Effective Preventive Strategies to Prevent Secondary Transmission of COVID-19 in Hemodialysis Unit: The First Month of Community Outbreak in Taiwan

Abstract

Background: Dialyzed patients are vulnerable to coronavirus infection disease 2019 (COVID-19). The incidence and outcome of COVID-19 in hemodialysis (HD) patients in Taiwan remain unclear. A series of preventive measures were executed to combat COVID-19 transmission among HD patients. Methods: We carried out a series of forward-looking and practical preventive strategies of COVID-19 control in our HD center. Incidences of COVID-19 of our HD unit were compared with those of national and local estimates from a community outbreak from 15 May to 30 June 2021. Prognostic factors associated with mortality were analyzed. Results: The national incidence of COVID-19 was 0.062%; being highest in Taipei City (0.173%), followed by New Taipei City (0.161%) and Keelung (0.083%). The overall incidence in Keelung HD patients was 0.666%. One patient of our HD center contracted COVID-19 from the household; however, we have contained secondary transmission in our HD center by implementing strict preventive measures. The mortality rate of HD patients in Keelung was 66.6%. The median Ct value of HD patients was 17.53 (11.75–27.90) upon diagnosis. The deceased patients had a higher cardiac/thoracic ratio than alive (0.61 vs. 0.55, p = 0.036). Conclusions: Taking aggressive and proactive infection preventive measures impedes the secondary transmission of COVID-19 in HD facilities. COVID-19-associated mortality was high in HD patients, being the high cardiac-thoracic ratio, an important prognostic factor for clinical outcome of infected HD patients.

Psychological Distress and Protective Behaviors During the COVID-19 Pandemic Among Different Populations: Hong Kong General Population, Taiwan Healthcare Workers, and Taiwan Outpatients

“…The differential impact of fear between Hong Kong and Taiwan suggests that the association between fear of COVID-19 and personal hygiene practices may need to be induced when the pandemic severity achieves a certain level. Such an observation echoes with a recent study capturing the temporal change in COVID-19 severity in Taiwan that the association between fear and protective behaviors was not significant during March and May 2020 but became significant during May and July 2021 when the largest COVID-19 outbreak in Taiwan was emerging ( 64 ).…”

Validation of an Automated Cardiothoracic Ratio Calculation for Hemodialysis Patients

“…A study with 2586 pairs of patients with normal and high CTRs matched by propensity scoring showed that a baseline CTR > 50% was associated with increased mortality and morbidity in patients with heart failure [ 7 ]. Among dialyzed patients infected with COVID-19 in Taiwan, deceased patients had a higher cardiothoracic ratio than surviving patients (0.61 vs. 0.55, p = 0.036) [ 29 ].…”

Risk of Thrombosis Following the First Dose of ChAdOx1 nCoV-19 Vaccine in Patients Undergoing Maintenance Hemodialysis: A Self-Controlled Case Series Study

“… 4 As of 1st July 2021, more than 80% of Taiwanese patients with ESRD had received their first dose of ChAdOx1 nCoV-19 (Oxford-AstraZeneca) vaccine, which was largely the only COVID-19 vaccine available to the nationwide vaccination program before 30th June 2021. 5 , 6 …”

“…4 As of 1st July 2021, more than 80% of Taiwanese patients with ESRD had received their first dose of ChAdOx1 nCoV-19 (Oxford-AstraZeneca) vaccine, which was largely the only COVID-19 vaccine available to the nationwide vaccination program before 30th June 2021. 5,6 The ChAdOx1 nCoV-19 vaccine is a non-replicating adenoviral vector vaccine. 7 Its use is correlated with an infrequent yet serious adverse reaction of vaccine-induced thrombosis with thrombocytopenia (VITT).…”