Public Policy Impact of the COVID-19 Pandemic on Blood Supply in the United States

William Riley, PhD; Kailey Love, MBA, MS; Jeffrey McCullough, MD


Am J Public Health. 2021;111(5):860-866. 

In This Article

Abstract and Introduction


The COVID-19 pandemic has precipitated an acute blood shortage for medical transfusions, exacerbating an already tenuous blood supply system in the United States, contributing to the public health crisis, and raising deeper questions regarding emergency preparedness planning for ensuring blood availability. However, these issues around blood availability during the pandemic are related primarily to the decline in supply caused by reduced donations during the pandemic rather than increased demand for transfusion of patients with COVID-19.

The challenges to ensure a safe blood supply during the pandemic will continue until a vaccine is developed, effective treatments are available, or the virus goes away. If this virus or a similar virus were capable of transmission through blood, it would have a catastrophic impact on the health care system, causing a future public health emergency that would jeopardize the national blood supply.

In this article, we identify the impact of the COVID-19 pandemic on blood supply adequacy, discuss the public health implications, propose recovery strategies, and present recommendations for preparing for the next disruption in blood supply driven by a public health emergency.


Blood donations are a pillar of modern medicine,[1,2] and an adequate supply of safe blood for transfusion is essential to protect the public's health. The US blood supply system has been seriously threatened by the COVID-19 pandemic, jeopardizing the ability to treat critically ill persons and emergency patients, with significant implications for the health care delivery system. The nation's blood supply was already tenuous before the COVID-19 pandemic,[3,4] and, since then, issues have been further compounded. Demand for blood has actually been declining since 2008 because of more conservative transfusion practices. This decline in demand caused blood centers to rapidly consolidate through mergers, resulting in reduced blood product availability,[5–10] leading to a loss of national surge capacity, leaving the highly complicated blood product supply chain struggling at the local, regional, and national levels.[11]

Blood is typically collected, processed, and stored at regional nonprofit blood centers and distributed to hospitals on a daily or weekly basis. Moreover, most blood products are perishable, with a short shelf life—42 days for red blood cells and 7 days for platelets—which precludes stockpiling a meaningful inventory for surge capacity or other emergencies. Safety for both the blood donor and recipient is the central concern in transfusion medicine and a key driver of blood availability. The pandemic has produced a heated debate regarding the safety of blood donations in endemic countries. While the lockdown reduces the amount of health care activity, unavoidable patient care continues. For example, it is estimated that there is a substantial backlog of new cancer patients across the nation;[12] as cancer programs look to restart operations, this backlog will grow.