The precipitous drop in airlift to and from Hawaii is having hidden consequences that could affect precious cargo including the supply of blood for patients in the islands.

The Blood Bank of Hawaii usually sends a small sample of each blood donation collected here every day on a direct, overnight American Airlines flight to a large laboratory in Phoenix. There the roughly 200 samples go through a battery of tests to ensure the original blood donation is safe for use in Hawaii.

But that American Airlines flight was canceled along with a slew of others last week as the tourism market collapsed due to the spread of COVID-19. And the blood bank was left scrambling for alternatives, with the clock ticking.

Platelets have a shelf life of five days, and the longer it takes for blood to get tested, the less time it will be available for patients, according to Dr. Kim-Ahn Nguyen, president and CEO of the Blood Bank of Hawaii.

“As soon as we pack those donor samples at the end of the day, the clock is running and testing has to happen,” Nguyen said. “If the tests don’t get done, the platelets sit on our shelves, and no one gets them. For these perishable lifesaving supplies, every minute, every hour counts.”

Hawaii is not alone in this conundrum, she noted.

“About 75% of America’s blood supply is tested by only four or five very large laboratories throughout the country,” Nguyen said. “We are all scrambling to figure out how we are going to get our samples to these national laboratories. The same thing happened after 9/11, but 9/11 was one week. We are now looking at two, three months of this scramble.”

The blood bank resorted to shipping via FedEx on Thursday and Friday and then found a temporary solution with Delta Airlines, but it’s not a direct flight. The samples are being shipped to Los Angeles and then on to Phoenix after a stopover. That will delay reporting of results back to Honolulu by another six to eight hours.

Creative Testing Solutions in Phoenix performs highly sensitive tests that are required to safeguard the blood supply — more than 12 tests per donation. Those tests, for evidence of exposure to diseases from HIV to Zika, differ from the clinical testing performed in local medical facilities and laboratories to diagnose patients.

“The tests that we do are much more sensitive than the tests that doctors do on patients,” Nguyen said. “The reason is because we test asymptomatic, healthy donors. They have no symptoms, and so our tests have to be much more sensitive to pick up the very low levels of virus in healthy people.”

Chief Operating Officer Todd Lewis described the Delta flights as the best option for now since they operate seven days a week.

“There are zero flights directly to Phoenix anymore, which is where our testing lab is,” Lewis said. “It’s a temporary solution because things are changing every day. We don’t know how long this Delta flight will be going. Our hope and prayer is that it stays there.”

Locally, Hawaiian Airlines has been able to keep blood donations moving smoothly interisland, Lewis said.

“We have a great relationship with Hawaiian Airlines,” he said. “They keep in close contact on any changes to their schedule, and currently we are not having any transportation logistics problems in the islands. Our state supports each other when we move products around the islands, and Hawaiian Airlines is critical in that. They are awesome.”

Like other airlines, Hawaiian has reduced its lift to the mainland but is keeping in mind its home state’s needs, said Alex Da Silva, director of external communications.

“We have been focusing on maintaining essential passenger and cargo services that, as Hawaii’s airline, we know are critical to our community’s well- being,” Da Silva said. “We are reducing U.S. mainland operations to one daily wide-body nonstop flight between Honolulu and Los Angeles and San Francisco to maintain critical flights for our guests and shippers.”

Hawaiian is also retaining air links among the islands for passengers and bolstering interisland cargo service to ensure movement of essential goods such as groceries, medical equipment and machinery.

“We carry food but also doctors, blood and other medical supplies, utility workers and stevedores,” Da Silva said.

Da Silva’s comments came before Gov. David Ige announced that, starting Wednesday, all interisland travelers, except essential workers, must undergo 14 days of self-quarantine upon arrival.

Regardless of how blood is shipped, the Blood Bank of Hawaii will continue to need donations. Nguyen thanked the community for the robust response to a recent call for blood donations after traditional blood drives had to be canceled due to the quarantine and social distancing.

“As the cases of COVID-19 continue to increase, my message is that blood donors are part of the health care workforce — a hidden, unpaid, volunteer, casual workforce,” Nguyen said. “When called to report to duty, please report to duty.”

“For us this is a marathon and not a sprint,” she added. “For us it’s looking into April and May. These donations have to be spread out.”