On March 11, 2020, the World Health Organization declared coronavirus disease caused by SARS-COV 2 Virus as a global pandemic. In the two years that followed, the healthcare industry had to face massive challenges, with deaths that crossed five million (as of January 2020). The healthcare industry in India stood up to the challenges and helped patients across the country battle the virus. While Covid-19 took centrestage for the medical community where doctors were engaged in fighting the virus and saving lives, treatment for patients with renal failure and in need of dialysis took backstage.
As hospitals weren’t catering to elective surgeries and treatment for non-communicable diseases was on a standstill. This is true for patients suffering from chronic heart disease, diabetes, liver disease, and kidney disorders. While many non-emergency surgeries were rescheduled, not everything could be put on the back burner. Same goes for kidney disease, as dialysis is essential for people suffering from Chronic Kidney disease (CKD).
Kidney diseases can be classified into Acute Kidney Disease (AKI), chronic kidney disease or Chronic Kidney Disease, which happens when kidney diseases last for more than three months.
Acute renal failure requires specialized attention and an intensive level of care. The reason for developing acute kidney disease is multi-factorial, including Cytokine’s storm caused due to the disorders of the immune system. Many of these patients require dialysis, and the mortality rate is high among patients who develop AKI, which emphasizes the need for dialysis.
On the other hand, chronic kidney disease patients fall into two categories. The first is those who are on dialysis and second are those who have undergone kidney transplants, which means they could survive without dialysis.
Covid-19 affected 3.3 percent of the dialysis population, which is significantly higher than 0.2 per cent of non-dialysis patients. In addition, the risk of getting Covid-19 to those receiving haemodialysis in dialysis centres is two times greater than those who enrolled for home dialysis.
According to reports, elderly males, current smokers, especially those with a compromised immune system and multiple co-morbid conditions such as diabetes, hypertension, cardiovascular disease, respiratory disease, are more likely to be affected by Covid-19 related infections. Compared to the general population, an alarmingly high level of mortality (20 percent) has been identified in Covid-19 haemodialysis patients. Further, current data show that kidney transplant recipients are more vulnerable to severe infections as well.
In Europe and large parts of Asia, aggressive steps were taken to control the spread of Covid-19 in the general population. These measures included mandatory physical distancing policies in times of high community spread, compulsory masking implementation policies, and the broad availability of contact tracing and testing, including among asymptomatic individuals, which together helped to reduce the mortality rate. In the United States, implementation of and adherence to public health measures have been inconsistent.
The pandemic posed many challenges for dialysis patients and their caregivers at home. Many dialysis centres were closed due to the pandemic, which resulted in fatalities for many patients. The scarcity of beds for Covid positive patients requiring dialysis or even for normal treatments was a real challenge. Many dialysis patients contracted Covid-19 infection after being exposed to the virus while travelling to dialysis centres, or after meeting Covid positive patients at dialysis centres or from family members. Unfortunately, many did not disclose their symptoms of Covid-19 for the fear of losing their dialysis slots, which resulted in the virus spreading to other patients and staff at the dialysis centres.
All this resulted in strategies to reduce the risk of SARS-CoV-2 transmission among patients receiving maintenance dialysis, which was an uphill task. However, through pre-emptive and war footing implementations of recommended techniques the lives of many dialysis patients were saved and at the same time transmission of Covid-19 virus was restricted. Providing dialysis was the key, but this could not be achieved successfully in suburban and remote areas.
The patients who got an opportunity to get a bed for admission or dialysis faced a second natural challenge, as there was no specific treatment plan for them. After several months of the pandemic, two medicines, namely Dexamethasone and Remdesivir, proved helpful. While Dexamethasone has robust positive data and Remdesivir has conflicting data, many patients on dialysis who had advanced Chronic Kidney Disease were saved probably due to Remdesivir. Further, patients who had undergone kidney transplants were highly vulnerable to coronavirus, but stringent social isolation helped them stay safe.
The Covid-19 posed enormous challenges for various people within the healthcare industry. Still, it is safe to say that the challenges and issues faced by patients suffering from kidney disease were unique. It is hoped that virtual healthcare and telemedicine will bridge the gap between patients and specialists in the coming days so that a pandemic will not be such a big hurdle to them receiving the care and support they need.
(The views expressed by the author are personal).
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