Thread by @kidney_boy

1. Last Wed March 11, the @ASNKidney did a webinar on COVID-19. I highly recommend it.

Link to recording: asn-online.org/ntds/resources…

I am going to do a #Tweetorial covering the high points.

2. Alan Kliger (@AlanKliger) started off discussing the transmissibility of COVID19. Note: Alan will be on Twitter Tuesday night to discuss COVID19 at #NephJC at 9EDT.

Nice pic demoing the R0 of COVID19. Hey, at least it's not small pox!

3. Then he showed the relative lethality of COVID19. Hey at least it's not MERS.

4. Suzanne Watnick (@KidneySW) Chief Medical Officer of Northwest Kidney Centers (@nwkidney) and Liz McNamara (@lizmcnamaraa[not sure that is actually her]) discussed their experience dealing with some of the earliest COVID19 infections in dialysis patients.

5. They provided a very practical minded flow sheet to deal with patients who arrive at dialysis with symptoms. Mainly, if they have symptoms mask them and then isolate them in a room if possible at the end of a row if not.

6. What to do with your staff? Another clever flow chart. If exposed and symptoms go home. Exposed and no symptoms, continue to work but monitor for sxs. And inform your supervisors regardless.

7. Watnick then discussed the importance of transparency. They are sending regular e-mails to patients and staff. They are holding regular conference calls to allow people hear them and ask questions.

8. Wartnick and McNamara wrap up.

Three guiding principles:
1. We can (and should) provide dialysis to COVID19 infected patients
2. Follow the science. Things are changing, stay up to date
3. Leadership is critical. Assurance, transparency, communication, support patients/staff

9. Next up Shannon Novosad MD MPH from CDC. She is unpacking the CDC guidelines for hemodialysis facilities. Document at cdc.gov/coronavirus/20…

10. How it spreads
• Person to person
• Contact with infected surfaces or objects

11. Signs and symptoms take 2014 days from exposure. Common: Fever, cough, shortness of the breath, sore throat.

12. Then on tho the hemodialysis center recommendations. They supplement the CDC healthcare setting recs.

cdc.gov/coronavirus/20…

13. Educate patients.
Educate Staff.
Update guidelines and procedures
• Non-punitive sick leave
• Tell staff not to come to work sick
• If become sick at work, facemark and return home
• Start active screening by taking temps on arrival
• Make PPE available

14. Make your waiting area safe from transmission. Symptomatic patients should call before entering.

15. How to dialyze symptomatic patients
Consider making a dedicated COVID19 shift (good luck trying to staff that shift).
Only use the Hep B room if you don't have a Hep B patient.

16. She closed talking about PPE shortages. God help us if this becomes a serious problem.