Saturday, May 30, 2020

COVID-19 AND MY RECENT HOSPITALIZATION

I was recently hospitalized in Munster Community Hospital, in Munster, Indiana from May 12th to May 17th, 2020. The official diagnosis was Gastrointestinal Hemorrhage. After a NM GI Bleeding Scan, an Endoscopy and a Colonoscopy, it was determined that I had Ulcers and Diverticulitis. Apparently, the majority of the bleeding was caused by a diverticuli that burst. I have PKD, (polycystic kidney disease). I am currently a kidney transplant patient, who recently celebrated my 4 year anniversary! I am one of those guys that is more susceptible to the virus than your average person. What I wish to talk about today was the precautions members of the hospital staff and physicians took to protect me from the Coronavirus.

PHYSICIAN AND STAFF COVID-19 PROTECTIONS

I was put on the 3rd floor, the heart and kidney floor of the hospital which is a non-COVID-19 wing of the hospital. I had a nurse and an aid on every shift. I had a Gastro doc, a Nephrologist, and a Hospitalist that visited me at least once a day. I have a port for blood draws and infusions. A member of the Intubation team (a nurse) checked my connection to my port and infusion bag at least twice a day. The nurses and the aides dropped by my room at least once an hour. The maintenance staff came by once a day. A social stopped by twice during my stay. So there was a lot of contact between myself and employees from the hospital. Here are some of the ways the Doctors and Staff tried to protect me from Cyrus the Virus:

1. Social Distancing - I noticed every time I had contact or a conversation with anyone from the hospital, they stood a minimum of six feet away from me;

2. Person Protective Equipment- I noticed that all physicians and staff wore PPE in my room at all times. This included masks, gowns, gloves and sometimes even shoe coverings. My Hospitalist also wore a face shield in addition to the other PPE.

3. Expectations for me during room visits- I was asked to wear a facemask any time someone came into the room. I was also asked not to shake hands or touch anyone.

4. Gloves- There were boxes of form-fitting plastic gloves in boxes in my room that came in sizes from small to large. I noticed that every time a nurse, doctor or aide came into the room, they would put on the gloves when they came into my room and immediately dispose of them when they left. This may be standard operating procedure, but there seemed to be more of an emphasis on not taking a set of gloves from one patient room to the next than I normally observed during a hospital stay. I have been fighting kidney disease for over 40 years now, and I average about 2 hospital stays a year. I don't recall seeing this much deliberate precision in the past.

5. Walking- Near the end of my stay, I walked around the floor to help prepare me to go home. My friend, the IV stand and a nurse had to come with me. I was asked to wear a mask and the nurse and people in the hallways maintained their social distance.

6. Admission & Discharge- I came into the hospital by ambulance because I was extremely light-headed due to blood loss and not able to ambulatory. Although social distancing was not possible under these conditions, PPE was worn at all times and I was masked. On discharge, the nurse did wheel me to the Lyft ride share that took me home. Same story, full PPE for her, mask for me. Even the Lyft driver had a plastic shield between the front and back seats and was wearing a mask.

CONCLUSION
The healthcare professionals at Munster Community not only took very good care of me, the made every effort to make sure I was protected from the virus. I greatly appreciate their help and professionalism. I would also like to thank all of my friends and my son, Jim, who supported me during my stay, and gave me a warm welcome home. I would like to thank my landlords at Mt Zion for helping me obtain an ambulance. I hope this blog gives those of you that need medical care for something other than the Coronavirus, the confidence to contact your local emergency room or health care team. They will take all necessary steps to try to keep you safe and informed. Peace my friends! Your Uncle Jim Myers

Friday, May 29, 2020

May 20th NKF ASN LETTER ON COVID-19

May 21, 2020 The Honorable Alex M. Azar II Secretary U.S. Department of Health and Human Services 200 Independence Avenue, S.W. Washington, DC 20201 Re: Guidelines for Opening Up America Again Dear Mr. Secretary, The National Kidney Foundation (NKF) and the American Society of Nephrology (ASN) appreciate the Administration’s efforts to address kidney patients’ needs as the nation navigates the COVID-19 epidemic. Our organizations urge the Administration to continue to take the unique needs of kidney patients into account as the nation takes steps to reopen. Kidney patients, including patients with chronic kidney disease (CKD), end-stage renal disease (ESRD) and kidney transplant recipients are especially vulnerable to severe COVID-19 infection due to compromised immune systems, multiple comorbid conditions that increase their risk for COVID-19 complications, and because patients with kidney failure require in-center dialysis care that requires frequent and close contact with others. Additionally, early data from New York City indicate that 20 to 40 percent of COVID-19 ICU patients develop kidney failure and need emergency dialysis. Perhaps most disheartening, new data suggests that the mortality rate for patients on chronic dialysis who develop COVID-19 is in the range of 10-20% and that for kidney transplant patients mortality associated with COVID-19 may be as high as a staggering 30%. NKF and ASN thank the Administration for recognizing that reopening the country must account for the needs of special populations that will continue to be vulnerable to the ongoing threat of COVID-19 infection. As a preliminary matter, we note, per the above statistics, that kidney patients are one of these special populations. To reinforce that point, we request that the Administration update its definition of “vulnerable individuals” to include patients affected by kidney disease.1 We also agree that patients affected by kidney disease, like all vulnerable individuals, should continue to shelter in place. For kidney patients and transplant recipients who rely on routine contact with the healthcare system, this requires that the Department of Health and Human Services (HHS), the Centers for Medicare and Medicaid Services (CMS) and the other federal agencies working to facilitate patients’ ability to isolate and social distance. As such, we ask that the Administration adopt policies and procedures that: • Ensure that kidney patients, their families and clinicians have adequate access to personal protective equipment, priority access to COVID-19 testing, and early access to a vaccine once it is developed. 1“Individuals with serious underlying health conditions, including high blood pressure, chronic lung disease, diabetes, obesity, asthma, and those whose immune system is compromised such as by chemotherapy for cancer and other conditions requiring such therapy”

Support end-stage renal disease (ESRD) patients’ ability to safely access dialysis services and other related care. • Prioritize the safe resumption of organ transplantation, which has significantly declined as a result of COVID-19. • Extend and build upon temporary policy changes that may be required to meet the ongoing needs of kidney patients. • Address the needs of patients who develop acute kidney injury (AKI) as a result of COVID-19 infection. • Ensure that every hospital has adequate supply of dialysis equipment and dialysis solutions to provide appropriate care for hospitalized patients with kidney failure. Testing, Supplies, and Vaccination Despite the Administration’s laudable efforts, many parts of the country cannot access adequate viral or serological testing. In the absence of universal testing availability, we encourage the Administration to work with state and territorial health departments responsible for testing decisions to stratify patient access to COVID-19 testing based on susceptibility to severe infection, including weekly SARS-Cov-2 testing for in-center dialysis patients until adequate measures of immunity can be developed The following risk stratification recommendations are closely aligned with the CDC’s Priorities for COVID-19 Testing.2 Per those recommendations, we note that kidney patients are high risk and should fall under the category of “[p]ersons identified by public health officials or clinicians as high priority.” We would welcome the assistance of the Administration in communicating the special vulnerability of these patients to state and territorial Departments of Health as they allocate scarce testing resources.3 1. All In-center dialysis patients, who should be tested weekly until adequate measures of immunity can be developed. 2. All CKD and ESRD patients, living donors, and transplant recipients who exhibit COVID-19 symptoms 3. All CKD and ESRD patients, living donors, and transplant recipients who reside in nursing homes, assisted living facilities, congregate living arrangements, multi-generational families, and multi-family communities 4. All ESRD patients living in communities that are experiencing or expected to experience surges in COVID-19 cases per the White House Task Force 5. Transplant patients (including recipient, living donor and deceased donor screenings) 6. Patients with CKD stages 3 through 5. NKF and ASN thank CDC for recognizing that patients with chronic kidney disease (CKD) are at higher risk for severe illness.4 Accordingly, CKD patients must be prioritized for testing. Unfortunately, awareness of CKD is low among both clinicians and patients and so it often goes undiagnosed until its latest stages. We are concerned that patients with undiagnosed CKD who are at high risk from COVID-19 infection may not be appropriately triaged for testing and subsequent care. CKD is closely related to other non- 2 https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-criteria.html 3 Ibid. 4 https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-at-higher-risk.html

communicable diseases like hypertension, diabetes mellitus and obesity, as well as older age. While CDC’s guidance on people who are at higher risk for severe illness includes people with CKD, people 65 years and older, people with severe obesity, people with diabetes, and people with severe heart conditions, it excludes people with hypertension. Hypertensive patients are independently at risk for more severe disease and may also have already or will develop CKD, which may compound their risk. NKF and ASN recommend that CDC add patients with hypertension to the list of people who are at higher risk of severe illness. Further, many of the populations identified as high risk for more severe cases of COVID-19 are also at high risk for undiagnosed CKD. The CDC should urge state and territorial health departments to facilitate the testing of high-risk patients for both COVID-19 and CKD. Doing so will enhance our national response to COVID-19 and improve population health and our resiliency to future public health threats. NKF and ASN would be pleased to work with CDC and partners at the state and territorial level to facilitate the identification of all high-risk patients and ensure they are managed appropriately, both for the purposes of the COVID-19 pandemic and for improving the health of the nation. NKF and ASN urge the Administration to work with FEMA to ensure that supplies of personal protective equipment (PPE) provided by the federal government are distributed as quickly as possible to areas with reported shortages. In line with the Administration’s recent action to distribute PPE to nursing homes across the country, we ask that, to the extent PPE is released from the stockpile, it be distributed to patients who are most at risk, especially dialysis and transplant patients, their families, and their health care practitioners, including dialysis facilities. Finally, NKF and ASN applaud the Administration’s efforts to accelerate the discovery, production, and distribution of a coronavirus vaccine. We are encouraged by estimates that suggest a vaccine could arrive in 12 to 18 months. We ask that the Administration communicate to its vaccine development partners that validation of the vaccine will require specific testing in patients with advanced CKD and ESRD, and transplant recipients, who may have an impaired immune response to vaccination. In addition, understanding that supplies of a vaccine may initially be limited, we encourage you to work with state and territorial health departments to develop a triage system that protects our most vulnerable populations, including CKD and ESRD patients, potential living donors, and kidney transplant recipients, by allowing them to be “first-in-line” for a vaccine.

Dialysis Dialysis patients are at special risk of contracting COVID-19 due to both underlying physiological vulnerabilities and the in-center model of dialysis, which requires patients travel to dialysis. This model of care puts patients in close contact with drivers, clinicians, dialysis facility staff, and other patients several hours per visit, three to four times a week while they undergo their necessary dialysis treatments. We thank the Administration for its swift response to the potential for transmission in dialysis facilities, which is likely responsible for limiting the scope at which COVID-19 was spread between dialysis patients relative to other countries. As states implement the Guidelines for Opening Up America Again, we strongly encourage the Administration to communicate that prioritizing the protection of dialysis patients will help mitigate the

risk of resurgence and protect the most vulnerable patients, thereby assisting states with achieving a balance between reopening their economies and ensuring the health of the public. The Administration should take the following actions at the federal level that will, at baseline, protect dialysis patients across the country. This includes, but is not limited to, extending the timelines for the regulatory flexibilities that have already been provided beyond the end of the public health emergency (PHE). This is especially important because surges in COVID-19 cases may overwhelm state resources and put vulnerable patients at risk even once the national PHE has concluded. Improve ESRD Patient Access to Home Dialysis • Implement through CMMI the ESRD Treatment Choice (ETC) and the Kidney Care Choices models, which will improve patient access to home dialysis. The COVID-19 public health emergency (PHE) highlights the vulnerabilities of the in-center model of dialysis delivery and so emphasizes the need for payment incentives to transition more patients to home dialysis and improve quality of care for patients with advanced CKD and ESRD. • Continue to provide regulatory flexibilities that enhance patient access to home dialysis, including: • Allowances for a Special Purpose Renal Dialysis Facilities (SPRDF) to serve as a home dialysis training facility.5 • Extension of the waiver at 494.100(c)(1)(i) which requires the periodic monitoring of the patient's home adaptation, including visits to the patient's home by facility personnel.6 • Extension of the waiver at § 494.180(d) to allow dialysis facilities to provide services directly on the main premises of a nursing home or skilled nursing facility and the associated flexibilities in billing procedures.7 • The majority of patients on home dialysis are sufficiently stable that the benefit of monthly labs does not outweigh the risk to the patient of coming into the facility. We recommend waiving the requirement to include monthly labs on claims during the PHE for home dialysis patients. For home dialysis patients who require lab work, NKF and ASN recommend that Medicare reimburse for a technician to come into the patient’s home, which can be paid separately from the ESRD bundle. • Add CPT code 90989 for home dialysis training to the approved telehealth list. • Create a temporary safe harbor through OIG for the provision by the dialysis facility of support services in the home for home dialysis patients. Improve ESRD Patient Safety in Dialysis Facilities • Waive the requirements to include monthly labs on claims if, during the billing month, a patient has been transferred to a facility dedicated to treating COVID-19 patients that is aggregating patients from different dialysis organizations. 5 https://www.cms.gov/files/document/covid-19-esrd-facilities.pdf 6 Ibid. 7 Ibid.

Suspend in-person infection control surveys/inspections, including those referred to as “desktop” surveys until the national PHE has ended. Improve ESRD Patient Access to Transportation • For the purposes of the PHE, ensure that dialysis patients who are Covid-19 positive or under investigation for Covid-19 can access non-emergency ground ambulance transport without burdensome documentation or prior authorization. This will require that CMS revise its medical necessity standard to include patients who require medical isolation due to confirmed or suspected COVID-19 infection. Prepare to Manage Growing Cases of Acute Kidney Injury (AKI) • Between 14 and 30 percent of COVID-19 patients develop Acute Kidney Injury (AKI) a condition associated with very high short-term mortality that can lead to chronic kidney disease or even permanent kidney failure requiring dialysis. Hospitals are struggling to respond to the unanticipated number of AKI cases overwhelming ICU and dialysis resources. We recommend the Administration implement the following policy changes that will enable states to efficiently manage their hospital resources during the PHE. We note that these policy changes may need to be extended beyond the end of the national PHE should some states continue to experience surges in COVID-19 cases that threaten their hospital capacity: • Allow physicians to bill the provision of AKI services via telehealth using CPT code 90935 during the PHE • Allow dialysis facilities to be reimbursed for providing peritoneal dialysis (PD) to COVID-19 patients who are placed on peritoneal dialysis (PD) when hospitalized and are able to continue it in the outpatient setting. • Patients with AKI who are using home dialysis can derived special benefit from assistance with dialysis that is provided in the patient’s home. Support services provided by a caregiver or a dialysis facility staff member may increase the likelihood that AKI patients discharged from the hospital can successfully recover in their homes rather than in Skilled Nursing Facilities (SNFs). Elective Surgeries NKF and ASN appreciate the Administration’s guidance that elective surgeries can resume, as clinically appropriate, on an outpatient basis. Despite this guidance, we are concerned that CKD patients approaching dialysis, as well as ESRD patients, are struggling to access procedures that are necessary for planned starts to dialysis, namely creations of arteriovenous fistulas and grafts and placements of venous and peritoneal dialysis catheters. As states resume elective procedures in outpatient and ultimately the acute setting, we ask the Administration to offer “reentry” guidance to hospitals to assist them in prioritizing medically necessary procedures that have been postponed due to the COVID-19 PHE. Organ Donation and Transplantation Transplantation is widely considered the preferred course of kidney replacement therapy for most patients. Securing transplants for patients

failure could insulate them from the risk of contracting COVID-19 in the dialysis setting, now or during future prospective outbreaks. Unfortunately, both deceased and living kidney donation have experienced precipitous declines during the COVID-19 crisis. Deceased donation has fallen from a high of 527 transplants per week to 323 during the week of April 26. Living donation has experienced an even more dramatic decline, falling to just 22 transplants during the most recent week for which data are available.8 Living donation has been virtually non-existent during the PHE. We are concerned that without a proactive effort on behalf of the Administration, living donation in particular may struggle to meaningfully recover. Living Donation The reasons for the suspension of living donor surgeries are multifactorial, including the limited availability of testing and PPE, the reticence to expose otherwise healthy living donors to COVID-19 in transplant centers, concerns about transmission of COVID-19 through donation, and the lack of operating room (OR), staff, and ventilator capacity for surgeries. Each of these barriers must be addressed before living donation will once again reach its pre-COVID-19 peak. • We reiterate our recommendation that transplant centers and transplant patients receive priority access to PPE. If PPE is released from the stockpile, we ask FEMA to work with states, regions, and territories to ensure that transplant centers in need of supplies get preference. • We request the assistance of the Department of Health and Human Services in ensuring that living donors and transplant recipients are included as high priority in the CDC’s guidance on Priorities for COVID-19 Testing. Though these patients may be asymptomatic, transplant centers may be hesitant to proceed with the transplant until the status of donor and recipient are confirmed. • As states reopen, we request that HHS work with stakeholders to determine appropriate pre-transplant quarantine procedures for living donors to minimize their risk for COVID-19 infection. • NKF and ASN greatly appreciate the clarification provided early in the PHE that transplants are essential surgeries. This was invaluable at a time where hospitals were engaged in discussions about how to allocate their limited resources. We ask again that the Department of Health and Human Services provide similar “reentry” guidance to hospitals that assists them with prioritizing medically necessary procedures such as transplants. • NKF and ASN are concerned that any potential economic downturn will have a disproportionate impact on living donation. We encourage the Department of Health and Human Services to deploy all levers at their disposal to provide financial assistance to willing living organ donors, including rapidly finalizing the proposed rules, Removing Financial Disincentives to Living Organ Donation (HRSA-2019-0001) and Reimbursement of Travel and Subsistence Expenses toward Living Organ Donation Program Eligibility Guidelines. • We note that the potential for COVID-19 transmission through donation exists. The Administration must be prepared for this possibility and not allow it to act as a national deterrent for transplantation, as the benefits of transplantation to the nation continue to outweigh the risks of COVID-19 transmission. • We appreciate that the Health Resources and Services Administration (HRSA) has noted that it will allow for flexibility in its post-transplant survival measure. NKF and ASN 8 https://unos.org/covid/

request that CMS similarly provide a formal waiver of its one-year post graft and patient survival measure for the purposes of the PHE. Deceased Donation While the above recommendations apply also to deceased donation and are similarly critical to its safe resumption, we ask the Administration to specifically facilitate a return to normal operations for the nation’s 58 Organ Procurement Organizations (OPOs). • “Reentry” guidance from the Administration to hospitals on prioritization of procedures and supplies should also note that OPO staff must be able to access trauma centers in hospitals in order to evaluate potential deceased donors and ORs in order to facilitate the organ recovery. • Donor hospitals must also have priority access to PPE, ventilators, and Covid-19 testing. We ask the Administration to note this in the requested guidance to hospitals. • NKF and ASN recommend that CMS convene the leadership of the ETC Transplant Learning Collaborative to discuss directly with CMS policymakers other policy solutions that may assist OPOs and transplant centers in overcoming COVID-19 related barriers to transplantation. Drug Supply Section 3714 of the ‘Coronavirus Aid, Relief, and Economic Security Act’’ or the ‘‘CARES Act” mandated that Medicare Part D and Medicare Advantage plans allow for up to a 3-month supply of prescription drugs through the COVID-19 “emergency period.” CMS has offered similar flexibilities to the Medicare Administrative Contractors (MACs) regarding greater-than-30-day supplies of Part B drugs including the immunosuppressive therapies on which transplant recipients rely. We are concerned that patients affected by kidney disease may continue to need these extended supplies after the national emergency has ended and ask the Administration and Congress to take steps to ensure Medicare plans continue to exercise this flexibility as long as it is required to assure patient safety. NKF and ASN appreciate the Administration’s leadership in responding to the PHE. We hope to continue to be a resource to federal and state policymakers as we collectively work through this national public health crisis. Please contact Miriam Godwin (Miriam.Godwin@kidney.org) or Rachel Meyer (rmeyer@asn-online.org) if you have questions or need additional information on the issues raised herein. Sincerely, Kevin Longino Holly Mattix Kramer, MD, MPH CEO and transplant patient President National Kidney Foundation National Kidney Foundation Tod Ibrahim Anupam Agarwal, MD, FASN Executive Vice President President American Society of Nephrology American Society of Nephrology

Thursday, May 28, 2020

THE HOPE COVID-19 & Kidney Transplant Patients

https://kibowhope.com/covid-19-and-kidney-transplant-patients/

COVID-19 AND KIDNEY TRANSPLANT PATIENTS

By James Myers

The Hope

May 28, 2020

Written By: James Myers

The views expressed here are those of the author and not necessarily those of The Hope or its sponsor Kibow BiotechⓇ. All information shared here is for educational purposes and does not constitute as medical advice. Always speak with you doctor before making any changes to your method of care.

Background

The Coronavirus usually causes the common cold. But not Cirus the Virus. COVID-19 or SARS-CoV-2 is a much severe disease, causing a worldwide pandemic that is rapidly affecting lives, especially those of us that have kidney disease. This blog is about exploring the effects that may have on kidney transplant patients. Currently, there are no antivirals or vaccines for the virus. Studies are ongoing.

COVID-19 SYMPTOMS

Symptoms include:
1. Fever
2. Cough
3. Shortness of Breath
4. Chills/Repeated Shaking
5. Flu-like symptoms (muscle ache, fatigue, headache, sore throat)
6. Nausea, diarrhea, abdominal pain
7. Loss of sense of smell and/or taste
8. Possibly pneumonia

According to Dr. William Goggins from Indiana University Health Kidney Transplant Center, Fever and Shortness of Breath are the main symptoms that should trigger a call to your transplant center doctor or transplant coordinator, for possible testing. Take a look at this video to better understand.

Lack of a Vaccine

Currently, as of the writing of this blog, there is no vaccine available for the Coronavirus.

Testing is Available But Limited

Currently, where I live in Lake County, Indiana testing is available, providing you have a doctor’s order. It is limited as far as locations. The availability of testing is different by regions. Check with your health care department or nearby hospitals to find out about availability near you.

Transplant Recipients Maybe at a Higher Risk for the Virus.

Currently, there is no scientific evidence that COVID-19 infections are more severe in kidney transplant recipients than healthy people. However, viruses in the past have cause a more severe version of the disease in people with kidney disease or people with low immune systems like kidney transplant recipients. Precautions need to be taken to prevent a higher rate of infection in these groups, including transplant recipients.

How is the Virus Transmitted?

Experts are certain that infect mostly occurs with direct contact with an infected person. However, recent theories have posited that the virus may be spread in the air by droplets. This is why there is a recent trend in the US of wearing masks and gloves when we go out and to maintain social distancing of at least six feet from others. Stay At Home Orders in certain states restrict travel only to essential travel, like going to the grocery or drug stores. Only essential services are open in those states.

It may also be possible to catch the virus from a surface touched by an infected person. If you touch a surface, washing your hands frequently and vigorously is recommended for 20 seconds before you touch your face, mouth or nose.

Also, people can be contagious when they have symptoms, but some people who appear non-symptimmatic may actually be carrying the virus. For this reason, many kidney transplant patients have shuttered themselves at home to avoid contact with others.

If the transplant patient is surrounded by persons who maybe infected, quarantine to a specific room maybe required to protect him.

Kidney Transplant Patients and Travel Restrictions

COVID-19 is a world-wide issue. A great place to check on the spread of the pandemic is the CDC website.

The American Society of Transplantation, makes the following recommendations on travel for kidney transplant patients:

• Follow public health recommendations for public distancing (at least 6 feet)
• Stay home as much as possible
• Avoid all unnecessary traveling, only leave home when it absolutely necessary
• The people who cohabit with kidney transplant patients, should also avoid all nonessential travel
• Avoid crowds
• Check travel restriction orders frequently as they may change. Reccommended places to check: Centers for Disease Control and Prevention (CDC); World Health Organization (WHO).

For example, in my home state of Indiana, there is a Stay At Home order in place, that is being more strenuously enforced. https://www.newsbreakapp.com/n/0Oj1zwa7?s=a1&pd=04frpavN.

• Patients and/or family members who have just returned from an area with high should avoid contact with family members & the public (quarantine) for 14 days after their return. If after 14 days, the individual remains healthy, he/she can resume contact. If he/she shows symptoms during that period, health care authorities should be contacted. If the transplant recipient shows symptoms, they should contact their transplant facility immediately.

• If avoiding contact is impossible, experts recommend
1. Frequently handwashing or hand sanitizer use
2. All householders avoid touching their face, eyes, nose and mouth
3. Limited contact with that family member as much as possible, maintaining social distancing
4. Cough and sneeze into your elbow or into a tissue, which is immediately disposed

• Transplant recipients should wear a mask or cloth covering in public, especially where social distancing is difficult to maintain. Better yet, to avoid public places to the extent possible. Cloth facemasks are recommended over surgical masks or N-95 respirators. The key is the mask should be tight-fitting, so it serves to prevent you from touching your nose and mouth. Check out the CDC’s Video on how to make your own facemask.

Actions Transplant Recipients Should Take if They Are Running a Fever or Coughing and Sneezing

• Call your transplant center, you may need a doctor’s order to obtain a test
• Put a mask on if you go out in public
• Avoid public places if possible
• Exercise good handwashing skills
• If you have flu-like symptoms or respiratory symptoms (fever, cough, shortness of breath, upset stomach ), call your transplant center immediately, avoid public places and put on a surgical mask. Even if you have mild symptoms, contact your transplant center first before going to a hospital or clinic.

Actions to be Taken if a Family Member , Co-Worker or other Close Contact is Diagnosed or Suspected of having COVID-19

• Call your transplant center immediately, make sure you tell your transplant coordinator that you had contact with some diagnosed or suspected of having COVID-19. Particularly if you have a fever, cough or shortness of breath
• Monitor yourself for symptoms
• Avoid any further contact with that person

How Do I Get Tested for COVID-19?

• Call your transplant center first, as you may need a doctor’s order to be tested
• Follow their instructions

Should I keep my Hospital Appointments?

• All of my doctors have canceled face to face appointments in favor of telemedicine appointments or rescheduling of appointments at a later date
• My kidney transplant doctor also pushed back my blood draws to every 4 months from every month
• Check with your transplant center for their instructions, particularly if you are newly transplanted, please remember that I am 4 years out from transplant. My instructions may be different than yours

What Can I Do To Prepare For An Outbreak of COVID-19 Where I Live?

• Check your local news for public health information
• Contact you local health department
• Always check with your transplant center
• Avoid crowded areas
• Avoid sick persons
• Frequently wash your hands, disinfect area that are frequently touched like door handles, counters, smartphones and tv remotes
• Make sure you have at least 2 weeks to 90 days worth of medicine and supplies on hand at all time. Avoid running out or rationing of your anti-rejection medication
• Have your medications mailed or delivered to your home, if that is not possible consider a pharmacy drive through or having a caregiver pick up your meds.

If I am waiting for a Kidney Transplant, Should I Worry About Getting the Coronavirus from my Donor?

• The risk of getting the virus from a donor is very low. Donors are screened for COVID-19 symptoms and asked about exposure history and travel.
• Organ Procurement Organizations are testing most potential donors for COVID-19.
• The issue comes into play when Donors have been to high-risk areas or have been exposed to someone diagnosed with the virus or a person being checked for the infection. That person may be asked to postpone a donation for 14 to 28 days.
• Living donors have been asked not to travel to high risk areas and to self- quarantine for 14 days before donation. During this time they are requested to monitor for symptoms of the Coronavirus.

How do I handle Situations Where my Community is Reopening or Changing Stay at Home Orders

• If you’re requested to return to work where you will be close to others, you may wish to have a medical examination and discuss with your transplant team the possible risks of exposure.
• It has been reccommended that you request a reassignment at work to a lower personal contact location.
• Practice social distancing as much as possible, continue to wear face coverings and protect yourself whenever possible to minimize the risk.

Where do I go to get Updated Information About the Virus?

• The CDC
• WHO

Sponsored By: Kibow BiotechⓇ

About The Author: Jim Myers

My name is James Myers. I live in Hammond, Indiana. I graduated from Valparaiso University Law School and I have 2 MBA’s in Business and Healthcare Administration. Polycystic Kidney Disease runs in my family. I’ve lost 5 members of my family to PKD, including my Father. I have PKD. I was fortunate. Because of my family’s history, I was diagnosed at the age of 25, and was able to put off dialysis until the age of 58. I was on dialysis for 4 years and was transplanted on April 27th, 2016. I named my new kidney Woody. Woodrow is a family name, so I did this to honor my father and my grandfather.

My advocate nickname is Uncle Jim. If you have a kidney question or issue you need help with, please do not hesitate to contact me at kidneystories@hotmail.com. I thank the NKF for all the opportunities they have given to me.

References

1. Coronavirus Disease 2019 (COVID-19): Frequently Asked Questions From Transplant Candidates and Recipients, https://www. myast.org/coronavirus-disease-2019-covid-19-frequently-asked-questions-transplant-candidates-recipients
2. https://www.pennmedicine.org/updates/blogs/transplant-update/2020/march/info-on-coronavirus-for-transplant-patients
3. https://www.kidneyfund.org/kidney-today/coronavirus-and-kidney-patients.html
4. https://www.kidneyfund.org/coronavirus/ (April 3rd, 2020)
5. https://www.kidney.org/coronavirus/transplant-coronavirus
6. https://youtu.be/RLoFQbf52cw

COVID-19 and Kidney Transplant Patients (The Hope)

https://kibowhope.com/covid-19-and-kidney-transplant-patients/

Home General Health

COVID-19 AND KIDNEY TRANSPLANT PATIENTS

The Hope

May 28, 2020

Written By: James Myers

The views expressed here are those of the author and not necessarily those of The Hope or its sponsor Kibow BiotechⓇ. All information shared here is for educational purposes and does not constitute as medical advice. Always speak with you doctor before making any changes to your method of care.

Background

The Coronavirus usually causes the common cold. But not Cirus the Virus. COVID-19 or SARS-CoV-2 is a much severe disease, causing a worldwide pandemic that is rapidly affecting lives, especially those of us that have kidney disease. This blog is about exploring the effects that may have on kidney transplant patients. Currently, there are no antivirals or vaccines for the virus. Studies are ongoing.

COVID-19 SYMPTOMS

Symptoms include:
1. Fever
2. Cough
3. Shortness of Breath
4. Chills/Repeated Shaking
5. Flu-like symptoms (muscle ache, fatigue, headache, sore throat)
6. Nausea, diarrhea, abdominal pain
7. Loss of sense of smell and/or taste
8. Possibly pneumonia

According to Dr. William Goggins from Indiana University Health Kidney Transplant Center, Fever and Shortness of Breath are the main symptoms that should trigger a call to your transplant center doctor or transplant coordinator, for possible testing. Take a look at this video to better understand.

Lack of a Vaccine

Currently, as of the writing of this blog, there is no vaccine available for the Coronavirus.

Testing is Available But Limited

Currently, where I live in Lake County, Indiana testing is available, providing you have a doctor’s order. It is limited as far as locations. The availability of testing is different by regions. Check with your health care department or nearby hospitals to find out about availability near you.

Transplant Recipients Maybe at a Higher Risk for the Virus.

Currently, there is no scientific evidence that COVID-19 infections are more severe in kidney transplant recipients than healthy people. However, viruses in the past have cause a more severe version of the disease in people with kidney disease or people with low immune systems like kidney transplant recipients. Precautions need to be taken to prevent a higher rate of infection in these groups, including transplant recipients.

How is the Virus Transmitted?

Experts are certain that infect mostly occurs with direct contact with an infected person. However, recent theories have posited that the virus may be spread in the air by droplets. This is why there is a recent trend in the US of wearing masks and gloves when we go out and to maintain social distancing of at least six feet from others. Stay At Home Orders in certain states restrict travel only to essential travel, like going to the grocery or drug stores. Only essential services are open in those states.

It may also be possible to catch the virus from a surface touched by an infected person. If you touch a surface, washing your hands frequently and vigorously is recommended for 20 seconds before you touch your face, mouth or nose.

Also, people can be contagious when they have symptoms, but some people who appear non-symptimmatic may actually be carrying the virus. For this reason, many kidney transplant patients have shuttered themselves at home to avoid contact with others.

If the transplant patient is surrounded by persons who maybe infected, quarantine to a specific room maybe required to protect him.

Kidney Transplant Patients and Travel Restrictions

COVID-19 is a world-wide issue. A great place to check on the spread of the pandemic is the CDC website.

The American Society of Transplantation, makes the following recommendations on travel for kidney transplant patients:

• Follow public health recommendations for public distancing (at least 6 feet)
• Stay home as much as possible
• Avoid all unnecessary traveling, only leave home when it absolutely necessary
• The people who cohabit with kidney transplant patients, should also avoid all nonessential travel
• Avoid crowds
• Check travel restriction orders frequently as they may change. Reccommended places to check: Centers for Disease Control and Prevention (CDC); World Health Organization (WHO).

For example, in my home state of Indiana, there is a Stay At Home order in place, that is being more strenuously enforced. https://www.newsbreakapp.com/n/0Oj1zwa7?s=a1&pd=04frpavN.

• Patients and/or family members who have just returned from an area with high should avoid contact with family members & the public (quarantine) for 14 days after their return. If after 14 days, the individual remains healthy, he/she can resume contact. If he/she shows symptoms during that period, health care authorities should be contacted. If the transplant recipient shows symptoms, they should contact their transplant facility immediately.

• If avoiding contact is impossible, experts recommend
1. Frequently handwashing or hand sanitizer use
2. All householders avoid touching their face, eyes, nose and mouth
3. Limited contact with that family member as much as possible, maintaining social distancing
4. Cough and sneeze into your elbow or into a tissue, which is immediately disposed

• Transplant recipients should wear a mask or cloth covering in public, especially where social distancing is difficult to maintain. Better yet, to avoid public places to the extent possible. Cloth facemasks are recommended over surgical masks or N-95 respirators. The key is the mask should be tight-fitting, so it serves to prevent you from touching your nose and mouth. Check out the CDC’s Video on how to make your own facemask.

Actions Transplant Recipients Should Take if They Are Running a Fever or Coughing and Sneezing

• Call your transplant center, you may need a doctor’s order to obtain a test
• Put a mask on if you go out in public
• Avoid public places if possible
• Exercise good handwashing skills
• If you have flu-like symptoms or respiratory symptoms (fever, cough, shortness of breath, upset stomach ), call your transplant center immediately, avoid public places and put on a surgical mask. Even if you have mild symptoms, contact your transplant center first before going to a hospital or clinic.

Actions to be Taken if a Family Member , Co-Worker or other Close Contact is Diagnosed or Suspected of having COVID-19

• Call your transplant center immediately, make sure you tell your transplant coordinator that you had contact with some diagnosed or suspected of having COVID-19. Particularly if you have a fever, cough or shortness of breath
• Monitor yourself for symptoms
• Avoid any further contact with that person

How Do I Get Tested for COVID-19?

• Call your transplant center first, as you may need a doctor’s order to be tested
• Follow their instructions

Should I keep my Hospital Appointments?

• All of my doctors have canceled face to face appointments in favor of telemedicine appointments or rescheduling of appointments at a later date
• My kidney transplant doctor also pushed back my blood draws to every 4 months from every month
• Check with your transplant center for their instructions, particularly if you are newly transplanted, please remember that I am 4 years out from transplant. My instructions may be different than yours

What Can I Do To Prepare For An Outbreak of COVID-19 Where I Live?

• Check your local news for public health information
• Contact you local health department
• Always check with your transplant center
• Avoid crowded areas
• Avoid sick persons
• Frequently wash your hands, disinfect area that are frequently touched like door handles, counters, smartphones and tv remotes
• Make sure you have at least 2 weeks to 90 days worth of medicine and supplies on hand at all time. Avoid running out or rationing of your anti-rejection medication
• Have your medications mailed or delivered to your home, if that is not possible consider a pharmacy drive through or having a caregiver pick up your meds.

If I am waiting for a Kidney Transplant, Should I Worry About Getting the Coronavirus from my Donor?

• The risk of getting the virus from a donor is very low. Donors are screened for COVID-19 symptoms and asked about exposure history and travel.
• Organ Procurement Organizations are testing most potential donors for COVID-19.
• The issue comes into play when Donors have been to high-risk areas or have been exposed to someone diagnosed with the virus or a person being checked for the infection. That person may be asked to postpone a donation for 14 to 28 days.
• Living donors have been asked not to travel to high risk areas and to self- quarantine for 14 days before donation. During this time they are requested to monitor for symptoms of the Coronavirus.

How do I handle Situations Where my Community is Reopening or Changing Stay at Home Orders

• If you’re requested to return to work where you will be close to others, you may wish to have a medical examination and discuss with your transplant team the possible risks of exposure.
• It has been reccommended that you request a reassignment at work to a lower personal contact location.
• Practice social distancing as much as possible, continue to wear face coverings and protect yourself whenever possible to minimize the risk.

Where do I go to get Updated Information About the Virus?

• The CDC
• WHO

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