exposure, some wonder if the FDA should reduce its deferral period accordingly (6). Others wonder why there needs to be a ban at all if donated blood is already being tested after collection (7). The cynics among us have noted the need of a global pandemic to force the hand of the FDA into reducing the ban to 3 months and wonder what global crisis we are waiting on now.

Despite the abundance of questions and lack of certain answers, one thing is abundantly clear: We have come too far and learned too much to conceal homophobia under the name of science.

Edited by: Jennifer Xu

Graphic Designed by: Acelo Worku

References

Do you need the COVID-19 booster? Is it ethical to get a third dose when many have not had a first?

Morgan Robinson
Nov 14, 2021
3 min read

Ever since the dreadful March COVID pandemic shut down, there has been one hot topic on the news and everyone's minds: the COVID-19 vaccine. When would it be made? Who would be able to get it? Would it be effective?

Thankfully, we are now months out from this time of heightened uncertainty and the vaccine has been developed, tested, and implemented relatively well, bringing the world to some sense of normalcy. However, questions have recently been raised regarding the necessity and ethicality of the COVID-19 booster shot.

So what exactly is the booster shot? For those who got Moderna or Pfizer, it is another dose of the vaccine given after the protection from the first two shots has begun to wear off over time (1). According to guidelines published by the CDC, iIt is highly recommended that those 65 years or older receive the third immunization at least 6 months after the original round of vaccinations (2). This is no surprise as the vaccine has often been recommended to the older generations first in the past and continues to start with the more elderly and work its way down to children.

But what about those who got the J&J vaccination, as many did at Duke? The premise is the same, another dose of the same vaccine; however, the recommended timeline for receiving this next dose is much shorter, only two months after the last (3). Interestingly, the CDC has issued guidelines saying it is safe to “mix and match” dosing for booster shots (2). As a result, irregardless of which vaccine an individual initially received, he can see effective results from choosing any one of the vaccine boosters.

On the other hand, there are many ethical concerns regarding the vaccine booster, as citizens in many countries have not yet received their first shot. Is it ethical for someone to be getting their third vaccine when some haven't gotten access to their first? It is a tough question considering, as an individual, you are not controlling where the vaccines are going. Should you feel guilty signing up for your booster at, for example, your university where they will be holding the vaccine anyways? In an article written by Matt Shipman for the NC State news, system engineers and vaccine distribution experts Julie Swann and Matt Koci debate some of these ethical considerations. They focus on the efficiency of healthcare supply chains and making the system more equitable. In an economically dominated world it is not surprising that the vast majority of doses (over 80%) have been distributed in countries with high or upper-middle income, such as the U.S. (6). While this is a disappointing statistic that illuminates the need for availability in lower income countries that have consequently experienced higher infection and death rates, the reality is more complicated. The time it would take to transfer the vaccines to many other countries would outrun the expiration date for the vaccines and is very difficult to coordinate. In addition, the U.S. is unfortunately still quite high in case number compared to the rest of the world (approximately 27% of the world's total cases) with such a large population so it is important to continue decreasing cases here to help the overall spread slow (6).

How do you get your booster? Here at Duke, the university has been offering booster vaccines of Pfizer or Moderna since August 23rd for immunocompromised faculty and staff and since November 2nd for students (4, 5). Appointments can be made with Student Health by calling an immunization nurse (919.681.9355) as well as through your Duke email following links sent out by the university. There are various locations available, including Blue Devil Tower adjacent to Wallace Wade Stadium and a quick walk from the BC Plaza. The process is quite efficient, as someone who went through the process recently.

So should you get your vaccine? It is still up to the individual, but the CDC as well as many other sources recommend the vaccine booster 2 months out for J&J recipients and 6 months out for Moderna and Pfizer recipients in order for the individual as well as for the world to return back to a less restricted way of life. The Delta variant, as well as other variants, is still surging among unvaccinated and vaccinated individuals. Anything that can be done to slow or stop the spread is a positive movement for society.

Edited by: Elissa Gorman

Graphic Designed by: Harris Upchurch

References

Impact of the Pandemic on Minorities

Marilyn Perez
Nov 10, 2021
2 min read

How has COVID-19 affected you? For many, the answer could include quarantine, working from home, virtual schooling, and more subtle changes in their daily routine. However, some populations have been more adversely affected by the changes the pandemic has brought, including several ethnic minority groups.

For that matter, the hospitalization and deaths for minority populations has been up to 3 times the rate of white and non-minority identifying populations1. In the Durham community alone, the Hispanic/Latinx population has accounted for 27.01% of COVID cases in the previous months while Black/African American communities accounted for almost 39.55% of COVID cases2. However, the Hispanic/Latinx community accounts for only 14% of the total Durham County population, while Black/African American communities account for 37% of Durham County. This discrepancy in numbers demonstrates how minorities are more profoundly affected by COVID in the county that we reside in.

So why do these discrepancies occur?

There are many factors and not a perfect way to answer this question, although it could be broadly answered by the impact of social determinants of health. For instance, minority groups are most likely to be employed as “essential workers”. These occupations include “farms, factories, grocery stores, and public transportation” 3. By working in these essential jobs and interacting more frequently with the general public, minority groups may be more susceptible to contracting the disease.

Moreover, institutional and lifelong racism can also play a part in the health risks for minorities. The long-term experience of racism is associated with tangible biological impacts on a person’s health.4 In particular, chronic inflammation has been linked to “race-related stressors”. This demonstrates the detrimental impacts of racism to the health of humans and the importance of eliminating institutional racism from our social spaces.

In addition, more than half of the uninsured population are from minority groups. This is important to consider because this is another way in which social determinants are associated with worse health outcomes for minorities who contract COVID, since the high costs of hospital bills discourage those without medical insurance to go to the hospital, which contributes to worse health outcomes than people that are insured. We also have to keep in mind that those without medical insurance could face even more health disparities because they do not have the security of going to medical providers or getting yearly check-ups. Furthermore, people who have been diagnosed with obesity or diabetes are more vulnerable to contracting COVID-19, which has also been linked to social determinants and institutional racism, creating an additional barrier for minorities who live with these diseases.

COVID-19 still continues to affect minorities today in a myriad of economic, social, and psychological ways, and as the pandemic continues on, we may still discover more of the adverse effects that minority groups continue to experience.

Edited by: Madi McMichael

Graphic Designed by: Heiley Tai

References

DMEJ

Duke Medical Ethics Journal