The COVID-19 pandemic is placing a strain on states and hospital systems across the nation as they face the challenge of limited medical resources, including ventilators.
The American Society of Nephrology (ASN) and the National Kidney Foundation (NKF) learned of reports of blanket crisis-management policies that were previously developed or under consideration. These arbitrary policies deprived certain patients, including kidney patients, of life-saving interventions, such as ventilation. Last week, ASN and NKF wrote to the National Governors Association and the National Conference of State Legislatures requesting that they urge their members to ensure that their states, and the healthcare systems within their states, do not tolerate this type of discrimination.
"The American Society of Nephrology and the American College of Emergency Physicians issue this joint statement on the appropriate use of emergency departments (ED) during the COVID-19 pandemic.
Dialysis facilities should implement measures to identify patients with signs and symptoms of respiratory infection (such as fever and cough) at or prior to arrival at a dialysis facility (before patients enter the treatment area).
When COVID-19 is suspected or confirmed in a hemodialysis patient, dialysis staff should follow the Centers for Disease Control and Prevention (CDC) Interim Infection Prevention and Control Recommendations for Patients with Confirmed Coronavirus Disease 2019 (COVID-19) or Persons Under Investigation for COVID-19 in Healthcare Settings.
Unless a patient is too sick, dialysis is most appropriately provided at an outpatient dialysis center. In the context of COVID-19, mild symptoms that do not require hospitalization should not be referred to the ED.
This guidance will ensure that dialysis is delivered safely, as prescribed, in the dialysis facility, and the patient will avoid exposure to an already overburdened hospital emergency department unless the patient’s signs or symptoms warrant such care.
If a patient is being referred to the emergency department for a complaint that is not a time – dependent emergency, the dialysis center should discuss the case with their medical director and with the ED before sending the patient."
States anticipating potential shortages of health care workers are temporarily relaxing requirements for medical licenses, in the hopes that a volunteer force of out-of-state doctors, retired physicians and medical students can fill the gap. States with flexible laws already on the books have issued emergency declarations and executive orders directing state health departments and medical boards to clear legal obstacles. In other states, legislation has been fast-tracked to create new emergency powers.
Sources: Federation of State Medical Boards; American College of Surgeons, “Uniform Emergency Volunteer Health Practitioners Act”; Interstate Medical Licensure Compact Commission
On March 31, American Society of Nephrology (ASN) President Anupam Agarwal, MD, FASN and National Kidney Foundation (NKF) President Holly Mattix-Kramer, MD, MPH urged Department of Homeland Security Acting Secretary Chad Wolf and Federal Emergency Management Agency Administrator Pete Gaynor to accelerate the production and distribution of personal protective equipment (PPE) for health care professionals and vulnerable populations during this national crisis.