High prevalence of asymptomatic COVID-19 in haemodialysis: learning day by day in the first month of the COVID-19 pandemic

Nefrologia (Engl Ed). 2020 May-Jun;40(3):279-286. doi: 10.1016/j.nefro.2020.04.005. Epub 2020 Apr 30.
[Article in English, Spanish]

Abstract

Dialysis patients are a risk group for SARS-CoV-2 infection and possibly further complications, but we have little information. The aim of this paper is to describe the experience of the first month of the SARS-CoV-2 pandemic in a hospital haemodialysis (HD) unit serving the district of Madrid with the second highest incidence of COVID-19 (almost 1,000 patients in 100,000h). In the form of a diary, we present the actions undertaken, the incidence of COVID-19 in patients and health staff, some clinical characteristics and the results of screening all the patients in the unit. We started with 90 patients on HD: 37 (41.1%) had COVID-19, of whom 17 (45.9%) were diagnosed through symptoms detected in triage or during the session, and 15 (40.5%) through subsequent screening of those who, until that time, had not undergone SARS-CoV-2 PCR testing. Fever was the most frequent symptom, 50% had lymphopenia and 18.4% <95% O2 saturation. Sixteen (43.2%) patients required hospital admission and 6 (16.2%) died. We found a cluster of infection per shift and also among those using public transport. In terms of staff, of the 44 people involved, 15 (34%) had compatible symptoms, 4 (9%) were confirmed as SARS-CoV-2 PCR cases by occupational health, 9 (20%) required some period of sick leave, temporary disability to work (ILT), and 5 were considered likely cases. CONCLUSIONS: We detected a high prevalence of COVID-19 with a high percentage detected by screening; hence the need for proactive diagnosis to stop the pandemic. Most cases are managed as outpatients, however severe symptoms are also appearing and mortality to date is 16.2%. In terms of staff, 20% have required sick leave in relation to COVID-19.

Keywords: COVID-19; Cribado; Hemodialysis; Hemodiálisis; Pandemia; Pandemic; SARS-CoV-2; Screening.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Asymptomatic Infections / epidemiology*
  • Betacoronavirus*
  • COVID-19
  • Clinical Protocols
  • Coronavirus Infections / diagnosis
  • Coronavirus Infections / drug therapy
  • Coronavirus Infections / epidemiology*
  • Female
  • Health Personnel / organization & administration
  • Health Personnel / statistics & numerical data*
  • Hemodialysis Units, Hospital / organization & administration
  • Hemodialysis Units, Hospital / statistics & numerical data*
  • Humans
  • Incidence
  • Lymphopenia / epidemiology
  • Male
  • Middle Aged
  • Pandemics*
  • Pneumonia, Viral / diagnosis
  • Pneumonia, Viral / drug therapy
  • Pneumonia, Viral / epidemiology*
  • Prevalence
  • SARS-CoV-2
  • Spain / epidemiology
  • Symptom Assessment
  • Time Factors
  • Triage / methods
  • Young Adult