Pandemic 2020


Without a doubt it's the nuttiest thing I've ever seen: This gawdawful COVID-19 coronavirus has been in the news for weeks, and the headlines keep getting worse.

It reminds me of stories I heard from my grandmother about the 1918 flu epidemic. Schools are closing, big-time basketball, hockey, and baseball have been idled, and our local film festival has been cancelled.

You think this is scary if you're healthy, just imagine how scary it must be if you're not healthy. See, one of the major side effects of kidney failure is a seriously compromised immune system, so Stephanie would have been very much at risk in this epidemic.

If Steph was here I would not be going to work every morningcan't be in the office all day and then bringing this deadly virus home to my wife. Nope, I'd have been on leave of absence since perhaps the end of February, two weeks ago. Earlier, if Steph had been more worried than me, but two weeks ago was when the nature and looming threat of COVID-19 became clear to me. So if Steph was still alive, we'd both be sheltering in place here at home, with me occasionally venturing out for groceries in the middle of the night, when the stores are emptiest.

But the vulnerability in that plan would be Stephanie's dialysis. When she was receiving in-clinic dialysis, it was three times weekly, four hours each time in a crowded room filled with other people receiving dialysis. Required. The chairs are close together, sometimes separated by a flimsy curtain, but more commonly not separated at all. With a contagion like this COVAD-19, going in for hemodialysis would mean spending four hours in a breeding ground for the disease.

Other times Stephanie received a different kind of dialysis at home, where she'd set up the machinery and tubes herself. No other patients, no staff, so she'd be much safer from this or other viruses — but she'd still be in danger because sheltering at home isn't really feasible on dialysis. Even with at-home peritoneal dialysis, Steph was still required to go to the clinic at least twice monthly, first for the blood tests and safety lecture, and then a few weeks later to be told the results of the blood test and hear another safety lecture. And some months, she was required to go into the clinic a third or even fourth time, if the staff didn't like the results of that month's blood test.

Every visit to the clinic meant at least ten minutes, more likely half an hour or longer in the waiting room, which was always crowded with people who have compromised immune systems — because everyone with kidney disease has a compromised immune system. Then we'd go in to see a nurse and then a doctor, and a dietician, and a social worker, all of whom work all day with people who have compromised immune systems.

The public safety instructions for dealing with this disease are to wash your hands a lot, stay home if you're feeling sick, and avoid crowds, but those last two ideas are moot, if dialysis is what's keeping you alive. People who aren't on dialysis can be smart and choose not to go to a crowded place during an epidemic. People on dialysis have no choice. So in addition to everyone else's wild but well-founded worries about this new coronavirus, Stephanie would have had extra worries. She would definitely be what they're calling the "high-risk population."

I've been clicking around the internet, to see how this is being addressed at kidney clinics, and near as I can tell there's no solution. Here are two comments (edited for spelling and grammar) from the Dialysis room on Reddit, an open-microphone website:

First comment: This is my nightmare, since I am on in-center hemo. The other patients have people come with them and most spend the four hours in the waiting room. The other day I was watching 15-plus people sitting there waiting during shift change, and thinking that if one person beings it in, everyone will get it.

Second comment: I asked my clinic what the plan is and they told me they won't let anyone in with a temperature over 100.4°. I asked how those people are supposed to get dialysis and their answer was basically ¯\_()_/¯. Pray if you get sick it's early in the curve, and there's still hospital beds and dialysis machines, I guess. 

That's terrifying. Tell me I'm nuts and I won't disagree, but even though Stephanie is long-gone, I'm worried about how we could have kept her safe through this coronavirus crisis.

For myself, though — meh. I will take what comes. The only value of worry is if it leads to a better strategy, so I've read about this virus, and decided my strategy: I'm washing my hands a lot more often, taking multivitamins, and avoiding crowds. After that, there's no point to worrying, so I'm only worrying about loved ones.

And whether you're worried about COVID-19 or pretending it's nothing, remember what I can't forget, that folks with kidney failure and/or on dialysis — or folks in otherwise weakened health — have even more reason to be frightened.