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Dialysis Patients Face Close-Up Risk From Coronavirus Dialysis Patients Face Close-Up Risk From Coronavirus
(about 13 hours later)
Mat Risher leaves the safety of his home near Seattle three days a week for dialysis at a clinic, a treatment he cannot live without but one that now most likely increases his risk of exposure to the coronavirus.Mat Risher leaves the safety of his home near Seattle three days a week for dialysis at a clinic, a treatment he cannot live without but one that now most likely increases his risk of exposure to the coronavirus.
About 20 patients sit in a small space with him, tethered for several hours to machines that filter toxins from their blood. All now have their temperatures taken before they enter. They can wear a surgical mask and are told that the rooms are cleaned and machinery disinfected regularly.About 20 patients sit in a small space with him, tethered for several hours to machines that filter toxins from their blood. All now have their temperatures taken before they enter. They can wear a surgical mask and are told that the rooms are cleaned and machinery disinfected regularly.
One of the first people to die from the virus in the United States had received dialysis at the very same clinic, information that triggered a panic attack in Mr. Risher.One of the first people to die from the virus in the United States had received dialysis at the very same clinic, information that triggered a panic attack in Mr. Risher.
As the coronavirus rages from state to state, the 500,000 people whose failing kidneys require them to get dialysis are among the most vulnerable. Each clinic may have dozens of patients during a single shift, often sitting less than the recommended six feet apart for hours.As the coronavirus rages from state to state, the 500,000 people whose failing kidneys require them to get dialysis are among the most vulnerable. Each clinic may have dozens of patients during a single shift, often sitting less than the recommended six feet apart for hours.
“It’s definitely a scary time for us,” said Mr. Risher, 33, of Everett, Wash.“It’s definitely a scary time for us,” said Mr. Risher, 33, of Everett, Wash.
Kidney dialysis is a last resort for many people, and they are endemically susceptible to infection in normal times. The dialysis industry has historically had a poor record when it comes to infection control so the current infectious climate is fraught with worry.Kidney dialysis is a last resort for many people, and they are endemically susceptible to infection in normal times. The dialysis industry has historically had a poor record when it comes to infection control so the current infectious climate is fraught with worry.
DaVita and Fresenius, the two for-profit companies that dominate the industry, say they have procedures in place to keep their patients and staff safe and say they have taken aggressive steps in recent weeks to prevent the spread of the virus at their facilities. “We’re all playing in real time, and we’re doing our best,” said Javier Rodriguez, the chief executive of DaVita.DaVita and Fresenius, the two for-profit companies that dominate the industry, say they have procedures in place to keep their patients and staff safe and say they have taken aggressive steps in recent weeks to prevent the spread of the virus at their facilities. “We’re all playing in real time, and we’re doing our best,” said Javier Rodriguez, the chief executive of DaVita.
DaVita and Fresenius claim they have had no significant outbreaks to date. Fresenius says less than half of 1 percent of its patients and staff have tested positive for the virus. “We’ve been remarkably successful in mitigating cross-contamination,” said Bill Valle, the chief executive of Fresenius Medical Care North America, which is a unit of the German company.DaVita and Fresenius claim they have had no significant outbreaks to date. Fresenius says less than half of 1 percent of its patients and staff have tested positive for the virus. “We’ve been remarkably successful in mitigating cross-contamination,” said Bill Valle, the chief executive of Fresenius Medical Care North America, which is a unit of the German company.
“None of the services we provide are elective in nature,” he said.“None of the services we provide are elective in nature,” he said.
DaVita would not say how many of its patients or staff have become infected. “At this time,” the company said, “we are not disclosing specific numbers for a variety of reasons, ranging from our desire to focus on both the mental and physical health of our patients and teammates, to the fact that things change frequently in this dynamic situation.”DaVita would not say how many of its patients or staff have become infected. “At this time,” the company said, “we are not disclosing specific numbers for a variety of reasons, ranging from our desire to focus on both the mental and physical health of our patients and teammates, to the fact that things change frequently in this dynamic situation.”
Critics of the large chains say the companies are not taking the threat seriously enough. Health care workers are concerned about protective equipment, with patients being asked to reuse masks and scattered shortages of the most protective gear for the nurses and technicians dealing with infected patients.Critics of the large chains say the companies are not taking the threat seriously enough. Health care workers are concerned about protective equipment, with patients being asked to reuse masks and scattered shortages of the most protective gear for the nurses and technicians dealing with infected patients.
“When it comes to responding to Covid-19, the response by large dialysis organizations has been inadequate, leaving some of the most vulnerable exposed to Covid-19, which is especially serious in people with end-stage renal disease,” said Dave Regan, president of the Service Employees International Union-United Healthcare Workers West, in a statement.“When it comes to responding to Covid-19, the response by large dialysis organizations has been inadequate, leaving some of the most vulnerable exposed to Covid-19, which is especially serious in people with end-stage renal disease,” said Dave Regan, president of the Service Employees International Union-United Healthcare Workers West, in a statement.
Representative Katie Porter, Democrat of California, also wrote both companies in late March to ask what steps they were taking. “We are concerned that DaVita, specifically, has failed thus far to understand the severity of this outbreak and the high transmission of the virus,” she said.Representative Katie Porter, Democrat of California, also wrote both companies in late March to ask what steps they were taking. “We are concerned that DaVita, specifically, has failed thus far to understand the severity of this outbreak and the high transmission of the virus,” she said.
In particular, she criticized DaVita for going ahead with an annual meeting of medical directors in early March, where one of the attendees later tested positive for the virus. In its response to Ms. Porter, DaVita defended the decision as being appropriate at the time and said no one appears to have been sickened as a result.In particular, she criticized DaVita for going ahead with an annual meeting of medical directors in early March, where one of the attendees later tested positive for the virus. In its response to Ms. Porter, DaVita defended the decision as being appropriate at the time and said no one appears to have been sickened as a result.
Infection has traditionally been one of the industry’s biggest problems.Infection has traditionally been one of the industry’s biggest problems.
“The second leading cause of death among hemodialysis patients is infections,” said Dr. Alan Kliger, a Yale nephrologist who is leading efforts to control the spread of coronavirus among dialysis patients. As many as one in 10 patients die from complications from an infection, often at the site where a patient has a catheter.“The second leading cause of death among hemodialysis patients is infections,” said Dr. Alan Kliger, a Yale nephrologist who is leading efforts to control the spread of coronavirus among dialysis patients. As many as one in 10 patients die from complications from an infection, often at the site where a patient has a catheter.
According to an analysis of Medicare data by the research department of the union, six out of 10 facilities undergoing routine inspections last year were cited for deficiencies involving infection control. Examples would include a staff member failing to wear gloves during a procedure or to properly clean equipment.According to an analysis of Medicare data by the research department of the union, six out of 10 facilities undergoing routine inspections last year were cited for deficiencies involving infection control. Examples would include a staff member failing to wear gloves during a procedure or to properly clean equipment.
At this juncture, with the highly infectious coronavirus, others are extremely concerned about the spread of the virus through inadequate supplies of special masks or gowns. “We don’t have enough of many of those protective equipments,” Dr. Kliger said.At this juncture, with the highly infectious coronavirus, others are extremely concerned about the spread of the virus through inadequate supplies of special masks or gowns. “We don’t have enough of many of those protective equipments,” Dr. Kliger said.
In areas like New York and Connecticut, the surge in patients has meant heavy use of whatever supplies are available, he said. “The burn rate has been incredibly high,” he said.In areas like New York and Connecticut, the surge in patients has meant heavy use of whatever supplies are available, he said. “The burn rate has been incredibly high,” he said.
Dialysis workers say they do not feel protected. One worker who asked not to be named because she might lose her job said she thought the clinic was downplaying the risk of employees getting sick. “You just don’t feel fine,” she said.Dialysis workers say they do not feel protected. One worker who asked not to be named because she might lose her job said she thought the clinic was downplaying the risk of employees getting sick. “You just don’t feel fine,” she said.
The industry is now scrambling to adopt new practices aimed at stemming potential infections. At the clinic where Mr. Risher gets treated, “We saw things change pretty immediately,” he said.The industry is now scrambling to adopt new practices aimed at stemming potential infections. At the clinic where Mr. Risher gets treated, “We saw things change pretty immediately,” he said.
Northwest Kidney Centers, the Seattle nonprofit network operating the clinic, worked with local health officials and the federal Centers for Disease Control and Prevention and tracked patients and staff who were in contact with the patient who became ill and died. The facility was disinfected, and employees were instructed how to wear protective gear when treating anyone with Covid-19. Northwest says 1 percent of patients tested so far have been positive.Northwest Kidney Centers, the Seattle nonprofit network operating the clinic, worked with local health officials and the federal Centers for Disease Control and Prevention and tracked patients and staff who were in contact with the patient who became ill and died. The facility was disinfected, and employees were instructed how to wear protective gear when treating anyone with Covid-19. Northwest says 1 percent of patients tested so far have been positive.
“It is tough to be on the forefront of an evolving pandemic,” said Elizabeth McNamara, the chief nursing officer of Northwest.“It is tough to be on the forefront of an evolving pandemic,” said Elizabeth McNamara, the chief nursing officer of Northwest.
Updated June 16, 2020Updated June 16, 2020
The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.
The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.
So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.
The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.
Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.
States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.
The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.
If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.
Dr. Suzanne Watnick, the chief medical officer for Northwest, added: “We’re also providing comfort to our medical staff. They are experiencing the same fear and anxiety.”Dr. Suzanne Watnick, the chief medical officer for Northwest, added: “We’re also providing comfort to our medical staff. They are experiencing the same fear and anxiety.”
DaVita and Fresenius have put in place similar measures in recent weeks to try to prevent infections. No one gets into a clinic without a fever check and a discussion about potential coronavirus symptoms. Their patients and employees are now required to wear masks.DaVita and Fresenius have put in place similar measures in recent weeks to try to prevent infections. No one gets into a clinic without a fever check and a discussion about potential coronavirus symptoms. Their patients and employees are now required to wear masks.
The companies have also decided to separate patients either suspected or confirmed to have the virus, putting them either in different clinics or scheduling their treatments on other shifts. The companies have taken the unprecedented step of agreeing to shift patients between their respective sites, if necessary, so infected or potentially infected patients are not spreading the virus.The companies have also decided to separate patients either suspected or confirmed to have the virus, putting them either in different clinics or scheduling their treatments on other shifts. The companies have taken the unprecedented step of agreeing to shift patients between their respective sites, if necessary, so infected or potentially infected patients are not spreading the virus.
Both companies acknowledge concerns over shortages of supplies but say they continue to have enough. Every patient is handed a new mask for each visit, the companies say, and workers have adequate protective equipment.Both companies acknowledge concerns over shortages of supplies but say they continue to have enough. Every patient is handed a new mask for each visit, the companies say, and workers have adequate protective equipment.
But some workers are questioning whether the clinics are making sure as few people as possible are there. Social workers and dietitians are being asked to come to work when they do not provide direct patient care, and some are being enlisted to help screen patients or wipe off machines, tasks that are outside their usual duties and could put them at risk. “We could easily call our patients from home and provide support,” one worker said.But some workers are questioning whether the clinics are making sure as few people as possible are there. Social workers and dietitians are being asked to come to work when they do not provide direct patient care, and some are being enlisted to help screen patients or wipe off machines, tasks that are outside their usual duties and could put them at risk. “We could easily call our patients from home and provide support,” one worker said.
The dialysis clinics say they consider these workers essential to take care of their patients, many of whom are struggling during the crisis to get food or travel to the clinics. “You need a lot of hands,” said Mr. Rodriguez of DaVita.The dialysis clinics say they consider these workers essential to take care of their patients, many of whom are struggling during the crisis to get food or travel to the clinics. “You need a lot of hands,” said Mr. Rodriguez of DaVita.
Workers also complain that the clinics are slow to inform them about whether any of their colleagues have developed the virus. Fresenius says it discloses information about infections at its facilities, and DaVita says it shares information when appropriate.Workers also complain that the clinics are slow to inform them about whether any of their colleagues have developed the virus. Fresenius says it discloses information about infections at its facilities, and DaVita says it shares information when appropriate.
Kisha Cox, a 45-year-old in Portland, Ore., said she was not particularly anxious about going to the DaVita clinic where she received dialysis. She says she is following the clinic’s new protocols about wearing masks and its advice about being careful to wash her hands.Kisha Cox, a 45-year-old in Portland, Ore., said she was not particularly anxious about going to the DaVita clinic where she received dialysis. She says she is following the clinic’s new protocols about wearing masks and its advice about being careful to wash her hands.
But she says the epidemic is definitely creating a strain on both workers and patients. “I think it’s overwhelming for a lot of them,” she said. “I can tell on the staff and patients’ faces, they are overwhelmed.”But she says the epidemic is definitely creating a strain on both workers and patients. “I think it’s overwhelming for a lot of them,” she said. “I can tell on the staff and patients’ faces, they are overwhelmed.”