The Potential Role of Super Spread Events in SARS-COV-2 Pandemic; a Narrative Review
Για να δείτε το έγγραφο με θέμα : “The Potential Role of Super Spread Events in SARS-COV-2 Pandemic; a Narrative Review” πατήστε εδώ .
Για να δείτε το έγγραφο με θέμα : “The Potential Role of Super Spread Events in SARS-COV-2 Pandemic; a Narrative Review” πατήστε εδώ .
Για να δείτε το έγγραφο του Υπουργείου Υγείας με θέμα : “Οδηγία για τη Διαχείριση Επιβεβαιωμένων Κρουσμάτων και Μεταφοράς αυτών σε Χώρους Φιλοξενίας” πατήστε εδώ .
How can we reduce transmission of COVID-19 in haemodialysis centres?
Οι υπεύθυνοι της Μονάδας Τεχνητού Νεφρού (ΜΤΝ) θα πρέπει να παρακολουθούν την κατάσταση της υγείας όλων των εμπλεκόμενων
Οι κορωνοϊοί προκαλούν εκτεταμένες επιδημίες SARS μέσω των περιπτώσεων υπερεξάπλωσης και υπέρ-μετάδοσης (Super Spread Events-SSE)
The rapid spread of the Coronavirus Disease 2019 (COVID-19) epidemic poses unprecedented challenges throughout the world. Fortunately, there is also new epidemiologic data emerging from China and Korea indicating that it is possible to bring this epidemic under control with draconic measures.
To serve the renal community at such a critical time, the ERA-EDTA Council has created a special web page pertaining to this global pandemic. This page includes links to general information on COVID-19 disease, specific information for nephrologists, other professionals and patients with kidney diseases, as well as relevant scientific articles. The website is updated regularly by a dedicated editorial team of nephrologists led by Ron Gansevoort (Groningen, The Netherlands) and Maria Jose Soler (Barcelona, Spain), with help of Coretta van Leer (Virologist, Groningen, The Netherlands) and Nuria Fernandez Hidalgo (Virologist, Barcelona, Spain).
We are at your disposal regarding questions or comments you have related to COVID-19. We also welcome information regarding the situation within your country. This may include, for example, numbers of affected dialysis and transplant patients, episodes of AKI attributable to COVID-19, management and treatment strategies. The wealth of knowledge that can be gained from the experience of others should never be underestimated. We very much hope that you will support this initiative and make it a success.
With best wishes
Carmine Zoccali ERA-EDTA President
Christoph Wanner, ERA-EDTA President elect
This text has been prepared by the ERA-EDTA Immunosuppression Working Group (IWG)
To health care authorities
Kidney patients using immunosuppression should be regarded as a high-risk group. Many of them are elderly and many have impaired kidney function and other co-morbidities known that enhance risk of adverse outcome of the COVID-19 infection. They use drugs that suppress the natural immune system and many of them have impaired kidney that in itself decreases immune functions. Taken together it is likely that this group will have a higher risk to have a more severe disease course when infected with the new Coronavirus. Authorities on all levels need to facilitate for these patients to be home on sick leave as a preventive measure to reduce individual risks and on a population level the burden of hospitalizations. Patients with co-morbidities such as CKD requiring immunosuppression will most probably consume more health-care resources when infected.
To clinicians
Background: Cases with the Corona virus SARS CoV 2 infection that cause COVID-19 have been detected in all European countries. In many areas there is transmission in the community. Personal communications from China suggest that CKD-patients treated with immunosuppression (IS) have the same risk of infection as the background population. Most COVID-19 infections are mild and self-limited, however, a published report from the US suggest that patients on IS (mainly transplant recipients) have an increased risk of severe disease. However, one publication on liver transplant recipients, emanating from a pediatric hospital in Italy, did not report of an adverse outcome in their cohort. Preliminary data from the “Brescia Renal COVID Task Force” on 20 renal transplant patients admitted with pneumonitis are circulating: despite a short median follow-up (7 days) 5/20 patients died; of note immunosuppression of this cohort has been managed with withdrawn of MMF/AZA, CNIs and mTOR inhibitor to be replaced by methylprednisolone 16 mg according to a protocol recently presented to the European renal community (https://www.era-edta.org/en/wp-content/uploads/2020/03/COVID_guidelines_finale_eng-GB.pdf).
Very little is known about the effect of IS in glomerulonephritis (GN) / vasculitis (AAV) patients with COVID-19 infection. In Brescia, up to the 22 of March, no patients on immunosuppressive treatment due to primary or secondary glomerulonephritis have been admitted or known to have symptoms imputable to SARS-Cov-2 infection; these patients were advised to respect social distancing rules since early stages of the coronavirus crisis.
Regarding patients in areas with few cases and no known community transmission of the virus
Regarding patients in areas with many cases and/or community transmission of the virus, but without known exposure to the virus
Regarding CKD patients on IS exposed to SARS CoV 2 (no symptoms, infection not confirmed)
Regarding CKD patients on IS with proven COVID 19 infection but no or only mild symptoms
Regarding CKD patients on IS with COVID-19 and overt symptoms.
This text has been prepared by the ERA-EDTA Working Group EUDIAL for patients on dialysis
The information in this section of the ERA-EDTA Covid-19 webpage is for a large part derived from the website of the Center of Disease Control (CDC). The site’s specific webpage for nephrologists and other professionals working with people on dialysis is very helpful, and contains much practical information. We urge you therefore to consult this webpage:
https://www.cdc.gov/coronavirus/2019-ncov/healthcare-facilities/dialysis.html
Please note that information may change over time. Please check this CDC webpage therefore regularly
General considerations
Duration of isolation precautions for patients under investigation for or with confirmed COVID-19
Operations
Patients who need vascular access surgery should be screened for COVID-19. Operations on patients with confirmed or suspected COVID-19 infection should be carried out in a designated room with necessary protection for medical staff.
Home haemodialysis and peritoneal dialysis
These patients should be assisted at home as far as is possible, using telereporting assistance or other electronic systems for clinical management and to supplement home visits by healthcare staff, as deemed necessary.
Considerations
It can be considered to decrease the frequency of hemodialysis sessions from three to two times per week in patients that tolerate such a regimen. This could be considered
ERA-EDTA sharing Milano experience on coronavirus management in dialysis centers
While considering that patients on dialysis treatment are undoubtedly more exposed to contracting infectious diseases and to have more severe manifestations than the non-dialysis population, nephrologists from the Milano dialysis unit argue that there is NO reason to adopt specific prophylactic measures for the entire dialysis population. In their opinion common sense and individual protection rules as for other high risk subjects should prevail.
Author: Professor Mario Cozzolino, MD, PhD, Renal Unit, San Paolo Hospital and San Carlo Hospital, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy
Read the complete text here: Milano experience on coronavirus management in dialysis centers by Prof. Mario Cozzolino, Milan, Italy
2020-04-06: ERA-EDTA WG Descartes expert opinion regarding the management of immunosuppressive medication for
kidney transplant patients during the COVID-19 pandemic.
https://www.era-edta.org/en/wp-content/uploads/2020/04/Expert-opinion-on-ISD-in-Covid-19.pdf
This text has been prepared by the ERA-EDTA Working Group Descartes for patients living with a kidney transplant
There are several guidelines that are adapted frequently and may differ according to epidemiological characteristics of the specific country as well as availability of resources. Health care professionals are therefore advised to follow local / regional / national guidelines. In addition, the most recent information can be found on the websites of WHO and the Center for Disease Control and Prevention (see below, but see especially the section ‘Relevant websites’).
It can be considered to cancel living and/or deceased donor kidney transplantations. Although there are no general guidelines, the following arguments may help in making such difficult decisions:
Weblinks of interest:
https://www.cdc.gov/coronavirus/2019-ncov/specific-groups/high-risk-complications.html
The American Society of Transplantation (AST) Infectious Disease Community of Practice (IDCOP) developed a frequently asked questions sheet to relay information on the current state of COVID-19 knowledge after receiving queries from transplant colleagues across the world. Please review this FAQ document for information: https://www.myast.org/sites/default/files/COVID19%20FAQ%20Tx%20Centers%202020.03
1. τη φυσιολογία των νεφρών
2. την επιδημιολογία, παθοφυσιολογία, παθογένεια, και αντιμετώπιση των πρωτοπαθών νεφρικών νοσημάτων
3. τη συμμετοχή των νεφρών στα συστηματικά, μεταβολικά ή άλλα νοσήματα
4. τη συμμετοχή των νεφρών στην ηλεκτρολυτική και οξεοβασική ισορροπία
5. την αρτηριακή υπέρταση
6. την αντιμετώπιση της οξείας μεταβολής της νεφρικής λειτουργίας νοσηλευμένων σε ειδικές μονάδες (ΜΕΘ, κ.λ.π.)
7. την αντιμετώπιση του τελικού σταδίου της νεφρικής ανεπάρκειας και
8. τη νεφρική μεταμόσχευση
Όσον αφορά τα μέσα με τα οποία θα επιτευχθούν οι παραπάνω σκοποί είναι ειδικότερα:
α. Η διοργάνωση σεμιναρίων, διαλέξεων, δημόσιων συζητήσεων, μετεκπαιδευτικών μαθημάτων και άλλων εκδηλώσεων επιστημονικής επικοινωνίας, αυτοδύναμα ή με άλλες Ελληνικές ή ξένες Επιστημονικές Εταιρίες ή Οργανώσεις, Στόχος των εκδηλώσεων θα είναι η συνεχής βελτίωση του επιστημονικού επιπέδου των μελών του και η ενημέρωση του κοινωνικού συνόλου.
β. Η ίδρυση, ανά την Επικράτεια, συνδεδεμένων με το Σωματείο παραρτημάτων, τοπικού ή θεσμικού χαρακτήρα, στο πλαίσιο των σκοπών του.
γ. Η ίδρυση αμιγώς επιστημονικών ή κοινωφελούς χαρακτήρα Κέντρων Έρευνας Ινστιτούτων, Εκπαιδευτικών ή Μετεκπαιδευτικών Ιδρυμάτων ή παραρτημάτων ανά την Επικράτεια.
δ. Η έκδοση βιβλίων ή περιοδικών με χρήση και των σύγχρονων ηλεκτρονικών ή ψηφιακών μέσων.
ε. Η επιχορήγηση υποτροφιών για μετεκπαίδευση και εξειδίκευση επί των εξελίξεων σχετικά με τα ανωτέρω νοσήματα (αρθρο 2, παρ. Αα)
στ. Η διοργάνωση επιστημονικών συναντήσεων, ο σχεδιασμός και η εκπόνηση ερευνητικών πρωτοκόλλων και πολυκεντρικών μελετών με τη συνεργασία Ελληνικών και Διεθνών Ερευνητικών Κέντρων , σε προγράμματα Εθνικά, της Ευρωπαϊκής Ένωσης ή Διεθνή.
ζ. Η συνεργασία σε θέματα κοινού ενδιαφέροντος με Επιστημονικά Κέντρα Πανεπιστημιακών, Κρατικών και Ιδιωτικών Νοσοκομείων της χώρας μας, με Ελληνικές ή ξένες Επιστημονικές Εταιρίες καθώς και κρατικού ή ιδιωτικούς φορείς και οργανισμούς της ημεδαπής ή αλλοδαπής για επίτευξη κοινών στόχων.
η. Η οργάνωση συνεδρίων και ιδιαίτερα διεθνών, στην Ελλάδα ή στο εξωτερικό, με αντικείμενα σχετικά με τους σκοπούς του Σωματείου, όπως έχουν αναφερθεί παραπάνω.
Μια ανοιχτή Ιατρική Ομάδα που έχει στόχο την εκπαίδευση και την ενημέρωση Ιατρών αλλα και κοινού, δεν θα ήταν δυνατόν να μην δέχεται Νέες Ιδέες, Προτάσεις, Αιτήματα αλλα και άρθρα καθώς και επιστημονικές εργασίες.