|Year : 2020 | Volume
| Issue : 2 | Page : 27-29
COVID-19 pandemic and care of chronic kidney diseases patients in India
Manas Ranjan Behera
Assistant Professor, Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
|Date of Submission||16-Aug-2020|
|Date of Acceptance||16-Aug-2020|
|Date of Web Publication||01-Sep-2020|
Dr. Manas Ranjan Behera
Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow - 226 014, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
In view of the coronavirus disease 19 (COVID-19) pandemic, most health-care resources focused on testing capability and increasing hospital beds and ventilators. Lockdown and reallocation of resources are two major interventions done by the government to tackle with the COVID outbreak. However, this is at the cost of patients living with noncommunicable diseases (NCDs) such as diabetes, hypertension, cancer, cardiovascular emergencies, and chronic kidney disease (CKD). Nevertheless, all health-care services related to NCD are impacted, but patients with CKD, especially those on dialysis, are affected mostly. People living with NCDs especially with CKD are at higher risk of severe COVID-19-related illness and death. It is vital that countries find innovative ways to ensure that essential services for CKD continue, even as they fight COVID-19.
Keywords: COVID-19 pandemic, lockdown, zoonotic disease
|How to cite this article:|
Behera MR. COVID-19 pandemic and care of chronic kidney diseases patients in India. J Renal Nutr Metab 2020;6:27-9
|How to cite this URL:|
Behera MR. COVID-19 pandemic and care of chronic kidney diseases patients in India. J Renal Nutr Metab [serial online] 2020 [cited 2020 Dec 3];6:27-9. Available from: http://www.jrnm.in/text.asp?2020/6/2/27/294185
| Introduction|| |
Coronavirus disease 2019 (COVID-19) is a zoonotic disease caused by the novel coronavirus 2 (nCoV2). Bat was suspected to be a natural host and was transmitted to humans through yet unknown intermediary animal (s). Human-to-human transmission occurs most often via droplets produced by coughing, sneezing, and talking and contaminated hand and surface. The median incubation period is approximately 4–5 days, and 97.5% of the patients develop symptoms within 11–12 days. Common symptoms include fever, cough, fatigue, shortness of breath, and loss of smell and taste. While most are asymptomatic or have mild symptoms, only few develop acute respiratory distress syndrome, multiorgan failure, and septic shock, possibly precipitated by a cytokine storm. The standard method of diagnosis is by real-time reverse transcription-polymerase chain reaction (RT-PCR) from a nasopharyngeal swab with a positivity rate of 71%. Till date, there is no effective antiviral therapy or vaccine for COVID-19, though many ongoing trials are in progress. Physical distancing, frequent hand washing, and using face mask are only means to prevent the transmission of virus.
Noncommunicable diseases (NCDs) account for 41 million deaths each year, equivalent to 71% of all deaths globally. More than 29% of these are “premature” deaths which fall between the ages of 30 and 69 years; more than 85% of these occur in low- and middle-income countries. According to a survey by the World Health Organization (WHO), health-care services for NCDs have been severely disrupted since the COVID-19 pandemic began., Nevertheless, the impact is global, but low- and middle-income countries are affected most. People living with NCDs are at higher risk of severe COVID-19-related illness and death. Hence, in this review, we aimed to discuss the unmet challenges of the COVID-19 pandemic and its impact on care of patients with chronic kidney disease (CKD).
| COVID-19 – A Global Challenge|| |
In December 2019, “severe acute respiratory syndrome-coronavirus-2” (SARS-CoV-2) disease outbreak occurred in Wuhan, Hubei Province, China., On December 31, 2019, the WHO was alerted as “pneumonia of unknown etiology.” On January 7, 2020, genetic sequencing from a throat swab revealed a novel coronavirus, originally abbreviated as 2019-nCoV by the WHO. On January 30, 2020, the WHO declared the SARS-CoV-2 outbreak as a public health emergency of international concern., On February 11, 2020, the name was changed to COVID-19 by the WHO. It rapidly spread over many parts of the world and on March 11, 2020, the WHO declared it as a pandemic. As of August 15, 2020, >21 million cases have been reported across 277 countries and territories, resulting in >755,000 deaths.
| COVID-19 Pandemic in India|| |
India currently has the largest number of confirmed cases in Asia, and has the third highest number of confirmed cases in the world after the USA and Brazil. On January 30, 2020, India reported its first case of COVID-19 in Kerala with a travel history to Wuhan, China. The total number of confirmed cases breached the 100,000 mark on May 19, 2020, and 1,000,000 on July 17, 2020. As on August 15, 2020, >25 lakhs of cases have been reported from India, with five states accounting for more than half of all reported cases – Maharashtra, Tamil Nadu, Andhra Pradesh, Karnataka, and Delhi., India's case fatality rate is among the lowest in the world at 1.94% as of August 15, with total number of deaths at 49,036.
| Impact of COVID-19 on Health-Care System|| |
There are neither proven vaccines nor effective antiviral therapy for COVID-19. Physical distancing, frequent hand washing, using face mask, contact tracing, and quarantine are means to prevent the transmission of virus. To prevent disease transmission, many countries including India have adopted the policy of lockdown, an action for mass quarantine. A nationwide complete lockdown was imposed in India for 3 weeks on March 24, 2020, which was subsequently extended until May 31, 2020, in a phased manner. Till date, selective lockdown continues in many places depending on the state policy. Although its direct impact on the prevention remains unclear, definitely it had delayed the peak and allowed time for preparation to fight with COVID-19. However, the lockdown restricted the movement of 1.3 billion people. Public and private transports were shut down. It has severely limited the ability of patients with chronic diseases to access medical care.
In most of the countries, majority of resources were diverted to testing capabilities and availability of hospital beds, ventilators, and personal protective equipment (PPE) at the cost of non-COVID health care. Health-care providers working in the area of NCDs were partially or fully reassigned to support COVID-19. Planned treatment or procedures were canceled to reinforce workforce to manage COVID-19. Apart from this, health-care providers need to undergo quarantine due to accidental exposure to COVID-19 patients. This reduces effective human resources compromising non-COVID health care.
The COVID-19 pandemic has put the health systems under immense pressure and stretched to beyond their capacity. Despite that, health-care providers have been shown more solidarity and gratitude. However, attacks on health-care providers and destruction of health-care facilities in incidents related to the COVID-19 pandemic have continuously been reported across the world. This created hostile environments for health-care providers and reduced the ability of health authorities to prepare for a full-blown epidemic. This will not only impact on the ability of the health systems to deliver services to those most in need, but also affect the psychosocial health of patients and health-care providers. To this was added social stigma associated with the care of COVID patients spread through social media. This created fear among the staff, leading to absenteeism.
Lockdown, diversion of health resources, and attack on health-care providers have led to reduction in access to NCD-related health care. This has impacted health services for diseases such as diabetes, hypertension, cardiovascular emergencies, chronic lung disease, and cancer.,, This situation is of significant concern because people living with NCDs are at higher risk of severe COVID-19-related illness and death.
| Impact of COVID-19 on Care of Patients With Chronic Kidney Disease and Renal Transplant Recipients|| |
Patients with CKD have multiple comorbidities such as diabetes and hypertension, which require regular follow-up. Again, uncontrolled diabetes and hypertension lead to faster progression of CKD. However, to prevent the transmission of virus, in many places, face-to-face outpatient services have been suspended, affecting the care of NCDs such as diabetes mellitus and hypertension., This can deteriorate patient's condition due to poor management and precipitate early need of dialysis. A survey by Prasad et al. revealed that lack of outpatient services also affected the follow-up of renal transplant recipients. Many patients were not able to get their medicine. Cancelation of routine surgery to reinforce workforce for COVID services leads to reduction in the number of kidney transplant surgeries. Similarly, the number of patients admitted to renal wards had decreased as most of the resources are diverted to COVID care. However, telemedicine services through different platforms such as phone calls, WhatsApp, E-mail, Skype, Zoom, and others could able to overcome some of these problems.
The impact of the COVID-19 pandemic on dialysis population was felt almost immediately. Collapse of public and private transports due to lockdown prevented patients from reaching dialysis centers. The lockdown also affected the availability of consumables for hemodialysis and peritoneal dialysis and essential medicines. Interruptions in supply chains and increased demand led to shortages of PPE, placing health-care workers, including dialysis staff, at undue risk., Many hospitals and dialysis centers were forced to close, and all staff quarantined for 2 weeks after a SARS-CoV-2-positive patient was detected. Reduction in capacity to deliver lifesaving in-center hemodialysis, led to a reduction in dialysis frequency and dropouts, directly attributable to the COVID-19 pandemic and lockdown. Although not captured fully, this is likely to have resulted in patient deaths.
The Indian Ministry of Health and Family Welfare, Government of India, and the Indian Council of Medical Research, New Delhi, issued guidance for testing SARS-CoV-2. Testing for COVID-19 was suggested only for patients with symptoms or history of travel from other countries or contact with SARS-CoV-2-infected individuals. The survey by Prasad et al. revealed that many centers were doing routine COVID-19 RT-PCR at a definite interval for screening of dialysis patients for early detection and hence to prevent shutdown of dialysis centers. This added financial burden to hemodialysis patients. Some centers have segregated SARS-CoV-2-positive or COVID-suspect patients. Many centers have adopted isolation rooms with dedicated machines for dialysis, whereas some had dedicated machines without isolation. Some centers had dedicated shifts for either positive or suspected patients.
| Conclusion|| |
COVID-19 significantly impacted health services for NCDs including care of CKD patients. Moreover, these people are at higher risk of severe COVID-19-related illness and death. It is vital that countries find innovative ways to ensure that essential services for CKD continue, even as they fight COVID-19.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest
| References|| |
Tay MZ, Poh CM, Rénia L, MacAry PA, Ng LF. The trinity of COVID-19: Immunity, inflammation and intervention. Nat Rev Immunol 2020;20:363-74.
Prasad N, Gopalakrishnan N, Sahay M, Gupta A, Agarwal SK, Nephrology O behalf of C-19 WG of IS of. Epidemiology, genomic structure, the molecular mechanism of injury, diagnosis and clinical manifestations of coronavirus infection: An overview. Indian J Nephrol 2020;30:143. [Full text]
Zhai P, Ding Y, Wu X, Long J, Zhong Y, Li Y. The epidemiology, diagnosis and treatment of COVID-19. Int J Antimicrob Agents 2020;55:105955.
Chudasama YV, Gillies CL, Zaccardi F, Coles B, Davies MJ, Seidu S, et al
. Impact of COVID-19 on routine care for chronic diseases: A global survey of views from healthcare professionals. Diabetes Metab Syndr 2020;14:965-7.
Lu R, Zhao X, Li J, Niu P, Yang B, Wu H, et al.
Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. Lancet 2020;395:565-74.
Lu H, Stratton CW, Tang YW. Outbreak of pneumonia of unknown etiology in Wuhan, China: The mystery and the miracle. J Med Virol 2020;92:401-2.
Harapan H, Itoh N, Yufika A, Winardi W, Keam S, Te H, et al
. Coronavirus disease 2019 (COVID-19): A literature review. J Infect Public Health 2020;13:667-73.
Hui DS, I Azhar E, Madani TA, Ntoumi F, Kock R, Dar O, et al
. The continuing 2019-nCoV epidemic threat of novel coronaviruses to global health — The latest 2019 novel coronavirus outbreak in Wuhan, China. Int J Infect Dis 2020;91:264-6.
Velavan TP, Meyer CG. The COVID-19 epidemic. Trop Med Int Health 2020;25:278-80.
Chandra V, Kumar BH. Novel coronavirus disease 2019: Pandemic 2020. J Renal Nutr Metab 2020;6:4. [Full text]
Rothan HA, Byrareddy SN. The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak. J Autoimmun 2020;109:102433.
WHO Coronavirus Disease (COVID-19) Dashboard WHO Coronavirus Disease (COVID-19) Dashboard. Available from: https://covid19.who.int/
. [Last accessed on 2020 Aug 15].
Richards M, Anderson M, Carter P, Ebert BL, Mossialos E. The impact of the COVID-19 pandemic on cancer care. Nat Cancer 2020;1:565-7.
Prasad N, Bhatt M, Agarwal SK, Kohli HS, Gopalakrishnan N, Fernando E, et al
. The adverse effect of COVID pandemic on the care of patients with kidney diseases in India. Kidney Int Rep 2020. https://doi.org/10.1016/j.ekir
Saxena A. COVID-19-A global health pandemic-safeguarding health-care workers. J Renal Nutr Metab 2020;6:1.
Abraham G. Facing challenges in medical practice during COVID-19 pandemic. J Renal Nutr Metab 2020;6:7. [Full text]