Have you thought about this?
There are more than ½ million folks in the US with ESRD. End-Stage Renal Disease. Kidney failure.
And, 90+% of them are treated in clinics. (The rest undergo home treatment; we are trying to increase that percentage dramatically. This is yet another reason why that’s important.)
Those dialysis clinics have chairs stacked closely together. 3 feet would be a luxurious stretch. In other words, there’s no way to effect social distancing in a dialysis clinic. 
This is just like it was when I working on my new dialyzer. I still remember the voice of Dr. Fred Shapiro (A”H) warning me as I walking around the Hennepin County Dialysis Center. “Keep your hands in your pockets at all times. This place is rampant with hepatitis”. (It was such a shocking statement to hear at that age that it has stuck in my memory for decades.)
And, his wasn’t the only clinic replete with hepatitis infections.. It’s why blood banks refused dialysis professionals’ blood for a very long time. Because there was no good blood test for the condition- and non-A/non-B hepatitis was impossible to treat. (We now know this as Hepatitis C- and there is a very expensive cure.)
I’m sure you recognize the similarity to Dr. Shapiro’s admonition- and the prevailing condition- to today’s pandemic.
The shortage of masks is not making it any easier to maintain safe conditions in the 5000 or so dialysis clinics in America. Nor is the concept of taking everyone’s temperature before they enter the clinic the best approach. (Where are those rapid serology tests? Or cheap Covid-19 PSA devices?)
After all, as I wrote earlier, these patients are among the primary at-risk groups for Covid-19. These folks have co-morbidities- diabetes, chronic heart disease, and/or chronic lung disease.
So, unless and until we let home dialysis companies thrive, there is no way these patients can self-quarantine at home. Unless, they plan to die of renal failure. And, if treating a Covid-19 patient is tough- just imagine how hard it could be when the patient has renal failure to boot.
You can bet that folks will have Covid-19 while requiring dialysis. So, either the clinic will have to treat way fewer patients to increase the distance (that means they lose money) or they will have to adjust shifts to have all those with the SARS-CoV-2 virus together- but separate from the other patients. And, that will also mean a full disinfection of the seats, the machines, the walls, etc. after the treatment. (I’m guessing this means these folks will be treated at the last shift of the day- leaving cleanup- and a circulating air purifier to run all night long.)
Of course, that doesn’t deal well with the ride services or ambulance drivers. Who probably are going to balk at transporting Covid-19 patients. (And, if they do, the vehicles will also need a complete disinfection process, too.)
A good sign- competing dialysis clinics (i.e., Fresenius/BMA, DaVita, and others) are coordinating a concept to share one clinic in an area that will treat Covid-19 folks- hoping to protect the rest of the patients- and all of the nurses, technicians, and physicians that treat our dialysis patients.
Fun times…
I haven’t thought about dialysis in some time now, my Dad was on dialysis. And yeah my Mom had mentioned those who had to do dialysis during this time. Ironically your post comes on the day of the 2 yr anniversary of the passing of my Dad – this is weird! Anyway, a friend who has been confined to a wheelchair and a quadriplegic needs to go in and have his catheter changed every so often or risk infection. He is afraid to go in the next time because of everything going on as well. His father also was on dialysis. And I agree with increasing home dialysis BUT isn’t it costly and difficult to do- and risky for the person hooking things up- I mean one wrong move and things can go bad for the person’s life no or at the very least cause infections which would or may prove deadly?!?!?
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Home dialysis is not really more expensive than center dialysis- depending upon how it’s performed. A while ago, a firm brought a self-contained unit with a technician to each house (4 a day), which meant the capital costs were low and got reimbursed about the same rate as center dialysis. That didn’t suit a lot of the big firms who complained this firm was skirting the rules- got it stopped. But, one of them bought the firm and is about to do the same practice now. But, now, there is an Executive Order prescribing more home dialysis.
There is no more likelihood of an error at a home site than in the unit.
Oh, that’s a good idea, that you mentioned at the end there. I hope something like that can be done.
We all do so hope, Jeanine!
Home dialysis sounds like the way to go, not just during the stay at home rule but less problematic for the patient in general. Hubby has a month infusion for his RA and they moved the chairs around so they have the 6′ apart rule but that limits the number of daily infusions also.
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I am so glad they did that for the infusion therapy sessions, Martha!
This sounds frightening, especially the part about hepatitis being everywhere. I agree that home dialysis is the way to go.
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Just like telemedicine that has been trying to become ‘universal’ and failing for decades, I believe home dialysis will be one of the other hidden benefits that the Covid 19 pandemic will manifest across America.
I’ve been reading about cases of kidney damage as part of the course of certain cases of COVID-19. I did not know about the conditions in the clinic, though, and my best friend has a friend in dialysis right now. This gives a new reason for at home dialysis – and last night’s news featured a woman in her early 20’s, her dad just deceased from COVID-19, doing home dialysis on her mother, so I got to see that process (briefly).
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I am not so sure that there is direct kidney damage from coronavirus infection- but that kidney disease is an amplifier of Covid-19. As I mention in today’s blog.
one virus, and so many issues to deal with..
like Jeanine, I too hope that the single center for treating COVID patients comes to fruition.
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From your mouth to God’s ears, Vidya.