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.