Dialysis Travel During the COVID-19 Pandemic

One of the perks of home dialysis is the ability to travel more easily than with in-center dialysis. Supplies can be delivered to one or more locations for a traveling patient, and patients can take a PD cycler or NxStage machine with them. Sending patients on a trip used to take time, but was not anxiety provoking. However, today there are many new things to think about when a patient wants or needs to travel, now that COVID-19 is in all 50 states and some places they may want to travel are known “hot spots.”

Who is at higher risk for COVID-19?

It’s important for dialysis patients to know and accept that they are at higher risk for serious complications if they get COVID-19, because they have kidney failure. This is true for any ESRD patient, not just those who are 65 or older. The CDC provides a list of conditions that is based on evidence available at the time. Check www.cdc.gov for updates to the list.

According to the CDC, “People of any age with the following conditions are at increased risk of severe illness from COVID-19:”

• Cancer

• Chronic kidney disease

• COPD (chronic obstructive pulmonary disease)

• Immunocompromised state (weakened immune system) from solid organ transplant

• Obesity (body mass index [BMI] of 30 or higher)

• Serious heart conditions, such as heart failure, coronary artery disease, or cardiomyopathies

• Sickle cell disease

• Type 2 diabetes mellitus

Based on what we know at this time, people with the following conditions might be at an increased risk for severe illness from COVID-19:

• Lung diseases: Asthma (moderate-to-severe), Pulmonary fibrosis (having damaged or scarred lung tissues), Smoking, Cystic fibrosis

• Heart diseases: Cerebrovascular disease (affects blood vessels and blood supply to the brain), Hypertension (high blood pressure)

• Weakened immune system: Immunocompromised state from blood or bone marrow transplant, immune deficiencies, HIV, use of corticosteroids, or use of other immune weakening medicines

• Neurologic conditions, such as dementia

• Liver disease

• Pregnancy

• Thalassemia (a type of blood disorder)

• Type 1 diabetes mellitus”¹

The CDC has published the supporting evidence for this list if you or your patients want to know more.

Reduce the risk of catching or spreading COVID-19

The CDC advises all of us to:

• Stay home if we are sick.

• Cover a cough or sneeze with a tissue we throw in the trash.

• Wash our hands with soap and water for at least 20 seconds or rub hands all over with gel that has at least 60% alcohol until dry:

  • Before we prepare and eat food or touch our faces

  • After we use a restroom, leave a public place, cough or sneeze, touch our mask, change a diaper, care for a sick person, or touch an animal.

• Stay 6 or more feet from others not from our households (indoors and outdoors), especially if they are sick.

• Wear a face covering in pubic.

• Clean dirty surfaces with detergent, use household disinfectant daily on high touch surfaces (tables, doorknobs, light switches, countertops, handles, desks, phones, keyboards, toilets, faucets, and sinks).

• Monitor symptoms and temperature daily.²

Encourage patients to wear eye protection in public. A recent systematic review and meta-analysis of 172 studies found that in addition to physical distancing, face coverings, and hand hygiene, eye protection (visor, face shield or goggles) can reduce COVID-19 risk.³

Tips for travel in the COVID-19 era

Some patients who have been cooped up for months want to get away from home for a daytrip or a longer vacation. Others may need to travel for work, an illness or death in the family, or other essential reason.

The CDC suggests considering these things before and while traveling:

• Dialysis patients should limit travel because they are at higher risk of serious complications if they get COVID-19.

• Check the status of the virus at the travel destination and along the way on this map. Click on any state to visit the state health department for COVID-19 updates.

• If anyone your patient lives with is in a high-risk group, traveling and bringing COVID-19 home could put that person’s health and life at risk.

• Take precautions when visiting family or friends: they may not be following guidelines.

• If camping, maintain physical distance of at least 6 feet from others at the campground, picnic tables, and in restrooms.

• Make sure patients know how to contact their healthcare provider and where to get care if needed while away.

• If using public transportation (plane, bus, train), it is not possible to physically distance, so follow guidelines for masks, disinfecting surfaces, and hand hygiene.

• If traveling by car, stopping for food or gas can increase risk, so follow social distancing plus the same guidelines as for public transportation.

• If traveling by RV and staying in an RV park, follow the same tips as for traveling by car.

• There are special tips for staying overnight while traveling.⁴

The CDC has published travel FAQs that answers many questions including recommending against international travel and cruising for now. Patients need to know—in advance—if they are traveling to a state or city that requires visitors to quarantine. They also need to know if their state requires them to quarantine when they return from a hot spot. The CDC’s guidelines for quarantine addresses those who may have been exposed to COVID-19. To get up-to-date information for a state’s policies, go to the state’s website or check out State Data and Policy Actions to Address Coronavirus that includes information on:

• State social distancing actions

• State COVID-19 health policy actions

• State actions on telehealth

• State level data on multiple topics

How an infectious disease doctor protected himself while traveling

For weeks I have been watching the University of Kansas Health System’s 8 a.m. news briefing on COVID-19 weekdays at. Chief Medical Officer Steve Stites and Medical Director of Infection Prevention and Control Dana Hawkinson are routinely on the show with state and county health officials, other area hospital medical directors, experts in various areas of healthcare, our U.S. Senator Jerry Moran and others. They answer questions from the media and public. On a few shows, Dr. Hawkinson described how he has protected himself when traveling. When he traveled by plane to Florida several weeks ago, he showed what he did. He wore a mask and safety glasses, said he washed his hands with soap and water in the restroom in the airport, used a bottle of alcohol-based hand gel that he carried in his carry-on bag, and cleaned his plane seat and arms, tray table, seat belt, and window shade with household disinfecting wipes. He recommended sitting in the window seat for distancing and air circulation. When asked about plane travel a few days ago, Dr. Hawkinson said he would NOT fly today now that planes are more crowded.

When Dr. Hawkinson took a family trip to Colorado, he preferred an Airbnb to reduce unnecessary contact with others that he could have had in a hotel. He reported disinfecting surfaces regularly and said the family chose to cook their meals in rather than eating out at restaurants. He said everyone he saw was wearing a mask. Dr. Stites often ends the show by asking viewers to follow the guidelines. He reminds viewers what was said in the Wizard of Oz, “There’s no place like home” (dialysis).

Information for home dialysis patients who go in-center when traveling

There may be times when a home patient needs to do in-center dialysis when traveling. Many are nervous about this. To address their anxiety, in addition to making sure patients know what changes they need to make to their diet and fluids, share the CDC fact sheet for dialysis clinics that describes the steps clinics are taking to keep patients safe and this fact sheet for patients that has tips, including those in this blog, to help them stay safe.

Conclusion

We are living in unusual times that require unusual measures. We all hope that a vaccine and more effective treatment for COVID-19 come soon to allow life to return to “normal.” If patients want to travel, encourage them to take short trips that provide a change of scenery at lower risk. Suggest looking up “one tank trips” on the Internet for ideas of nearby places to go. Remind them of their last vacation and ask if planning for it wasn’t at least half the fun? During the months when nonessential travel should be limited, encourage restless patients to scope out places for future vacations and things to do when they get there. Impress on your patients that unsafe nonessential travel and failing to follow guidelines and public health experts’ advice could risk their health and/or lives and limit their ability to take a future vacation.