High prevalence of asymptomatic COVID-19 in hemodialysis: Daily learning during first month of COVID-19 pandemic

Albalate, Marta; Arribas, Patricia; Torres, Esther; Cintra, Melissa; Alcázar, Roberto; Puerta, Marta; Ortega, Mayra; Procaccini, Fabio; Martin, Juan; Jiménez, Eva; Fernandez, Isabel; de Sequera, Patricia; Perez-Villar, M. I.; Romero, R.; Rodriguez-Suarez, E.; Ramos, A.; Liébana, B.; Vinagre, G.; Ruiz, S.; Herrera, E.; Quesada, M. T.; Saenz, A. J.; Argote, P. Diaz de; Garcia-Martinez, P.; Bermejo, M. B.; Sánchez-Fernandez, N.; Martinez-Gonzalez, M.; Cerrajero, R.; Bernabé, M.; Rojas, V.; Martínez-Dios, I.; Conejo, D.; Rodriguez-Presa, P.; Varona, Y.; Muñoz-Blazquez, R.; Sanz-Martinez, D.; Montoro, J. J.; Aviles, A. I.

Abstract Dialysis patients are at risk for SARS-CoV-2 infection and possibly with more complications than other individuals; however, the information available is scarce. The objective of the present work is to describe the experience during the first month of the SARS-CoV-2 pandemic in a hemodialysis (HD) unit from a hospital in Madrid serving the 2nd district with the highest incidence of COVID-19 (almost 1,000 patients in 100,000 inhabitants). The information presented includes the actions carried out, the incidence of COVID-19 in HD patients and in health personnel, clinical characteristics and the result of a screening of all patients from the HD unit. At the beginning, we had 90 HD patients: 37 (41.1%) had COVID-19, of which 17 (45.9%) were diagnosed by symptoms detected in the triage or during the HD session, and 15 (40.5%) were diagnosed in a subsequent screening of patients in whom the diagnostic test by PCR-SARS-CoV-2 had not been done previously. The most frequent symptom was fever, 50% presented lymphopenia and in 18.4% the O2 saturation was <95%. Hospital admission was required in 16 patients (43.2%) and 6 died (16.2%). We found that contagion was clustered in turns of HD sessions and also in patients using collective transportation. Out of the 44 staff personnel, 15 (34%) presented compatible symptoms and 4 (9%) had SARS-CoV-2 diagnosed by PCR performed by the personnel health service, 9 (20%) required some transitory sick leave (TSL) and 5 were considered probable cases of Covid-19. Conclusions We detected a high prevalence of COVID-19 with a high percentage being diagnosed by screening and therefore it is necessary to be proactive in the diagnosis to stop the pandemic. Most patients positive for COVID-19 are being managed on an outpatient basis, although severe cases may occur and the mortality so far is 16.2%. Regarding the staff, 20% have required TSL in relation to COVID-19.