Effective Preventive Strategies to Prevent Secondary Transmission of COVID-19 in Hemodialysis Unit: The First Month of Community Outbreak in Taiwan.

Chun-Yu Chen,Yih-Ting Chen,Heng-Chih Pan,Jung-Jr Ye,Yun-Hsuan She,Kuo-Su Chen,Hao-Hsi Kao,Chia-Chun Ko,Chi-Chun Lai,Heng-Jung Hsu,Cheng-Kai Hsu,Chin-Chan Lee,Chiao-Yin Sun,Ting-Shuo Huang,I-Wen Wu,Chun-Ying Wu,Shang-Jyh Hwang

doi:10.3390/healthcare9091173

Abstract

Background: Dialyzed patients are vulnerable to coronavirus infection disease 2019 (COVID-19). The incidence and outcome of COVID-19 in hemodialysis (HD) patients in Taiwan remain unclear. A series of preventive measures were executed to combat COVID-19 transmission among HD patients. Methods: We carried out a series of forward-looking and practical preventive strategies of COVID-19 control in our HD center. Incidences of COVID-19 of our HD unit were compared with those of national and local estimates from a community outbreak from 15 May to 30 June 2021. Prognostic factors associated with mortality were analyzed. Results: The national incidence of COVID-19 was 0.062%; being highest in Taipei City (0.173%), followed by New Taipei City (0.161%) and Keelung (0.083%). The overall incidence in Keelung HD patients was 0.666%. One patient of our HD center contracted COVID-19 from the household; however, we have contained secondary transmission in our HD center by implementing strict preventive measures. The mortality rate of HD patients in Keelung was 66.6%. The median Ct value of HD patients was 17.53 (11.75–27.90) upon diagnosis. The deceased patients had a higher cardiac/thoracic ratio than alive (0.61 vs. 0.55, p = 0.036). Conclusions: Taking aggressive and proactive infection preventive measures impedes the secondary transmission of COVID-19 in HD facilities. COVID-19-associated mortality was high in HD patients, being the high cardiac-thoracic ratio, an important prognostic factor for clinical outcome of infected HD patients.

Highlights

The 2019 novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection related disease (COVID-19) is extremely contagious, sometimes lethal in high-risk patients, and was declared a global emergency affecting 2.53% of the 7.8 billion population worldwide [1]
All patients must comply with national public health preventive measures for the COVID-19 pandemic from the Taiwan Center for Disease Control (CDC) and several additional specific preventive strategies promulgated by our HD center
COVID-19-associated mortality is high in HD patients, being the high cardiac-thoracic ratio, an important prognostic factor for clinical outcomes of infected HD patients

Summary

Introduction

The 2019 novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection related disease (COVID-19) is extremely contagious, sometimes lethal in high-risk patients, and was declared a global emergency affecting 2.53% of the 7.8 billion population worldwide [1]. As of 30 June, Taiwan has reached 14,804 laboratory-confirmed SARS-CoV-2 infection cases with an increasing death toll to 648 fatalities, especially in two hardest-hit areas, Taipei City and New Taipei City [9]. This community outbreak has been rapidly controlled nationwide. One patient of our HD center contracted COVID-19 from the household; we have contained secondary transmission in our HD center by implementing strict preventive measures. COVID-19-associated mortality was high in HD patients, being the high cardiac-thoracic ratio, an important prognostic factor for clinical outcome of infected HD patients

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