Abstract
The COVID-19 pandemic has been particularly threatening to patients with end-stage kidney disease (ESKD) on intermittent hemodialysis and their care providers. Hemodialysis patients who receive life-sustaining medical therapy in healthcare settings, face unique challenges as they need to be at a dialysis unit three or more times a week, where they are confined to specific settings and tended to by dialysis nurses and staff with physical interaction and in close proximity. Despite the importance and critical situation of the dialysis units, modelling studies of the SARS-CoV-2 spread in these settings are very limited. In this paper, we have used a combination of discrete event and agent-based simulation models, to study the operations of a typical large dialysis unit and generate contact matrices to examine outbreak scenarios. We present the details of the contact matrix generation process and demonstrate how the simulation calculates a micro-scale contact matrix comprising the number and duration of contacts at a micro-scale time step. We have used the contacts matrix in an agent-based model to predict disease transmission under different scenarios. The results show that micro-simulation can be used to estimate contact matrices, which can be used effectively for disease modelling in dialysis and similar settings.
Highlights
The COVID-19 pandemic has had a massive impact on all facets of public health
The maintenance hemodialysis (MHD) population is highly susceptible to infection by SARS-CoV-2 and at the same time, there is a high risk of outbreaks of COVID-19 in MHD centres [5]
To obtain the parameters of the contacts generator model, we ran the dialysis unit simulation model in one-second time steps for a full week, using two scenarios: a) “base model”; and b) a model without a break schedule
Summary
The COVID-19 pandemic has had a massive impact on all facets of public health. As a disease, it is threatening to patients with end-stage kidney disease (ESKD) on intermittent hemodialysis and their care providers. Patients with ESKD who receive in-centre hemodialysis, face unique challenges. They are obligated to be at a dialysis unit three or more times a week, where they are confined to specific seating and tended to by dialysis nurses in close proximity. MHD unit daily operations incorporate several patient-to-patient and patient-to-caregiver operations that increase the risk of COVID-19 transmission. This is because of synchronous schedules of dialysis that have patients entering and exiting the department at the same time, as well as close contacts with healthcare workers that have a similar type of interaction with other patients. Because of the unique characteristics of MHD patients and MHD units, it is more difficult to prevent and control infectious diseases in these settings compared to imposing control measures for the general population and in other settings [10]
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