American Society of Nephrology, CDC offer updated coronavirus guidelines
Patients with kidney disease who suspect they may have COVID-19 should not stay home to miss dialysis treatments due to fear of spreading the virus, a panel of nephrology experts said during a webinar on March 13.
“ ... Ensure that patients are coming to dialysis,” Suzanne Watnick, MD, chief medical officer for Northwest Kidney Centers (NKC), told attendees. “Make sure not just patients and families know, but that the staff know as well, that patients need to come to get their treatment.”
Watnick reminded attendees that COVID-19 “is a viral illness, a droplet disease. Some of the messaging has been that you need to take airborne precautions. You do not have to do that at this point.”
The webinar was hosted by the Nephrologists Transforming Dialysis Safety initiative, which is a national partnership between the CDC and the American Society of Nephrology.
Watnick, along with Elizabeth McNamara, RN, vice president of patient care services and chief nursing officer for NKC, learned firsthand about the connection between COVID-19 and kidney care; the first patient to die in the United States was a patient with ESKD who received treatment at NKC, they said during the webinar.
“It is so important that we have clear professional messaging to our staff,” Watnick said in providing care for patients in NKC’s 19 dialysis clinics.
“We provide regular updates and hold a call every evening for 100-plus medical staff. We contact our facilities frequently .... we are showing that we have a presence” in national discussions of COVID-19, she said.
Alan Kliger, MD, clinical professor of medicine at the Yale School of Medicine in New Haven, Connecticut, and NTDS chair, said presentation of the latest recommendations from the CDC may be a recurring event as more information is gathered on the virus.
“This is a quickly evolving situation that we are all living through. The [recommendations] have evolved in the past week and a half, and surely will continue to evolve as the next days and weeks go by," he said.
Kliger said those most vulnerable to dying from COVID-19 are the elderly and those with chronic diseases, such as diabetes, heart disease and mostly likely, chronic kidney disease.
As part of the webinar, Shannon Novosad, MD, MPH, the medical officer with the Dialysis Safety Team in the Division of Healthcare Quality Promotion at the CDC, presented the agency’s updated guidelines on how to address patients diagnosed with COVID-19 in the dialysis clinic.
The primary mode of transmission of COVID-19 is via person-to-person who are in close contact with one another, she said. The infection is spread through respiratory droplets when a person coughs or sneezes. “It may also be possible to get COVID-19 by touching surfaces and then touching your mouth, nose, or eyes,” she said.
Common signs of COVID-19 are similar to other respiratory illnesses, and it takes between 2 to 14 days for symptoms to start, she said. Fever, cough, sore throat, shortness of breath, muscle aches and fatigue are common.
“Initial symptoms might be mild, and fever might be absent,” she told the attendees.
Notifying your health department “is very important, ”Novosad said, once a patient tests positive for the virus. “They can tell you what is available for testing and facilities that can take patients,” she said.
The following are some CDC recommendations:
- Staff should identify patients with fever or symptoms of respiratory infections before they enter the dialysis treatment area. Instruct patients to call ahead to report fever or respiratory symptoms. “Ask patients about fever or respiratory symptoms when they arrive at the facility,” Novosad said. “Put facemasks on symptomatic patients; facemask[s] should be worn for the duration of their stay in the facility.” Patients should consider waiting in a personal vehicle or outside the facility until it is their turn for dialysis;
- Provide education about hand hygiene, respiratory hygiene and cough etiquette, as well as how and when to use facemasks;
- Implement sick-leave policies that are non-punitive and flexible, Novosad said. “Advise [health care personnel] not to report to work when ill ... If [they] develop fever or symptoms of respiratory illness (eg, cough, sore throat, shortness of breath) while at work, they should put on a facemask and return home,” she said. Actively check body temperature and symptoms of health care personnel before their shift;
- If treating patients who are symptomatic of COVID-19, create at least 6 feet of separation from other patients. “Ideally, symptomatic patients would be dialyzed in a separate room [if available] with the door closed,” Novosad said. “If a separate room is not available, perform treatment at a corner or end-of-row station, away from the main flow of traffic. If the patient is unable to tolerate a mask, then they should be separated by at least 6 feet from the nearest patient station in all directions;” and
- If a hemodialysis facility is dialyzing more than one patient with respiratory symptoms, consideration should be given to cohorting the patients and the health care professional caring for them together in the section of the unit and/or on the same shift, Novosad said. “Consider the last shift of the day. If the etiology of respiratory symptoms is known, patients with different etiologies should not be cohorted,” she said.
To date, the mortality rate from COVID-19 has been highest among elderly patients: 14.8% for patients at least 80 years old, Novosad said, citing an outside report. Mortality rates are 0.2% for patients younger than 40 years old and are around 8% for patients 70 to 79 years, she said.
To listen to a recording of the webinar and download the slides from the speakers, visit https://www.asn-online.org/ntds/