Management of Hemodialysis Patients with Suspected or Confirmed COVID-19 Infection: Perspective of Two Nephrologists in Brazil.

Abstract

Brazil is the largest Latin American country with a population of 211.75 million inhabitants as of March 2020. Sao Paulo, the capital city of Sao Paulo State, is the most economically developed and populous city (12.25 million inhabitants), and it is located in the southeastern region of the country (1). There is a unified public health system all over Brazil that has been implemented since 1993, and it provides care to about 80% of the population in a relatively well organized, although insufficient, network of basic primary health care units and public hospitals for higher-complexity cases. On the other hand, 20%–25% of the population has private health insurance and may receive care provided in other accredited hospitals. The first case of the novel coronavirus disease (coronavirus disease 2019 [COVID-19]) pandemic in Brazil was reported on February 24 in Sao Paulo. Since then, the outbreak has spread to all states in the country, and the number of cases has been increasing on a geometric scale. To date (April 23), 49,492 confirmed cases and 3313 deaths have been reported (2). Although the national and state public health authorities provided guidelines and step-by-step orientations and measures to prevent the infection from spreading in the community early in the course of the epidemic, the number of cases has still soared steeply. The outbreak initially affected people from higher social classes and afterward, those living in more vulnerable and poorer metropolitan areas, thus leading to an overburden of the public health system. Patients with mild flu-like symptoms were advised to stay at home. Physicians in the Sao Paulo Hospital, a public hospital of the Federal University of Sao Paulo, were scheduled to work shifts in a recently created ambulatory service separated from the emergency care area of the hospital to assist patients with more …