COVID-19 Frequently Asked Questions by ESRD Patients
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All dialysis facilities have emergency/disaster plans that are implemented during events such as hurricanes, floods, power outages and even pandemics like the Coronavirus 2019 (COVID-19). While dialysis facilities are not expected to close during this COVID-19 outbreak, your facility has back-up plans in place to ensure that you and all other patients have access to dialysis treatments. Ask your dialysis facility about its emergency plan. Make sure you know where to go, what to do, and who to contact if your facility closes so that your treatments can be continued.
Dialysis facilities are following the Centers for Disease Control and Prevention (CDC) guidance, which includes having space in waiting areas for ill patients to sit separated from other patients. Some clinics may have medically stable patients wait in a personal vehicle or outside the healthcare facility where they can be contacted by mobile phone when it is their turn to be seen. Additionally, facilities are:
- Screening for:
- Signs and symptoms of respiratory infections such a fever, cough, shortness of breath, or sore throat at entry into the clinic and frequent monitoring during treatment.
- Contact with someone with or under investigation for COVID-19 or ill with respiratory illness.
- International travel within the last 14 days
- Residence in a community where community-based spread of COVID-19 is occurring.
- Requiring patients with symptoms of respiratory infection to wear a face mask while in clinic upon check-in and until they exit the facility.
- Taking patients with respiratory symptoms to a designated treatment area for evaluation as soon as possible in order to minimize any time in common waiting areas.
- Posting signs at the entrance with instructions to patients with fever or signs/symptoms of respiratory infection to alert staff so that appropriate precautions can be implemented.
Normal PPE should be worn by dialysis facility staff when caring for patients who are negative for COVID-19, including gloves, face mask, eye protection (e.g., goggles, a disposable face shield that covers the front and sides of the face). However, when a patient has an undiagnosed respiratory infection, fever of unknown origin, or has tested positive for COVID-19, dialysis facility staff should follow standard, contact, and droplet precautions. This includes all normal PPE listed above, plus an isolation gown, if available.
There is a possibility that someone who is infected with COVID-19 can transmit the virus even if they are not showing symptoms. In an abundance of caution, some facilities are requiring that all patients wear a mask during treatment, if available or an appropriate cloth face covering.
Symptoms may range from mild to severe and may appear 2–14 days after exposure. Here are some symptoms: fever, cough, and shortness of breath.
Patients are being asked to follow the diet and fluid restrictions recommended by their nephrologist and renal dietitian. If possible, kidney patients should ask a family member or friend to go grocery shopping on their behalf in order to avoid large crowds. For patients who must go grocery shopping, some large chain grocery stores offer special hours for elderly or individuals with a compromised immune system to shop. Also remember, the CDC recommends wearing a cloth face covering in public where other social distancing measures (i.e., keeping 6 feet apart) is difficult to maintain, such as grocery stores.
It is recommended that patients do not skip or postpone their dialysis treatments.
Surgical masks are usually meant to be used one time, but due to some shortages, the CDC has provided guidelines for using the masks more than once:
- The face mask should be removed and discarded if soiled, damaged, or hard to breathe through.
- Mask removal and replacement be done in a careful and deliberate manner.
- Face masks should be carefully folded so that the outer surface is held inward and against itself to reduce contact with the outer surface during storage.
- The folded mask can be stored between uses in a clean, sealable paper bag or breathable container.
N95 respirators (masks) are not intended for re-use and are meant to be used by medical professionals only, unless you have been instructed by your physician.
Based upon new information garnered from recent studies, it is now known that COVID-positive individuals may be transmitting the virus while they are symptom-free if close to others while speaking, coughing, or sneezing. Therefore, the CDC is now recommending a cloth face covering in public settings where other social distancing measures are difficult to maintain (e.g., grocery stores and pharmacies), especially in areas of significant community-based transmission. This recommendation is intended to complement, not replace the CDC Coronavirus Guidelines. While it may prevent people from touching their face, that is not the original intent of the recommendation.
If your caregiver starts showing sign of infection:
- Have the caregiver stay in one room.
- Use a separate bathroom.
- Wash your hands frequently.
- Avoid touching your eyes, nose, and mouth.
- Clean surfaces that are frequently touched.
- Wash laundry thoroughly.
- Avoid unnecessary visitors.
- Maintain social distancing.
If symptoms worsen for your caregiver, contact their healthcare provider. For medical emergencies, call 911 and notify the dispatch personnel that they have or are suspected to have COVID-19.
You should also advise your dialysis team and nephrologist that someone in your home is ill.
The Centers for Disease Control and Prevention (CDC) does not recommend that the general public wear N-95 masks to protect themselves from COVID-19. If you have an N-95 mask that is damaged or soiled, you should discard it properly by placing it in a plastic bag and putting it in the trash. Please be sure to always wash your hands before putting on the mask and before and after removing the mask.
The Centers for Disease Control and Prevention (CDC) recommends cloth face covers when around others. A cloth face cover is meant to protect other people in case you are infected. If you have a cloth face covering, you can wash it in your laundry with regular laundry detergent and the warmest water setting appropriate for the cloth used to make the face covering. Or you can hand wash it and dry it in the drier on high heat or air dry. For more information visit the CDC website on How to Wash Cloth Face Coverings.
This is not true. During a pandemic, such as the current COVID-19 outbreak, infection control practices are enhanced and carefully followed to minimize infection spread. Dialysis facilities are recommended to follow the Centers for Disease Control and Prevention (CDC) guidelines concerning the use of PPE.
To minimize mask shortages, dialysis centers can implement policies that allow staff to reuse masks or wear them for an extended period or decontaminate them. This is not considered a relaxed protocol. In addition, dialysis facilities are to maintain an inventory of PPE to reduce the chance of running out of supplies.
Yes, kidney transplant procedures are still being performed at this time for patients on a case-by-case or center-by-center decision. Some centers may have temporarily put elective living donor transplantation or non-urgent deceased donor transplants on hold.
Yes, patients can still be screened for and put on the active list at some transplant hospitals. Transplant centers will base these decisions on issues, such as the level of circulating COVID-19 infection in their areas and/or operational issues (such as testing availability, bed space, and availability of basic supplies, and equipment, including personal protective equipment).
The answer is maybe on a temporary basis.
Dialysis centers have protocols for dialysis treatments for patients who have symptoms or who have COVID-19. These patients should be kept in separate areas and away from other non-infected patients. For example, some dialysis centers may reserve specific days of the week or times of the day to treat patients with symptoms. They may also have these patients treated in a different area of the clinic or in another center until they are recovered from COVID-19 and are no longer able to transfer the virus.
If you have a confirmed case of COVID-19, or have symptoms of COVID-19, or believe you may have been exposed to it, call your dialysis center before your scheduled treatment. There may be new procedures they would like you to follow.
To reduce virus exposure, the Centers for Disease Control and Prevention (CDC) recommends that facilities limit visitors to only those who are essential to the patient’s care, such as a caregiver. Dialysis centers are encouraged to follow the CDC guidelines.
Some facilities may have patients wait in their cars to avoid contact with other patients. If you need to wait in the patient waiting room, you should maintain at least a 6-foot distance from others and wear a face covering, as recommended by the Centers for Disease Control and Prevention (CDC) to protect yourself and others.
To prevent transmission of COVID-19 in the dialysis facility, many centers are requiring patients to wear a mask at all times. This makes it difficult or impossible to eat or drink during dialysis. It is recommended that you eat or drink before or after treatment, if possible. If you have a medical issue that necessitates that you eat or drink something during treatment, you should speak with your social worker or nephrologist to discuss your concern and help find a solution.
To protect patients and staff, dialysis centers are following the Centers for Disease Control and Prevention (CDC) guidelines, which recommend patients with symptoms, who have been infected with COVID-19, or who have been exposed to someone with COVID-19 are kept in separate areas.
Always remember, the best way to protect yourself and others is to wash your hands and surfaces often, avoid close contact (stay six feet away), cover your mouth and nose with a cloth face cover when around others, and cover your coughs and sneezes.
The Centers for Disease Control and Prevention (CDC) guidelines recommend that dialysis centers clean and disinfect surface areas and equipment regularly and between patient sessions. The Environmental Protection Agency (EPA) publishes a list of disinfecting agents that dialysis facilities can use to clean surfaces that kill the SARS-CoV-2 virus that causes COVID-19. Bleach is one of those disinfectants that can be used. Dialysis centers are following these guidelines to keep patients safe from COVID-19.
Staff are not required to clean their facemasks between patients; however, if their facemasks become soiled, the staff will immediately dispose of the masks and use new ones.
At this time, to ensure the safety of patients and staff, most facilities are not allowing family to be in the treatment area because of increased risk to them and others. If your family member is essential for your care, please talk with your facility staff or nephrologist regarding this special circumstance. If your family member is deemed essential for your care and passes the screening criteria, he or she will likely be allowed into the treatment area. Dialysis centers are encouraged to follow the Centers for Disease Control and Prevention (CDC) guidelines.
The CDC guidelines recommend that all individuals who enter the facility are screened for symptoms (e.g., fever, cough) and offered a facemask if they do not have one.
No. People, who are on dialysis are at high-risk. If your symptoms are mild, you might be able to go to your normal dialysis center for your scheduled treatments. If you have a confirmed case of COVID-19, or have symptoms of COVID-19, or believe you may have been exposed to the coronavirus, call your dialysis center prior to your scheduled appointment as there may be new procedures to follow.
The Centers for Disease Control and Prevention (CDC) has interim guidance for patients on dialysis who have COVID-19 and all centers should be following these guidelines.
Yes, continue to follow all infection prevention practices. Dialysis patients are considered high-risk and it is best for them to stay home unless they need to attend dialysis treatment. Personal protective equipment includes face masks. Everyone should be aware of and follow local face mask mandates. Gloves are recommended only in certain circumstances.
The Centers for Disease Control and Prevention (CDC) recommends only wearing gloves when cleaning or caring for someone who is sick. In most situations, like running errands, wearing gloves is not necessary. Instead, individuals should wash their hands with soap and water for 20 seconds (or use a hand sanitizer with at least 60% alcohol) and practice social distancing (stay at least six feet from others).
There is currently no regulation that requires dialysis centers to publicly disclose whether there have been positive cases of COVID-19 treated at their facility. Facilities must follow state and local health department regulations regarding notification.
We suggest asking your dialysis center about its current policy for handling persons who are under investigation for COVID-19 or have been infected with the SARS-CoV-2 virus that causes COVID-19. Your facility staff can also share the state and local regulations they must follow.
HIPAA = Health Insurance Portability and Accountability Act
Practicing social distancing does not mean that you must feel isolated. You can stay in touch with friends and family by phone or email. You can also video conference with them using Messenger, Skype, FaceTime, WhatsApp, Zoom, and similar apps. Check out the National Coordinating Center (NCC) resource Multiple Ways to Connect With Others During COVID-19 for more details. Your facility staff can guide you in using social media if you have not used it before.
Stay connected with others by playing online games, chatting via text messaging, or posting messages and photos on Facebook, Twitter, Instagram, and other social media. You can also use this time to educate yourself on important topics. The NCC offers a weekly live webinar for patients every Tuesday at 5:00 p.m. ET. You can even ask questions of the presenters. Register at ESRD NCC Patient Webinars. Share the COVID-19 Quickinar Events flyer with others and have a virtual listening party.
Pay attention to your own needs and feelings and engage in healthy activities that you enjoy and find relaxing. Try to exercise regularly, keep regular sleep routines, and eat healthy foods.
If you are feeling overwhelmed with emotions such as sadness, depression, anxiety, or feel like you want to harm yourself or someone else, call 911 or the National Suicide Prevention Lifeline at 1.800.273.TALK (1.800.273.8255).
Traveling increases the risk of getting and spreading the coronavirus that causes COVID-19. To lower the chance of getting infected, transplant recipients should not be traveling at this time. If emergency travel is necessary, please contact your healthcare provider for medical clearance prior to travel.
Nowadays, most telehealth or telemedicine visits are conducted via video conferencing, which requires access to either a computer with a camera connected to the Internet and an audio connection, or a mobile phone with a data plan and a camera. Some healthcare providers may conduct the telehealth visit as an audio-only visit (phone, but no camera).
If you would like to participate in a telehealth visit with your healthcare providers, ask them if this is an option for you. Ask about their technology requirements since each provider may use a different technology.
Medicare costs are the same amount for telehealth services as if the service were conducted in person.
All dental settings are advised to follow the same Centers for Disease Control and Prevention (CDC) guidelines as dialysis centers and other healthcare settings in response to COVID-19.
The CDC guidelines state that dental practices should prioritize urgent visits and delay elective visits and procedures to minimize the risk to patients and staff.
Contact your dental office to see if it is currently performing teeth cleanings at this time, as it may have new procedures for you to follow before your visit.
To prevent the transfer of COVID-19 during dialysis, centers educate staff and patients about hand washing, wearing a facemask, and coughing etiquette. They monitor staff and patients for symptoms (e.g., fever, cough). Staff with symptoms are advised to stay home. If you have symptoms, you still need your dialysis treatment. Patients with symptoms are kept in separate areas. For example, some dialysis centers may reserve specific days of the week or times of the day to treat patients with symptoms. They may also choose to have these patients treated in a different area or in another center.
Dialysis facilities follow the Centers for Disease Control and Prevention (CDC) guidelines that recommend cleaning and disinfection of surface areas and equipment regularly and between patient treatments. They may also limit visitor access to the treatment floor.
The best way to protect yourself and others is to understand that COVID-19 spreads mainly from person-to-person by coughing, sneezing, and touching. This means you should wash your hands and surfaces often, avoid close contact (stay six feet away), cover your mouth and nose with a cloth face cover when around others, cover your coughs and sneezes, and monitor your health for any symptoms, like a fever. If you feel healthy but recently had close contact with someone with COVID-19, please contact your nephrologist and dialysis center for guidance.
Because there is a small risk that people with COVID-19 could spread it to animals, the Centers for Disease Control and Prevention (CDC) recommends that you do not let your pets interact with people outside of your household. This is especially relevant in places with high community spread of COVID-19.
If you are healthy, you should continue to walk your pets outside. Treat your pets as you would other human family members—do not let them interact with people or other animals outside the household. Do not forget to wash your hands before and after each walk.
Antimicrobial soap is important because it kills germs on the skin that can cause infections where regular soaps do not. The skin around the catheter should be washed every day with antibacterial soap or a cleanser recommended by your center. Bar soap is not recommended because germs can grow on it. Other types of cleansers, such as hydrogen peroxide or alcohol, should NOT be used unless your nephrologist or home dialysis nurse told you to do so.
If you are unable to find antimicrobial soap in stores, contact your nephrologist or home dialysis nurse for specific guidance.
The Centers for Disease Control and Prevention (CDC) recommends that individuals with symptoms have a higher priority for COVID-19 testing. Individuals with no symptoms may also be prioritized for testing by their medical provider or local health departments.
Individuals who received a transplant have a weakened immune system and are among the high-risk group because their inability to fight infections, like COVID-19, is reduced.
As a high-risk individual, it is best to practice strict hand hygiene and respect social distancing guidelines. Watch for new information on the potential impact to your health after transplant. If you develop symptoms and want to get tested, contact your nephrologist or state or local health department.
If a patient comes to dialysis with a fever, they will be given a facemask and kept six feet away from other patients and staff members. Immediately after the patient with symptoms leaves the waiting room, the staff disinfects surfaces within six feet of that patient. Items that cannot be disinfected, such as papers or magazines, are sent home with the patient or discarded.
Patients should notify the facility prior to arriving if they have symptoms (e.g., cough, fever). This will allow the facility the time to prepare for their arrival. If a patient shows symptoms without a fever, the patient should be provided a facemask and kept six feet away from other patients and staff in the waiting area. The staff who will be working directly with this patient should be notified and the patient should be taken to the appropriate treatment area as soon as possible to minimize time in the waiting area.
Peritoneal dialysis patients are advised to stay home. Avoid hospitals, unless it is necessary. If possible, those on peritoneal dialysis should only meet with their healthcare team by telemedicine.
If you need something (e.g., supplies, medical records) reach out to your home program for their recommendations.
According to the Centers for Disease Control and Prevention (CDC), people who have recovered from COVID-19 infection have antibodies to the virus. However, since it is not known yet whether a person can be re-infected with the virus, you should continue to practice handwashing, social distancing, and other recommendations from the CDC and your healthcare team.
The specific virus that causes Coronavirus Disease 2019 (COVID-19) is called Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2).
There have been some reported mutations or variants of the virus (SARS-CoV-2) and researchers are still studying whether these mutations are changing how the virus works. Currently, there is only one SARS-CoV-2 virus that causes COVID-19, yet there are six other types of coronaviruses that can infect humans, but these other viruses do not cause COVID-19.