CDC has released a new HAN Health Alert Advisory on Severe Illness Associated with Using Non-Pharmaceutical Chloroquine Phosphate to Prevent and Treat COVID-19. The Summary includes “Chloroquine phosphate, when used without a prescription and supervision of a healthcare provider, can cause serious health consequences, including death. Clinicians and public health officials should discourage the public from misusing non-pharmaceutical chloroquine phosphate (a chemical used in home aquariums). Clinicians should advise patients and the public that chloroquine, and the related compound hydroxychloroquine, should be used only under the supervision of a healthcare provider as prescribed medications.” Find the CDC HAN at https://emergency.cdc.gov/han/2020/han00431.asp?deliveryName=USCDC_511-DM24285.
AAKP is asking dialysis patients to take a survey on their experience with and concerns about COVID-19. AAKP’s introduction follows:
“AAKP works closely and constructively with Federal and state officials on health issues of concern to both the general public and those who are immunocompromised – like kidney patients. As we have in the past with flu and vaccines, we are interested in relaying your insights about the Coronavirus to relevant officials so that their actions and communications are better informed and responsive to your concerns. As a dialysis patient, has the Coronavirus impacted your thinking or behavior? What communication, if any, have you, as a dialysis patient, received with your healthcare team and/or dialysis facility? TAKE A FEW MINUTES, TELL US YOUR THOUGHTS! AAKP will share insights gleaned from you with the brave medical and scientific professionals fighting the Coronavirus! … Answers and any comments provided will not be attributed to any individual – the FLASH SURVEY is completely anonymous.”
Find the survey at https://www.surveymonkey.com/r/DialysisandCoronavirus. They do not indicate how long the survey will be available.
NBC News has published an article on Coronavirus testing: Information on COVID-19 tests according to state health departments. The article includes:
- Alaska: “For information about coronavirus in Alaska, check the Alaska Department of Health and Social Services’ coronavirus website [at http://dhss.alaska.gov/dph/Epi/id/Pages/COVID-19/general.aspx].”
- California: “Call your health care provider or local public health department [see https://www.cdph.ca.gov/Pages/LocalHealthServicesAndOffices.aspx] to be evaluated for testing if you are symptomatic, may have had contact with a person with coronavirus, or recently traveled to countries that have community spread. As of March 13, [2020,] California had 18 public health labs [see https://www.cdph.ca.gov/Programs/CID/DCDC/CDPH%20Document%20Library/COVID-19_CA_Map_03.11.20.png] testing for coronavirus, with three more expected to be offering tests by next week. There are some private labs testing as well, though the state is not tracking their testing data. For a patient to be tested by a public health lab, their provider must contact the local public health department for approval and instructions. Most test results are available within 48 to 72 hours. The state has requested all labs notify the Department of Public Health about positive results. For more coronavirus information, visit the California Department of Public Health’s webpage [at https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/Immunization/ncov2019.aspx].”
- Idaho: “Call your health care provider if you believe you need to be tested. Any provider can request a test from the state, as long as they meet CDC infection control requirements for collection. However, not all providers in the state are set up to meet those requirements, according to the Department of Health. Test results are usually available 24 hours after they are sent to the state lab. There are four private labs conducting tests in the state that may have different response times. For more information, call 2-1-1 or your local public health district [see https://coronavirus.idaho.gov/contact/], or visit Idaho’s coronavirus website [at https://coronavirus.idaho.gov/].”
- Montana: “Call your health care provider to discuss whether you are a candidate for testing before appearing in person. If you do not have a primary care provider, you can call a community health center or urgent care clinic about getting tested. Providers are testing according to CDC guidance [see https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-criteria.html], with a focus on people exhibiting symptoms that could indicate COVID-19. Providers do not need department approval to administer a test, but the department consults on cases as necessary. Test results from the state public health lab are typically returned daily. For more coronavirus information, visit the Montana Department of Public Health and Human Services website [at https://dphhs.mt.gov/publichealth/cdepi/diseases/coronavirusmt] or contact your county or tribal health department [see https://dphhs.mt.gov/publichealth/FCSS/countytribalhealthdepts].”
- Oregon: “For information about coronavirus in Oregon, check the Oregon Health Authority’s website [at https://www.oregon.gov/oha/PH/DISEASESCONDITIONS/DISEASESAZ/Pages/emerging-respiratory-infections.aspx].”
- Washington: “Call your health care provider to discuss whether you should be evaluated in person and considered for testing. Currently, there are no restrictions on who can be tested, however, it’s up to the provider to decide. Sample collection is done at the provider’s office. Samples are then sent to facilities such as the Washington State Public Health Lab or the University of Washington Virology Lab for analysis. Results are generally available within 24 to 48 hours. Turnaround time can be affected by demand. For more information, read the Washington State Department of Health’s medium article on testing [at https://medium.com/wadepthealth/covid-19-testing-process-what-you-need-to-know-ad741ed1a806] or visit the department’s coronavirus website [at https://www.doh.wa.gov/Emergencies/Coronavirus].”
Dialysis Patient Citizens has published a recording of their March 13, 2020 webinar on What the COVID-19 Means for Kidney Patients. The webinar goes into far more useful detail than most of the available material on the subject. Find the recording at https://www.youtube.com/watch?v=lWXHlHp7wqs. The first four minutes are unintelligible, but after that the sound quality is a little muddy but understandable, so it’s very worthwhile to persevere. As usual, ignore the beeping hospital-room-monitor alarm.
Both ASN and NTDS have published guidance for dialysis facilities on dealing with COVID-19:
- ASN – Information for Screening and Management of COVID-19 in the Outpatient Dialysis Facility, https://www.asn-online.org/g/blast/files/DIALYSIS%20COVID%202019%20Update%202.28.20%20FINAL.pdf. A few excerpts:
- “Ensure rapid triage and isolation of patients with symptoms of suspected COVID-19 or other respiratory infection (e.g., fever, cough). Identify patients before or immediately upon arrival to the dialysis facility (e.g., during or before patient triage or registration at the time of patient check-in). Ask all patients about fever or symptoms of lower respiratory tract infection, including cough or trouble breathing. Ask all patients about travel to an affected geographic area in the last 14 days OR contact with a patient with known COVID-19 illness.”
- “At present, samples should be taken in an airborne isolation room or examination room with a door closed by a healthcare provider wearing appropriate PPE (gown, gloves, eye protection,and a fit-tested N-95 mask or higher-level respirator). Dialysis patients who require testing will need to be transferred to a facility with these capabilities. Notify and discuss with the health department prior to transfer to determine appropriate disposition. In addition, notify the receiving facility before transferring a patient who meets PUI criteria.”
- “Shared decision making between health departments and clinicians should occur when testing is considered. The ‘Person Under Investigation’ (PUI) definition can be used to help inform testing decisions but reliance on the PUI definition should never impede or override clinical judgment. The PUI definition can change over time as more is learned so check here for the current definition: https://www.cdc.gov/coronavirus/2019-nCoV/hcp/clinical-criteria.html.”
- “Most dialysis facilities do not have airborne isolation rooms (AIIR). Currently PUIs or individuals with confirmed COVID-19 should not receive dialysis in an outpatient dialysis facility due to inability to perform dialysis in an AIIR. Therefore, if unable to perform home dialysis, these individuals will need to undergo dialysis in an acute care hospital in an AIIR. The decision to transfer care back to the dialysis facility should be determined on a case-by-case basis, in conjunction with local, state, and federal health authorities.”
- NTDS – Coronavirus, https://www.asn-online.org/ntds/. This is a comprehensive list of resources, including all relevant CDC links. One example resource is an APIC FAQ at https://apic.org/wp-content/uploads/2020/02/02420_Coronavirus_HiresNoBleed.pdf. Another is a suggested poster for your facility, at https://www.asn-online.org/g/blast/files/Coronavirus%20poster%2002.28.2020%20R.pdf and reproduced below:
The National Forum of ESRD Networks Medical Advisory Council Vaccination Toolkit (Revised 2020) was updated in January 2020. Find it at https://esrdnetworks.org/resources/toolkits/mac-toolkits-1/vaccination-toolkit/vaccination-toolkit-revised-2020/view.
The Centers for Disease Control and Prevention (CDC) and the ASN Nephrologists Transforming Dialysis Safety (NTDS) group have partnered to develop a new online learning module, Managing Infection in an Outpatient Dialysis Facility. Find it at https://www.asn-online.org/ntds/olm.aspx.
A new MEI online continuing-education course on Include Dialysis Patients in your Facility Culture of Safety focuses on effective systems and teamwork – including patients – to accomplish the mutual goal of safe, high-quality patient care. When something goes wrong, the focus is on what, rather than who, is the problem, with the intent to bring process failures and system issues to light and solve them in a non-biased, non-threatening way. Find the course at https://course.wcea.education/app/mei/elearning/nurse/medical-education-institute/194758/include-dialysis-patients-in-your-facility-culture-of-safety.
CMS reviews where we are with the “ordinary” flu, and what we need to do about it, at https://www.cms.gov/outreach-and-educationoutreachffsprovpartprogprovider-partnership-email-archive/2020-02-13#_Toc32395783.
And last but certainly not least, you can find CDC’s nexus page on the Coronavirus that began in Wuhan, China, which the WHO has named “Covid-19,” at https://www.cdc.gov/coronavirus/2019-ncov/index.html. The WHO’s central page on Covid-19 is located at https://www.who.int/emergencies/diseases/novel-coronavirus-2019.
Home Dialyzors United, Comagine Health ESRD Network 16, and other sponsors will present a free September 21, 2019 all-day patient educational meeting on home dialysis and transplant in Puyallup WA, called Going Home, Staying Home. The meeting will include sessions on patient priorities, home modalities, patient safety at home, how the Network can help, a panel on transplants, and a real-time support group. For details see these resources: