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| An Overlooked, Possibly Fatal Coronavirus Crisis: A Dire Need for Kidney Dialysis | An Overlooked, Possibly Fatal Coronavirus Crisis: A Dire Need for Kidney Dialysis |
| (1 day later) | |
| For weeks, U.S. government officials and hospital executives have warned of a looming shortage of ventilators as the coronavirus pandemic descended. | For weeks, U.S. government officials and hospital executives have warned of a looming shortage of ventilators as the coronavirus pandemic descended. |
| But now, doctors are sounding an alarm about an unexpected and perhaps overlooked crisis: a surge in Covid-19 patients with kidney failure that is leading to shortages of machines, supplies and staff required for emergency dialysis. | But now, doctors are sounding an alarm about an unexpected and perhaps overlooked crisis: a surge in Covid-19 patients with kidney failure that is leading to shortages of machines, supplies and staff required for emergency dialysis. |
| In recent weeks, doctors on the front lines in intensive care units in New York and other hard-hit cities have learned that the coronavirus isn’t only a respiratory disease that has led to a crushing demand for ventilators. | In recent weeks, doctors on the front lines in intensive care units in New York and other hard-hit cities have learned that the coronavirus isn’t only a respiratory disease that has led to a crushing demand for ventilators. |
| The disease is also shutting down some patients’ kidneys, posing yet another series of life-and-death calculations for doctors who must ferry a limited supply of specialized dialysis machines from one patient in kidney failure to the next. All the while fearing they may not be able to hook up everyone in time to save them. | The disease is also shutting down some patients’ kidneys, posing yet another series of life-and-death calculations for doctors who must ferry a limited supply of specialized dialysis machines from one patient in kidney failure to the next. All the while fearing they may not be able to hook up everyone in time to save them. |
| It is not yet known whether the kidneys are a major target of the virus, or whether they’re just one more organ falling victim as a patient’s ravaged body surrenders. Dialysis fills the vital roles the kidneys play, cleaning the blood of toxins, balancing essential components including electrolytes, keeping blood pressure in check and removing excess fluids. It can be a temporary measure while the kidneys recover, or it can be used long-term if they do not. Another unknown is whether the kidney damage caused by the virus is permanent. | It is not yet known whether the kidneys are a major target of the virus, or whether they’re just one more organ falling victim as a patient’s ravaged body surrenders. Dialysis fills the vital roles the kidneys play, cleaning the blood of toxins, balancing essential components including electrolytes, keeping blood pressure in check and removing excess fluids. It can be a temporary measure while the kidneys recover, or it can be used long-term if they do not. Another unknown is whether the kidney damage caused by the virus is permanent. |
| “The nephrologists in New York City are going slightly crazy making sure that everyone with kidney failure gets treatment,” said Dr. David S. Goldfarb, chief of nephrology at the New York campus of the New York Harbor VA Health Care System. “We don’t want people to die of inadequate dialysis.” | “The nephrologists in New York City are going slightly crazy making sure that everyone with kidney failure gets treatment,” said Dr. David S. Goldfarb, chief of nephrology at the New York campus of the New York Harbor VA Health Care System. “We don’t want people to die of inadequate dialysis.” |
| “Nothing like this has ever been seen in terms of the number of people needing kidney replacement therapy,” he said. | “Nothing like this has ever been seen in terms of the number of people needing kidney replacement therapy,” he said. |
| Outside of New York, the growing demand nationwide for kidney treatments is fraying the most advanced care units in hospitals at emerging hot spots like Boston, Chicago, New Orleans and Detroit. | Outside of New York, the growing demand nationwide for kidney treatments is fraying the most advanced care units in hospitals at emerging hot spots like Boston, Chicago, New Orleans and Detroit. |
| Kidney specialists now estimate that 20 percent to 40 percent of I.C.U. patients with the coronavirus suffered kidney failure and needed emergency dialysis, according to Dr. Alan Kliger, a nephrologist at Yale University School of Medicine who is co-chairman of a Covid-19 response team for the American Society of Nephrology. | Kidney specialists now estimate that 20 percent to 40 percent of I.C.U. patients with the coronavirus suffered kidney failure and needed emergency dialysis, according to Dr. Alan Kliger, a nephrologist at Yale University School of Medicine who is co-chairman of a Covid-19 response team for the American Society of Nephrology. |
| Hospitals’ “usual supplies are very quickly running out,” he said. | Hospitals’ “usual supplies are very quickly running out,” he said. |
| One doctor in New York City, who was not authorized to speak publicly, recalled anguished exchanges with other physicians last week. “You’re yelling at them. You’re telling them you don’t have a dialysis machine to give them. You hear the intensity and the desperation in the other person’s voice,” the doctor said. “My job was hell.” | One doctor in New York City, who was not authorized to speak publicly, recalled anguished exchanges with other physicians last week. “You’re yelling at them. You’re telling them you don’t have a dialysis machine to give them. You hear the intensity and the desperation in the other person’s voice,” the doctor said. “My job was hell.” |
| As the coronavirus spread rapidly in New York and in other cities, governors and mayors clamored for thousands more ventilators. But doctors have been surprised by the scarcity of dialysis machines and supplies, especially specialized equipment for continuous dialysis. That treatment is often used to replace the work of injured kidneys in critically ill patients. | As the coronavirus spread rapidly in New York and in other cities, governors and mayors clamored for thousands more ventilators. But doctors have been surprised by the scarcity of dialysis machines and supplies, especially specialized equipment for continuous dialysis. That treatment is often used to replace the work of injured kidneys in critically ill patients. |
| The shortages involved not only the machines, but also fluids and other supplies needed for the dialysis regimen. Having enough trained nurses to provide the treatment has also been a bottleneck. Hospitals said they have called on the federal government to help prioritize equipment, supplies and personnel for the areas of the country that most need it, adding that manufacturers had not been fully responsive to the higher demand. | The shortages involved not only the machines, but also fluids and other supplies needed for the dialysis regimen. Having enough trained nurses to provide the treatment has also been a bottleneck. Hospitals said they have called on the federal government to help prioritize equipment, supplies and personnel for the areas of the country that most need it, adding that manufacturers had not been fully responsive to the higher demand. |
| The fluids needed to run the dialysis machines are not on the Food and Drug Administration’s watch list of potential drug shortages, although the agency said it was closely monitoring the supply. The Federal Emergency Management Agency described the shortage of supplies and equipment as “unprecedented,” and said it was working with manufacturers and hospitals to identify additional supplies, both in the United States and overseas. | The fluids needed to run the dialysis machines are not on the Food and Drug Administration’s watch list of potential drug shortages, although the agency said it was closely monitoring the supply. The Federal Emergency Management Agency described the shortage of supplies and equipment as “unprecedented,” and said it was working with manufacturers and hospitals to identify additional supplies, both in the United States and overseas. |
| “Everybody thought about this as a respiratory illness,” said Dr. David Charytan, the chief of nephrology at N.Y.U. Langone Medical Center. “I don’t think this has been on people’s radar screen.” | “Everybody thought about this as a respiratory illness,” said Dr. David Charytan, the chief of nephrology at N.Y.U. Langone Medical Center. “I don’t think this has been on people’s radar screen.” |
| The supplies allocated by manufacturers are insufficient, Dr. Charytan said, adding that the hospital switched to another type of machine when it couldn’t get additional equipment it had wanted. “It just doesn’t come anywhere close to meeting the need,” he said. | The supplies allocated by manufacturers are insufficient, Dr. Charytan said, adding that the hospital switched to another type of machine when it couldn’t get additional equipment it had wanted. “It just doesn’t come anywhere close to meeting the need,” he said. |
| Early reports out of China suggested a low incidence of kidney damage from Covid-19, although there were some indications that the virus might directly affect the kidneys. As more data emerged from there, and as the pandemic began to take hold in Italy, word began to filter out to the broader nephrology community that many of the most seriously ill patients, those on ventilators, would also require dialysis. | Early reports out of China suggested a low incidence of kidney damage from Covid-19, although there were some indications that the virus might directly affect the kidneys. As more data emerged from there, and as the pandemic began to take hold in Italy, word began to filter out to the broader nephrology community that many of the most seriously ill patients, those on ventilators, would also require dialysis. |
| It’s not yet known whether the organ injury results from the virus infecting kidney cells or is a secondary effect of critical illness or the increased tendency for blood clots to form in people with the disease. | It’s not yet known whether the organ injury results from the virus infecting kidney cells or is a secondary effect of critical illness or the increased tendency for blood clots to form in people with the disease. |
| The volume of patients needing dialysis is “orders of magnitude greater than the number of patients we would normally dialyze,” said Dr. Barbara Murphy, who is the chair of the department of medicine at Mount Sinai Health System. At her hospital alone, the number of patients requiring dialysis has risen threefold, she said. | The volume of patients needing dialysis is “orders of magnitude greater than the number of patients we would normally dialyze,” said Dr. Barbara Murphy, who is the chair of the department of medicine at Mount Sinai Health System. At her hospital alone, the number of patients requiring dialysis has risen threefold, she said. |
| The shortages in the United States highlight a lack of planning among state and federal officials to ensue that “hot spots like New York are given preferential access given the sheer volumes,” Dr. Murphy said. | The shortages in the United States highlight a lack of planning among state and federal officials to ensue that “hot spots like New York are given preferential access given the sheer volumes,” Dr. Murphy said. |
| Dr. Murphy said areas of the country that are planning for a possible surge in the demand for ventilators “also need to think about dialysis” and a national distribution system. | Dr. Murphy said areas of the country that are planning for a possible surge in the demand for ventilators “also need to think about dialysis” and a national distribution system. |
| Hospitals are now pleading with the major manufacturers to send more supplies. As the coronavirus reached the United States, Baxter and NxStage, owned by Fresenius, placed limits on what hospitals could order to prevent hoarding. | Hospitals are now pleading with the major manufacturers to send more supplies. As the coronavirus reached the United States, Baxter and NxStage, owned by Fresenius, placed limits on what hospitals could order to prevent hoarding. |
| Dr. Michael J. Ross, the chief of the nephrology division at Montefiore Health System in New York, said he spoke on the phone last Sunday with leaders of a company that produces dialysis supplies, “expressing how critical a situation this was for our patients.” | Dr. Michael J. Ross, the chief of the nephrology division at Montefiore Health System in New York, said he spoke on the phone last Sunday with leaders of a company that produces dialysis supplies, “expressing how critical a situation this was for our patients.” |
| The call was about getting more machines, filters, pre-mixed fluids and tubing for continuous dialysis, he said. | The call was about getting more machines, filters, pre-mixed fluids and tubing for continuous dialysis, he said. |
| The shortage of dialysis supplies in New York City hospitals was first reported by Politico. | The shortage of dialysis supplies in New York City hospitals was first reported by Politico. |
| The two main manufacturers of equipment and supplies for dialysis said orders were up fivefold, and that they were ramping up manufacturing as well as sending equipment and nursing staff to the New York region. Baxter, which is based in Illinois, said it also saw an increase in demand from China and Europe, and was flying in extra products from Europe this weekend. | The two main manufacturers of equipment and supplies for dialysis said orders were up fivefold, and that they were ramping up manufacturing as well as sending equipment and nursing staff to the New York region. Baxter, which is based in Illinois, said it also saw an increase in demand from China and Europe, and was flying in extra products from Europe this weekend. |
| “The demand spike was so fast and so high,” said Lauren Russ, a spokeswoman for Baxter. “We’re doing everything we possibly can.” | “The demand spike was so fast and so high,” said Lauren Russ, a spokeswoman for Baxter. “We’re doing everything we possibly can.” |
| On Friday, Fresenius announced it was creating a national supply of machines that can be moved from place to place. “We are committed to supporting hospitals with continuous supply, particularly in markets most heavily impacted, so that patients can get the care they need,” said Bill Valle, the chief executive of Fresenius Medical Care North America in Massachusetts, in a statement. | On Friday, Fresenius announced it was creating a national supply of machines that can be moved from place to place. “We are committed to supporting hospitals with continuous supply, particularly in markets most heavily impacted, so that patients can get the care they need,” said Bill Valle, the chief executive of Fresenius Medical Care North America in Massachusetts, in a statement. |
| Updated June 16, 2020 | |
| 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. |
| Gov. Andrew M. Cuomo of New York was asked at his briefing on Thursday about hospital reports indicating that dialysis machines were in short supply. Dr. Howard Zucker, the state’s health commissioner, said “there are not shortages across the board,” and Mr. Cuomo said that hospitals in need of equipment would get it. | Gov. Andrew M. Cuomo of New York was asked at his briefing on Thursday about hospital reports indicating that dialysis machines were in short supply. Dr. Howard Zucker, the state’s health commissioner, said “there are not shortages across the board,” and Mr. Cuomo said that hospitals in need of equipment would get it. |
| In a statement, José E. Almeida, Baxter’s chief executive, said that the company was trying to prioritize the delivery of products “where they are most needed — hospitals that are being overwhelmed by an influx of patients who are critically ill from Covid-19.” | In a statement, José E. Almeida, Baxter’s chief executive, said that the company was trying to prioritize the delivery of products “where they are most needed — hospitals that are being overwhelmed by an influx of patients who are critically ill from Covid-19.” |
| At Columbia University Irving Medical Center, Dr. Donald Landry, the chair of medicine, directly contacted Mr. Valle of Fresenius when other efforts failed and the situation grew desperate. While Dr. Landry said he was appreciative that the company responded by sending more machines, supplies and dialysis nurses, he described the experience as a warning to better prepare. “New York City gave us a glimpse of when a system comes up right to the edge,” he said. | At Columbia University Irving Medical Center, Dr. Donald Landry, the chair of medicine, directly contacted Mr. Valle of Fresenius when other efforts failed and the situation grew desperate. While Dr. Landry said he was appreciative that the company responded by sending more machines, supplies and dialysis nurses, he described the experience as a warning to better prepare. “New York City gave us a glimpse of when a system comes up right to the edge,” he said. |
| Dr. Joshua Rosenberg, an attending physician in the intensive care unit at The Brooklyn Hospital Center, said on Thursday that he was seeing acute kidney injury in a wide range of patients, beyond those who were predisposed to kidney disease because they had high blood pressure or diabetes. | Dr. Joshua Rosenberg, an attending physician in the intensive care unit at The Brooklyn Hospital Center, said on Thursday that he was seeing acute kidney injury in a wide range of patients, beyond those who were predisposed to kidney disease because they had high blood pressure or diabetes. |
| Miriam Figueroa, a dialysis nurse at the hospital, went from patient to patient on Thursday, providing three-hour dialysis treatments in a Covid-19 intensive care unit set up in a former chemotherapy infusion unit. | Miriam Figueroa, a dialysis nurse at the hospital, went from patient to patient on Thursday, providing three-hour dialysis treatments in a Covid-19 intensive care unit set up in a former chemotherapy infusion unit. |
| Some patients in the I.C.U. had developed acute kidney injury. They were receiving emergency dialysis through a vein in the neck, including one hospital staff member. | Some patients in the I.C.U. had developed acute kidney injury. They were receiving emergency dialysis through a vein in the neck, including one hospital staff member. |
| Ms. Figueroa said that as the need for dialysis for critically ill patients increased, the dialysis service had coped by moving machines and supplies from outpatient clinics to the inpatient wards. “We have to pull machines to do bedside” dialysis, she said, “so there are less patients that can be done as an outpatient.” | Ms. Figueroa said that as the need for dialysis for critically ill patients increased, the dialysis service had coped by moving machines and supplies from outpatient clinics to the inpatient wards. “We have to pull machines to do bedside” dialysis, she said, “so there are less patients that can be done as an outpatient.” |
| More than a dozen of the hospital’s roughly 240 patients in its outpatient dialysis clinic have died of Covid-19, according to Dr. Priyanka Singh, one of the attending nephrologists. People with chronic kidney disease may be particularly vulnerable. | More than a dozen of the hospital’s roughly 240 patients in its outpatient dialysis clinic have died of Covid-19, according to Dr. Priyanka Singh, one of the attending nephrologists. People with chronic kidney disease may be particularly vulnerable. |
| Doctors are also employing alternative types of dialysis. | Doctors are also employing alternative types of dialysis. |
| Some New York hospitals, including N.Y.U., Montefiore and Weill Cornell, that are in short supply of the more specialized dialysis machines — needed for what is known as continuous renal replacement therapy — have turned to peritoneal dialysis. It is typically used in patients with chronic kidney disease who want to treat themselves at home. The treatment is not always optimal in hospital patients, especially in those whose conditions are less stable, but “we are trying to give patients something,” Dr. Charytan said. | Some New York hospitals, including N.Y.U., Montefiore and Weill Cornell, that are in short supply of the more specialized dialysis machines — needed for what is known as continuous renal replacement therapy — have turned to peritoneal dialysis. It is typically used in patients with chronic kidney disease who want to treat themselves at home. The treatment is not always optimal in hospital patients, especially in those whose conditions are less stable, but “we are trying to give patients something,” Dr. Charytan said. |
| One problem with peritoneal dialysis in the context of Covid is that it requires putting a catheter in a patient’s abdomen. That makes it difficult to use in those with failing lungs who need proning, a technique in which patients are rolled onto their stomach to help them take in oxygen. Some hospitals, including Montefiore, are placing the catheter toward the patient’s side to help with the problem. | One problem with peritoneal dialysis in the context of Covid is that it requires putting a catheter in a patient’s abdomen. That makes it difficult to use in those with failing lungs who need proning, a technique in which patients are rolled onto their stomach to help them take in oxygen. Some hospitals, including Montefiore, are placing the catheter toward the patient’s side to help with the problem. |
| Some hospitals are also struggling to find enough nurses and technicians to provide dialysis, especially after some who were most skilled at providing the therapy fell sick with the virus themselves. “We did lose nurses to illness,” Dr. Murphy of Mount Sinai said. “We’re just getting some of those nurses back, but it’s been a challenge. We’ve exhausted every avenue that we have within the state with regards to being able to increase nursing.” | Some hospitals are also struggling to find enough nurses and technicians to provide dialysis, especially after some who were most skilled at providing the therapy fell sick with the virus themselves. “We did lose nurses to illness,” Dr. Murphy of Mount Sinai said. “We’re just getting some of those nurses back, but it’s been a challenge. We’ve exhausted every avenue that we have within the state with regards to being able to increase nursing.” |
| Doctors say they are wrestling with how to ensure that patients who require immediate care receive it while assessing whether others can wait. | Doctors say they are wrestling with how to ensure that patients who require immediate care receive it while assessing whether others can wait. |
| “Now we have to think harder about whether or not that patient truly needs it and can we manage them medically without dialysis another day so we can provide dialysis to someone who more urgently needs dialysis,” Dr. Ross of Montefiore said. “Those are not decisions we like to make.” | “Now we have to think harder about whether or not that patient truly needs it and can we manage them medically without dialysis another day so we can provide dialysis to someone who more urgently needs dialysis,” Dr. Ross of Montefiore said. “Those are not decisions we like to make.” |
| Joseph Goldstein contributed reporting. | Joseph Goldstein contributed reporting. |