ASN is hearing from nephrologists in multiple COVID-19 hot spots that their patients are facing serious logistical transportation challenges, specifically with ensuring COVID-19 patients can access safe transportation to dialysis facilities. The ramifications are significant and include barriers to discharging kidney failure patients with COVID-19 from hospitals, risks of admitting patients to hospitals who cannot get to dialysis facilities, and risks of spreading COVID-19 during transportation. While nephrologists and dialysis facilities are coordinating with state and local authorities, there is also a role for the Department of Health and Human Services.
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.
This podcast includes an interview with Suzanne Watnick, MD, FASN. Dr. Watnick is the Chief Medical Officer at Northwest Kidney Centers in Washington state and Professor of Medicine at the University of Washington. She discusses the steps her organization took to protect kidney patients and health care workers once the Coronavirus hit her state.
This podcast covers a COVID-19 update from Dr. Barbara Murphy who is on the ground in New York City, a current hotspot in the US for COVID-19 cases. Dr. Murphy, MB BAO BCh, FRCPI, is currently the Murray M. Rosenberg Professor of Medicine and department chair for the Mount Sinai Health System (NYC). She is also dean of Clinical Integration and Population Health for the New York system’s Icahn School of Medicine and an ASN Councilor. Dr. Murphy is on the front lines of the COVID-19 crisis in New York City and plays a leading role in organizing the care effort there.
"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.
On Friday, March 20, ASN President Anupam Agarwal, MD, FASN issued an email to all ASN members addressing the COVID-19 pandemic and how ASN is responding.
He began, “as the president of a society headquartered in the United States, I must acknowledge the deep debt we owe to our colleagues in other countries. Thank you for sharing your experiences and wisdom in treating patients affected by Coronavirus Disease-2019 (COVID-19) as well as for providing advice on how to manage the unprecedented strains this pandemic is adding to our health care systems. Your focus, dedication, and spirit of collaboration exemplifies the essence of medicine.”
We had an amazing “emergency edition” Twitter Chat on COVID-19 and the kidneys. This was a joint project between ASN and #NephJC. The special guests were Drs. Alan Kliger (@AlanKliger) and Jeffrey Silberzweig (@SilberjRogosin) from Nephrologists Transforming Dialysis Safety (NTDS) and the ASN Emergency Partnership Initiative (EPI), respectively. The chat was hosted by the dynamic social media duo and co-founders of #NephJC, Drs. Joel Topf and Matt Sparks.
The current pandemic associated with the SARS-CoV-2 virus and COVID-19 disease is unprecedented and catastrophic.
As concerned physicians and scientists working in this area, we summarize the evidence on the NephJC website, The Coronavirus Conundrum: ACE2 and Hypertension Edition, (which will be updated in real time) and call for greater understanding and systematic data gathering, rather than hasty decision-making based upon incomplete or inaccurate information, or unjustified extrapolations.