Nick is a gay man facing a dilemma. Having recovered from COVID-19, he's in a position to donate his antibody-rich plasma to potentially save lives. However, despite the FDA relaxing its restrictions on donations from gay men, because he has a long-term partner, he's still officially ineligible. This is the story of his tricky decision. Nick is not his real name. He has been hesitant to publicly share his experience because of potential professional, personal, or legal retaliation, so we agreed to do this interview with him remaining anonymous.
Nick is in his early 30s. A cancer survivor, he's classed as immunocompromised. He started to show symptoms of COVID-19 in early March. "I had a fever and chills," he says. "At this point, the city was not shut down, there was no stay-at-home order, and Bernie Sanders was still in the Democratic race – which is the marker I have in my head of when I was feeling ill.” He went to an urgent care center near his home in Hell's Kitchen, where they checked his lungs (which were clear), tested for the flu (negative), and sent him home with directions to complete a course of antibiotics. “I dealt with that for a week and my fever didn't subside. I began to start feeling pressure and pain in my chest. At this point, I had completely lost my taste and a sense of smell. So I called my doctor and said, ‘Hey, what should I do?'"
This time, he was advised to bypass urgent care and go directly to the hospital, where he could get properly tested. “I walked up to the hospital and was tested there. Four days later they called me back – I had tested positive." The chest X-ray revealed Nick had pneumonia, but because he wasn't having breathing problems, he was able to return home. “All in all, I was probably sick for just over two weeks with a fever and chills – just utter exhaustion. Fortunately, my breathing never got worse than pressure and pain in my chest when I took deep breaths.” For two weeks, Nick and his partner self-isolated in their apartment and relied on the support of friends who delivered them food. “When I had cancer in my mid 20s, I had chemotherapy for a few months and there were good days and bad days – days where you feel sick, nauseous, tired. I always felt I was able to overcome that day to day. With COVID-19, I had no time to feel any better. It was just relentless ... a constant feeling of fever and body aches that I could get no respite from.”
Today, he is mostly recovered and feels almost "normal." But he knows he's not 100% right. “When I cycle, I can tell that my lung function is still pretty messed up," he says. "I’m just not as strong. I'm having a hard time catching my breath.” After his second week in recovery, the hospital contacted him and asked if he’d be willing to be part of the plasma donation program to check for antibodies. He enthusiastically signed up, though he anticipated questions about his sexuality as part of their protocol.
Last month, the FDA announced it was relaxing its restrictions on blood donations from gay men, first created in 1983 during the height of the AIDS epidemic, when HIV was not fully understood and few men with the disease survived. In light of the pandemic, it said, it was now allowing donations from gay men, providing they had not had sex for three months (previously the time period was one year).
Controversy still surrounds the guidance. “There are thousands of gay and bisexual men, and other LGBTQ people, who want to donate their blood and plasma to help address this current health crisis, but are unable to because of the FDA’s discriminatory and outdated blood ban," says Rich Ferraro, GLAAD’s chief communications officer. "Leading medical organizations, medical professionals, elected officials, and other notables have called on the FDA to lift these restrictions and establish blood donation policies that no longer discriminate based on sexual orientation. It’s time for the FDA to listen to these experts and remove the deferral period once and for all.”
In mid-April, more than 500 US doctors signed and sent an open letter to the FDA pressing for an “overturning of the scientifically outdated ban” to deal with the shortage of blood. The letter included the clear statement: “Lifting the ban would increase the number of convalescent plasma donors, a promising treatment for COViD-19.”
According to the CDC, all donated blood products are now tested for HIV and other pathogens, such as hepatitis C virus.
“I would never donate blood and jeopardize anyone's health.”
“I went back to the hospital," says Nick, "and they tested me again to ensure that I was COVID negative. Sure enough, I had the antibodies in my blood. In fact, I had almost 10 times the number of antibodies that they would recommend for donation, which is kind of cool. Never during that time did they ask me any of those questions: ‘Have you had sex with a man? Have you ever taken drugs with a needle? Have you ever lived in these countries?’” Nick was approved to donate his plasma and was welcomed at the donation center – where he was asked whether he had had sex with other men.
He did not tell the truth. “I've gone in three times total to donate," he says. "I donate 800 milliliters per session. For reference, a bottle of wine is 750 milliliters.” Each donation can benefit up to four patients. “Plasma donation is a pretty arduous process that can take up to two hours. They hook you up to this machine that pulls your blood to sort out the platelets and blood cells from the plasma. You see these bags fill up with this yellow, orange liquid, and feel this cold sensation of your blood going back into your arm. It's been great, at this point, to help up to 12 people. It makes me feel really good. “I've tried to figure out how I can direct my energy positively," he says. "If I do have this immunity, what can I do to help? Being able to donate plasma has been an inspiring way for me to give forward. "I remember when I got cancer ... people sent me books and flowers and cards and spent time with me at the hospital, and people shaved their heads in solidarity. It really made a difference for me. I knew coming out of that fight that, whatever I was going to do with the rest of my life, I wanted to help contribute in some way.”
The decision to donate his plasma was grounded in that same sense of community and wanting to make a difference; but it was not an easy one to make. “I would never donate blood and jeopardize anyone's health," he says. ”But I really struggled with my decision because of the FDA ban."
He did the research and weighed the benefits and risks. “The FDA says that every blood donation is screened for all the diseases that you would expect they would search for in a gay man. I knew myself, having just been tested and being in my relationship, that I was healthy. I'm not a lawyer and I don't know the legal ramifications of that.
"A big part of me thought that I could just protest and add my name to the growing list of folks that have written articles and gone on social media." Or, he says, he could donate and "potentially help four people that are in the ICU and struggling to take a breath.” He decided that donation had the greatest upside.
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