By now, most people will probably have heard that older and immunocompromised individuals have a higher risk for serious complications from COVID-19. But for one group of patients, those who need dialysis – the normal recommendations of simply isolating at home, isn’t really an option.
Dr. Preethi Yerram is a nephrologist for the University of Missouri Health Care System, as well as the Medical Director at the DCI Transitional Care Unit and Home Dialysis Unit here in Columbia. She spoke with KBIA’s Rebecca Smith about the additional risks that individuals receiving dialysis are having to navigate during the COVID-19 pandemic – as they have to risk exposure every time they receive necessary, life-sustaining treatment.
Rebecca Smith: So, Dr. Yerram, just to begin, can you tell me what you've been hearing from your patients?
Dr. Preethi Yerram: So, I think you make a great point in terms of how these patients cannot avoid having dialysis because it is a life-sustaining procedure, you know, “just get your supplies and do not come out for two, three weeks or whatever time it is,” that's not going to work for dialysis patients. They have to be out there, regardless of what's going on – three times a week.
So, every time they're going out, they may be, if they do not have transportation of their own, they are expected to ride a shared bus of some sort or like a shared transportation, so, you may be exposed to other people.
And obviously, once you're at the dialysis unit, there is always a chance of having infection from other patients. Because when you go to an in-center dialysis unit, it is usually a series of dialysis chairs set side by side, and there is no way for, you know, patients to be completely confident that the person sitting next to them is, you know, completely, healthy or they're not transmitting or anything.
Rebecca Smith: I know you guys have started taking temperatures when people arrive at the dialysis center, but what other steps have you guys taken to try and mitigate that risk for patients?
Dr. Preethi Yerram: If there is indeed a COVID positive patient, the patient will have to be treated separately, in either an isolation room, if that's available, or at least six feet away from any other patient in all directions.
And as I said, most of the dialysis units, you know, have just a series of chairs next to each other and may not have an isolation room.
So, the recommendation from the CDC is to just dialyze these patients at the end of the row, at least six feet away from any other patients, in all directions, and they should wear masks and basically follow droplet precautions,
Rebecca Smith: Dr. Yerram, what are some of the other challenges that these patients could be facing and what can the rest of us do to help?
Dr. Preethi Yerram: Yeah, so I am we've been hearing a lot of concerns relating to transportation for these dialysis patients. So, there is a lot of concern about, you know, what would happen to these patients should they get diagnosed with COVID and how they will get to the Dialysis Unit.
So, the community can definitely step in in such situation, and perhaps, you know, provide transportation to these patients.
And please be aware that these dialysis patients are a more vulnerable population. They can have a more severe kind of COVID disease, and, as a person in the community, you can help these patients by helping them perhaps with grocery delivery or, you know, other things that they may need that would help them avoid getting out of the house.
So, if somebody is in need of some supplies to be brought to their home, you know, you can volunteer to do that, instead of the patient having to go out and get them on their own.