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It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity… Dickens On March 12th, the Dutch government announced its first measures to combat COVID-19 in the Netherlands through implementation of strict social distancing (e.g. closing of public venues and employees working from home) as part of maximum control measures, lasting until April 6th 1. For Sanquin, the national blood establishment solely responsible for the blood supply in the Netherlands, it was vital the organization continue to operate. The leadership knew that as outbreaks may adversely impact blood supply and its related activities, steps would be needed to assess, plan and respond appropriately in a time like this 2. Thus, the employees directly involved in the supply chain, from collection to distribution, remained hard at work. However, as Sanquin is not merely a blood establishment, but an umbrella organization for research and laboratory services, diagnostics, reagents and plasma products, these employees also remained active in brainstorming and implementing new initiatives. In the first week of strict social distancing, from March 16th to 20th, an acceleration of activities occurred. Within Sanquin's management, a task force and crisis management team were created that met daily to review the evidence and determine vital occupational health measures for the organization. While offices were abandoned, the collection centres were flooded. This was a dual effect resulting from national media coverage that advocated for the need for continual blood donation (bolstered by a 'tweet' from the Minister of Medical Care and Sport), followed by reports of Sanquin Research's first initiative to test blood donations for SARS-CoV-2 antibodies to track the level of immunity in the population. The effects were staggering: more than 10 000 whole blood donations were made (compared to 8000 on average), which had not happened since 2014. There were 6400 registered new donors (compared to an average of 1250 in a 'normal' week). Telephone and social media lines were overloaded with approximately 10 000 inquiries and comments. For the first time in years, the large collection centres offered weekend opening times. (An ongoing study is being conducted on the effects of COVID-19 events on donor behaviour). On March 23rd, governmental measures were made much more stringent, with all public events requiring a permit being banned until June 1st. Within this second week, from March 23rd-27th, the flurry of activity continued, although slightly abated. While donors were still eager to donate, stock levels of blood had risen to secure levels (above 8 days), and fewer donations were needed. Despite the abundance of supply, demand for blood components decreased as hospitals postponed elective surgeries and cancelled cancer treatments. During this week, Sanquin announced its second initiative against COVID-19: collecting plasma from donors that had recovered from COVID-19 as a potential treatment for sick patients, I) in partnership with the municipal health organization and two university hospitals for two different multi-centre clinical trials on direct transfusion of convalescent plasma, and II) for production of an anti-COVID-19 immunoglobulin. In the third week, from March 30th-April 3rd, more key events occurred. The first person donated convalescent plasma and the first unit was delivered. The Dutch Prime Minister and the Minister of Health announced the aforementioned maximum control measures to remain active until April 28th. In their speech, they mentioned Sanquin and thus publicized Sanquin's third initiative: testing a broad range of healthcare workers (not limited to those with direct contact with hospital patients) for SARS-CoV-2 infection, as part of the national emergency plan to quadruple testing capabilities to 17 500 nationwide 3. This came at an opportune time, as Sanquin's National Screening laboratory had already taken precautionary preparations to have sufficient resources for its PCR machinery, supplies and manpower to perform up to 3600 tests daily. Additionally, as in-house research initiatives continued budding, an internal directing group was created that focused on clinical services and products for COVID-19 care, related to biobanking, laboratory-based immunology studies, clinical trials and pharmaceutical developments. With regard to supply, the blood bank diminished weekly planning from 10 000 to 6700 donations. This was in response to decreased hospital demand and the implementation of the 1·5 meters distancing in all fixed and mobile locations, which reduced overall bed capacity by approximately 35%. While stocks of whole blood and platelets remained stable, generalized plasma collection (unrelated to the convalescent plasma) had dropped due to social distancing measures and reduced whole blood demand. Efforts were needed to re-establish plasma levels to meet demand. From April 6th-10th, the first phase of the immunity study began. Approximately, 5000 donors were tested, and initial results were communicated with the Ministry of Health, Welfare and Sport. The blood bank accelerated its pilot plan to invite donors digitally, changing their historical habit of only using the postal service. Due to a continuation of diminished invitations, donations were right at the 7000 mark. Hospital demand began increasing for the first time within this time frame, but supply was sufficient to fulfil it. In retrospect, this first month of COVID-19 in the Netherlands has shown the need for tremendous concentrated and combined efforts in all aspects of the blood supply. Blood establishments play a crucial role in the treatment of vulnerable patients in society, while having access to healthy blood donors, which create possibilities for further research. Like the opening Dickens quote, this pandemic reveals the paradoxical nature of these times and of human nature. In Sanquin, we have seen the 'best' of donor turnout due to the commitment of the Dutch public and our tireless blood collection staff. In the face of uncertainty, we have seen the 'best' of our employees as internal collaborations were created and milestones were reached at previously unprecedented levels and speed. This pandemic has sparked innovations, united departments and changed traditional habits for the better. In this epoch of incredulity, strong connections and constant clear communications with governmental and medical institutions, healthcare providers, media and suppliers, continue to be crucial. We now better understand the tremendous value of a well-organized, well-coordinated system on local and national levels to respond adequately in a time like this. As prevalence and mortality increase, so has the flow of new (research) initiatives, reflecting the strength of Sanquin's multi-disciplinary knowledge institution in playing a decisive role in creating clinical solutions and contributing evidence towards governmental health policy decisions regarding COVID-19. Overall, perhaps the paradoxical nature of this pandemic reveals to us that our response and responsibility of whatever little part we play matters. We acknowledge that our situation is unique and other blood establishments may not be in the same position – we share our experiences to provide glimpses that good and goodwill still happen in these difficult times. We thank the many hands, feet and veins of all those who have given in every way, and we honour your contributions. These words are not simply for us in the Netherlands, but all of our colleagues around the world reading this: 'Samen, samen sterker'. Together, we are stronger. To end Dicken's quote, 'It was the season of light, it was the season of darkness, it was the spring of hope'. May this spring still bring you hope. The authors declare no competing interests.
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