194 Chapter 5 Respondents shared how setting up the project was a myriad of complex steps, including obtaining ethical approval and modifying the electronic information system (eProgesa). However, all these steps were completed rapidly within 14 days so that by March 30, the first plasma donor arrived and could donate. “It was a lot of hard work for a lot of people in a few days. It was pretty impressive, what we did at that time” (Respondent 3). The document analysis recorded the rapid, weekly progress along with the publicity the project began to attain. Interview respondents, while well-experienced, openly acknowledged the challenges and problems they faced from the beginning. These challenges included lack of knowledge of SARS-CoV-2, time constraints, logistical and administrative issues, found in nearly every step of the process (listed in Table 5.2). They stated that two of the major issues regarded (I) donor eligibility, identification, and recruitment and (II) SARS-CoV-2 antibody testing. For the latter, for cost-effectiveness, Sanquin developed sensitive total antibody bridging assays compatible to the EUROImmun assay.19 Additionally, the project was divided into two: collecting CCP for clinical studies and collecting plasma for fractionation (hyperimmunoglobulins). For the former, the CCP group was part of the set-up of randomized clinical trials (RCTs) occurring in university hospitals (one was published internationally as one of the first RCTs about CCP’s effects20). To obtain more donors for the latter group, a key requirement was waived, which eventually led to a backlog of thousands of donors whose antibody levels were unknown (Table 5.2). As CCP collection was done parallel to whole blood collection, there was steady demand of the latter and no shortage of it. However, respondents spoke of staff safety considerations and the Intranet posts highlighted one improvised solution of triaging donors at the door comprised of healthy volunteers (Table 5.2). Additionally, respondents could readily identify the elements of an acute crisis: urgency which mandated speed (“in the beginning, it was a bit scary because they wanted to go that fast. Everything was too quick, too fast, and there was no time to think about it” Respondent 8); other events simultaneously occurring which forced this speed; a shortage of supplies; an avalanche of communication requests; and constant changes and adjustments (“every week, it’s something different where you have to make adjustments for” Respondent 3). These elements forced respondents to cope constantly with the benefit of increased flexibility but with the negative aspect of overwhelmed staff making (small) mistakes. Throughout it all, there were unspoken goals of putting the patients first and maintaining safety standards. Therefore, this situation forced respondents to improvise incrementally and radically through teamwork at every step, expediting processes (Table 5.2).
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