POS-580 BURDEN OF COVID-19 IN A HEMODIALYSIS CENTER IN SUB-SAHARAN AFRICA

Abstract

The current COVID-19 pandemic remains a great challenge to healthcare workers, especially caregivers of patients with chronic diseases. Despite the advances in knowledge on Covid-19, data on COVID-19 in haemodialysis (HD) remains rare in Africa where the burden of disease seems to be lower compared to others. Many hypotheses have been emitted to explain this observation; however, there is a high variability of clinical manifestations, with asymptomatic and mild cases being most frequent in the general population. We conducted a review of records from 2020 May 13th (date of first case) to 2021 June 30th in a haemodialysis (HD) unit of a resource limited country in Africa. All staff and patients in the HD unit were included. Clinical, laboratory, and radiological characteristics and outcomes data were obtained using data collection forms from medical records. The study protocol was approved by the Ethics Committee of the Yaoundé General Hospital. A case of COVID-19 was defined as a person who was tested positive for the SARS-CoV-2 pathogen in accordance with testing standards, irrespective of clinical signs and symptoms. A suspected case referred to a person who develops a fever ≥ 37.5°C or respiratory symptoms such as coughing or difficulty breathing with pulmonary lesions suggestive of SARS-CoV-2 on chest computed tomography (CT) scan. Patients with respiratory distress, high grade fever or altered general state were hospitalized in public isolation centers; asymptomatic patients and those with mild symptoms were quarantined at home with re-evaluation before each dialysis session. During the study, depending on their availability, real-time reverse transcriptase–polymerase chain reaction (rtPCR) or antigenic testing (STANDARD™ Q COVID-19 Ag Test) was used to test for presence of SARS-CoV-2 in nasopharyngeal swab samples. Blood tests done included complete blood count, CRP, D-Dimers and Lactate Dehydrogenase (LDH). Chest X-ray or CT scan was done at time of the diagnostic. Laboratory parameters were done at diagnosis and when possible14 days later. All statistical analyses were performed using SPSS 21.0 software (Chicago, IL). A total of 27/198 haemodialysis patients and 3/27 staff members were infected within a period of 52 weeks, giving an overall prevalence of 13.3%. The median age of the infected population was 56 years (37.25-62) and the median dialysis vintage was 42 months (24-96). Hypertension (73.3%) and diabetes (36.6%) were frequent comorbidities. About 10% (n=3) were asymptomatic whereas those who were symptomatic had a mean duration of symptoms of 7±5.6 days. Fatigue (23/30), fever (21/30), cough (14/30) and diarrhoea (11/30) were the main symptoms. Oxygen saturation was low in 36.6 % (n=11) ranging from 82-89%. About 50% were admitted in hospital; there was no admission in intensive care unit. Laboratory test was done in 60% (n=18) of cases. Lymphopenia was seen in 72.2% (n=13) with median lymphocyte count of 896/mm³ ([800-1513]) and anemia in 77.7% (median 8.5 g/dl [7.5-9.8]). Three patients (10%) died: 2 from respiratory distress and 1 for severe anemia. HD patients are highly susceptible and HD center are high risk areas for COVID-19 infection.