Challenges for the Nephrologists and CKD patients during the COVID-19 era

Covid 19 virus which is now a pandemic with no proven cure or vaccine has turned the world into a turmoil never seen by any of us in our life time.

The Virus is highly contagious is a fact and doctors, research scientists, epidemiologists, politicians, journalists and even Astrologers give their own opinion and suggestions and these keep changing from time to time so the common man is confused and lives in fear. Fear of the disease is worse than the disease.

As a Nephrologist and Transplant Physician the problems I faced in this era are many but fortunately, our hospital and our professional societies have given various guidelines to guide us.

Dr Zocalli President of ERA EDTA Dr Agarwal President ASN, Dr Agarwal President ISN and our own Indian Society of Nephrology Secretary Dr Prasad and Dr Kute Secretary of ISOT have given clear guidelines to help us.

The core suggestions in all the guidelines are:

Prevention is the key and this can only be achieved by Social Distancing, Hand Washing, Cough Etiquette, wearing masks and avoiding visiting hospitals and crowded places.

What we have done over the last 2 months of the lockdown is there are strict restrictions of movement into the hospital with thermal scanning and hand sanitizing.

All areas and vulnerable spots are sanitized and all front-line staff be it doctors or paramedical personnel use PPEs

The hospital doctors and staff over the last 2 months worked in shifts and TELE Consultations is the norm.

Elective surgeries including Transplants were deferred and only now we have Restarted our Transplant program with all precautions. This has been feasible as our hospital is in the Green zone.

The Transplant patients are immunosuppressed and hence need lot of precautions and we have educated them on this and we follow strict protocols as per the guidelines.

As the mortality rate is very high if Transplant recipients get COVID 19 infection they need proper management by the Transplant team which included Infectious Disease specialist, Critical Care and Pulmonary physicians. The Immunosuppressive drug dosage needs to be adjusted and sometimes stopped under strict supervision by the Transplant Team.

Nearly 30 % of the patients with COVID 19 infection who get into the ICU develop kidney damage and may need some form of Renal Replacement Therapy. Our Hospital has a separate wing for COVID 19 infected patients with dialysis facilities.

Regular Maintenance Dialysis patients suffer a lot as transport restrictions during the lockdown made it difficult for them to reach the dialysis units. Many of the patients switched to twice a week dialysis instead of thrice and the patients who could afford home haemodialysis opted for that.Some of the patients opted for CAPD (Continuous Ambulatory Peritoneal Dialysis) so that they could get dialysis at home. The use of apps, android phones and Tabs helped in monitoring our patients and give adequate care.

The COVID 19 era has taught us humility, patience and also helped us to innovate new means for helping our patients. The story of Corona virus (COVID19) is that it is not the END; it is not even Beginning of the END but probably is the END of the Beginning,(Quote of Sir Winston Churchill during World War II) so it is better we learn to live with the Virus till such time a cure and a vaccine becomes available.