COVID-19 (the new Coronavirus) has made its way to 185 countries (at the time of writing this article). It is highly contagious, a completely new viral strain that had caught us all off-guard and is of particular concern to anyone with a weak immune system.
A sizeable chunk of Kidney Patients has poor immunity. This is either due to the respective disease state itself (such as Diabetes) or due to specific “immuno-suppressive” medicines (such as steroids) that are necessary to treat certain kidney disease states & prevent them from flaring up.
Hence, it is necessary that people like us, belonging from the kidney patient community put particular emphasis on:
1️⃣ Fully understanding what COVID-19 is all about
2️⃣ The impact that it may have on our kidneys (whether in good health or with a kidney disease state or post-kidney transplant)
3️⃣ How to best deal with it and keep ourselves safe
4️⃣ Gathering authentic information but not to the point of inviting anxiety
5️⃣ Fight off all misinformation / superstitious practices / ineffective to downright harmful “Corona hacks” circulating on social media
6️⃣ Following the necessary health-etiquette to keep people around us healthy
This article aims to handhold you through various COVID-19 resources sourced from authentic sources (WHO & Official Government websites) and our explanations (where necessary) to help you become “Corona-Smart” with Kidney Disease in tow.
Let’s begin, shall we?
TABLE OF CONTENTS
What exactly is the Novel Coronavirus?
Who all are vulnerable?
How can COVID-19 impact Kidney Patients?
The new Coronavirus can affect Kidney Patients in 3 ways:
1. By the disease itself progressing to cause direct kidney damage
From studying the natural history of COVID-19 over the past months, we now know that apart from impacting the Lungs, Heart & Intestines, COVID19 may affect your kidneys too.
Currently, research evidence confirms that Acute Kidney Injury (AKI) is a possible complication of respiratory tract infections caused by Coronaviruses (including COVID-19).
CT scans of a segment of patients who succumbed to this infection show “dense” kidneys. This is suggestive of kidney damage due to toxins called “Cytokines” released from the viral infection.
In addition, there is clinical evidence of kidney damage from the viruses directly injuring the tiny kidney filters as well. The poster by the International Society of Nephrology explains this part.
However, it is not clear if these patients had kidney disease beforehand or developed kidney complications despite good health prior to the coronaviral infection.
Further on, because COVID-19 is chiefly a pneumonia-causing virus, it basically solidifies air spaces in the lungs (as in all pneumonia cases). And it begins doing so, rapidly over merely 48 hours. This reduces the overall Oxygen exchange spaces in our body. As a result, blood oxygen levels drop perilously. This again impacts kidneys adversely.
All these factors come together to cause Acute Kidney Injury, sometimes to the point of a complete kidney shutdown.
2. By infecting immunocompromised kidney patients more easily
A significant chunk of Kidney patients end up with poor immunity. This subset includes kidney patients:
1. With Diabetes
2. On Steroid medicines
3. On Dialysis
4. Who underwent a Transplant
Hence, we are at a greater risk of catching the COVID-19 infection as compared to a person with average health.
In addition, poor immunity means that the disease is likely to show symptoms and spread more rapidly as well. So, kidney patients are more likely to depend on critical care facilities as opposed to those with prior good health.
3. By disrupting the workflow at Dialysis Units
Dialysis Units cater to multiple patients at a time. Isolation and containing the spread of infection could be a challenge, especially in centres which reuse Dialyzers. However, this risk must not be a reason to stop Dialysis.
Talk to your Dialysis Team to know about what precautions are in place to safeguard your health without interrupting your in-centre treatment routine.
Clinical evidence on the risk of COVID-19 in Dialysis patients advises against the re-use of Dialyzers at this moment. (written in blue at the bottom right corner of the ISN infographic below):
In case your centre re-uses Dialyzers, enquire if this could be avoided during this time. If your kidney health permits, Home Dialysis could also be a safe option. Talk to your Dialysis facility & Health Insurance provider to see if this is possible.
If you are a Dialysis Patient & have been diagnosed with COVID-19 (new coronavirus), you will be put up at an isolation ward in a hospital catering to the Coronavirus patients. Make it a point to let your attending medical team know about your kidney illness & Dialysis. In all likelihood, it would be arranged for you at your ward.
Also, once you recover from the Coronavirus infection, do let your usual Dialysis Unit know about this. There is no law that can allow your Dialysis Unit to deny you treatment for your history of COVID-19 illness. However, there may be new rules for recently recovered patients both for the safety of other patients and you.
FREE WEBINAR: Dialysis Protocol for patients diagnosed with COVID-19 (Click to play)
How does COVID-19 spread & how can you protect yourself from it?
7 simple steps to prevent the spread of COVID-19
Maintenance of Hand & Respiratory Hygiene
With the COVID-19 pandemic, health stakeholders the world over, have been constantly stressing how something as simple as handwashing and following a cough/sneeze etiquette could effectively break the chain of transmission of the coronavirus infection. This could be the much-needed respite the world needs right now.
How exactly does hygiene help?
“Prevention is (much) better than (waiting unguarded for a) cure”, wouldn’t you agree?
It is no news that COVID-19 is highly contagious. However, the fact that it spreads by “inhaling infected droplets” & lax hygiene practices on our part contributed greatly towards giving this disease a free run. Here droplets technically mean the tiny drops of nasal discharge that fly-out when a person sneezes or coughs out. The viruses use these droplets as “vehicles” to spread out in the environment. This is a lot like the Common Flu Virus.
However, what makes COVID-19 different is its longer survival in the environment. Depending on the material on which the infected droplet settles, new coronavirus lives for up to 9 days! On the contrary, most other viruses perish within a few minutes to hours.
Breathing-in air loaded with such infected droplets or touching your mouth /nose /eye area with hands unclean from touching infected surfaces (including human hair) is how this virus transmits from person-to-person.
This is exactly where the concept of maintaining strict personal hygiene chips in!
Now, with necessary information flowing-in, the research community has been able to advise experimental medicine combinations that have successfully cured coronavirus patients as well.
However, developing a specific vaccine and laying down proper medicine combinations & dosing protocols will take anywhere between 1.5-2 years to secure regulatory approvals for regular community use.
So, if there’s anything that will hold us in good stead for that duration, it is following measures to “break the chain of transmission” & “help reduce the caseload on hospitals”. Maintaining personal hygiene is one such simple yet effective measure.
How do you go about it?
Social Distancing: Maintain a distance of at least 1 metre from others such that any cough/sneeze droplets don’t enter our “breathable zone”
Avoid touching your face with unclean hands
Wash your hands frequently with soap & water thoroughly
If you are outside with no access to soap, use an alcohol-based hand sanitizer with at least 60% alcohol. However, plain soap & water are the best options to clean visibly grimy hands.
Follow a cough / sneeze etiquette and encourage others around you to do the same
Stay at home and choose to run your errands online.
If you cannot avoid going out, wear a mask that properly fits your face & covers your nostrils and mouth.
Wear eyeglasses/shades for eye protection. Swimming goggles for underwater viewing are good alternatives!
Also, cover your hair (cap / helmet / scarf) to avoid your hair from being contaminated.
The WHO-approved Handwash method
How does soap/alcohol help kill Coronavirus
The correct way to wear a medical mask
P.S. We tend to disagree on 1 point in the video above, that says masks are solely for those showing symptoms. In these unprecedented times of a global pandemic, it is important to use the mask as a preventive tool.
- Asymptomatic individuals who are “at-risk”, such as Kidney patients or organ transplant recipients must use a mask to protect themselves from any possible exposure.
- Those who may have had exposure (university students / those who travelled for business or leisure elsewhere) should use a mask to minimise any potential “viral shedding” before symptoms show-up.
Choose Tele-medicine for medical consultations
If you are a kidney patient, hospital visits become an integral part of your lifestyle.
However, with the coronaviral crisis, we would strongly recommend limiting your hospital visits to emergency situations or for critical medical procedures.
For follow-ups, it is better to prefer contacting your medical team via telehealth facilities (phone/video chat/other online portals).
This is to offset the risk of your potential exposure to COVID-19 carriers / patients.
Buying your grocery/consummables: Go Online!
It is definitely necessary to stock up on all essential commodities such as your medicines, medical devices you may be using, food, bath & sanitary supplies. However, going to the store/supermarket at this stage is best avoided because:
Stores will tend to be crowded, so transmission of infection is a very real possibility.
Further, the products in the shelf may be contaminated with infected droplets from COVID-19 patients who haven’t had symptoms yet. Since this virus survives for as long as 9 days on plastic surfaces, these could easily transfer to your fingertips & potentially infect you.
What to do?!
Order your essentials Online or ask your grocer over phone if they could arrange for delivering the goods at your doorstep.
NOTE: Avoid panic buying or stock-piling though. These only strain the goods supply chains in the market and lead to price rise (hurts you ultimately!)
Best practices on handling store-bought items /products ordered online
1. Once you receive your order, leave the goods in a separate area for 72 hours (3 days) before using them.
However, if some items needs refrigeration/freezing, wash / clean such items & keep them in the fridge/freezer immediately.
2. Alternatively, disinfect all the items immediately, with the following steps:
WEAR GLOVES DURING THE DISINFECTION PROCESS
This is necessary to avoid soiling your hands with any potential “contaminated droplets” on the surface of your items.
Avoid touching your face (mouth, nose, eyes) with these gloves on, else it defeats the very purpose.
1️⃣ Wash the surfaces of non-food items and packaged stuff with a soap/detergent thoroughly or clean the surface with an alcohol based sanitizer (with more than 70% Alcohol)
Soak all “packaged” goods in a bucketful of soap/detergent solution for an hour. If necessary, do so in batches. Then wash the surface of the goods with plain tap water & leave them to dry. Discard the soap/detergent solution, wash the bucket with tap water and disinfect it separately with a surface cleaner like Chlorex.
2️⃣ Transfer as many items from plastic packaging to storage containers of your own. Discard the plastic packaging safely in a closed bin.
1️⃣ Thoroughly wash fruits, vegetables, meat, fish, eggs under clean tap water before refrigeration or freezing (as required).
2️⃣ Cook your food thoroughly. Average cooking temperatures typically exceed 60 – 70 degrees Celsius. The protective protein & fat coating of viruses ruptures beyond such temperatures and kills them.
3️⃣ If you eat salads or fruits, wash the ingredients thoroughly with water again, before consumption. Whenever possible, peel the fruits / veggies in such a scenario.
Myth busters on COVID-19
At all costs, avoid falling prey to fake news and ineffective health hacks, unfortunately, doing the rounds of Social Media at this difficult time.
The World Health Organization busted some common myths around COVID19.
Click on the link below for more:
Continent-wise Government/WHO resources
Only trust authentic information sourced from Government Websites. For your ease of reference, we have prepared a continent-wise repository of Government Resources on COVID-19 here.
Most of these resources here provide information & guidance specifically for Kidney Patients with respect to COVID-19 (coronavirus).
🔸️WHO Website for COVID-19 updates https://www.who.int/emergencies/diseases/novel-coronavirus-2019
🔸️FAQ page for COVID-19 (New Coronavirus) — WHO
🔸️Center for Disease Control (CDC), USA
🔸️Coronavirus FAQs for Kidney Patients, National Kidney Foundation (NKF), USA
🔸️COVID-19 resources, Official website of the Government of Canada
🔸️COVID-19 Information, University Hospital Network (UHN), Canada
🔸️Coronavirus (COVID-19) resources, Kidney Foundation of Canada
🔸️COVID-19 resources, Ministry of Health, Government of Jamaica
🔸️Coronavirus Latest Information, National Kidney Federation, UK
🔸️Coronavirus Advice, Kidney Care, UK
🔸️Coronavirus Infection Guide, Official website of Government of Germany/Deutscheland
🔸️Coronavirus (COVID-19) Information, Official website of the Government of France
🔸️Coronavirus update, Ministry of Health, Federal Government of Nigeria
🔸️Official Twitter handle of the Ministry of Health, Federal Government of Nigeria
🔸️COVID-19 (Coronavirus Updates), Ministry of Health and Family Welfare, Government of India
🔸️Revised Guidelines for Dialysis of COVID-19 patients, Ministry of health and family Welfare, Government of India
🔸️COVID-19 Guidance (English), Ministry of Health and Prevention, United Arab Emirates (UAE)
🔸️Coronavirus Guide, Kidney Health Australia
🔸️Novel Coronavirus (COVID-19) Health Advice, Ministry of Health, Government of New Zealand
🔸️COVID-19 latest updates, Government of New Zealand
P.S. The list is definitely not exhaustive. We would urge readers to contribute with more web links to Official Government websites of other countries that inform on COVID-19 in the comments section. We will update this list accordingly. Goes without saying, No Spam Please!
COVID-19 Research & Development
Link to WHO R&D Database on COVID-19. Find all the scientific research published on COVID-19 (novel Coronavirus) to date.
Mental health & COVID-19
Fighting the stigma associated with a COVID-19 Diagnosis
The new Coronavirus is highly contagious. It is true that lax basic hygiene practices, irresponsible attitudes by some “super-spreaders” and general global under-preparedness for combating this new virus have significantly led to its spread at such an unprecedented scale. However, most of those infected did nothing to “earn” the disease. There should be absolutely no place for stigmatizing the confirmed cases or their contacts.
It is the fear of being stigmatised & isolated by the Society that has also unfortunately made a lot of people opt for illogical and downright harmful tactics like escaping detection at thermal screening or even skipping Quarantine. This alone could have led to an exponential spurt in the numbers.
Let’s spread awareness. And fight this phobia of Corona stigmatization.
COVID19: Safety in the workplace
(For countries not under restricted movement)
Policy level updates:
1. American Society of Nephrology President Anupam Agarwal, MD, FASN meets with President Donald Trump.