CORONAVIRUS DISEASE (COVID-19): FAQ for transplant candidates and recipients

Updated: May 26

Information from the American Society of Transplantation

**Updated on March 16, 2020**


Information regarding COVID-19 is changing rapidly. This document will be updated as able with new information. Please contact your transplant center with specific concerns. A PDF version of this information can be found here.


Background:

Coronaviruses are common viruses that usually cause a simple cold. When new strains of viruses emerge, they can cause more severe diseases, as seen with the recent novel coronavirus disease called Coronavirus disease 2019 (COVID-19). This coronavirus is called the Severe Acute Respiratory Syndrome 2 virus (SARS-CoV-2). This new virus and disease were the cause of the outbreak in Wuhan, China, starting in December 2019 and now has spread to many parts of the world.


COVID-19 Symptoms:

  • Fever

  • Cough

  • Shortness of breath

  • Other flu-like symptoms

  • Some transplant recipients may develop pneumonia.


Currently, there are no antivirals or vaccines effective against this virus, although studies to develop these are ongoing.


Many transplant recipients and their families have questions regarding COVID-19. The information and questions below are designed to help give answers with currently available information, as well as links to national and international websites for regularly updated information.


Frequently Asked Questions

Q: Are transplant recipients at higher risk for the virus?

A: We do not have specific information on whether COVID-19 infection will be more severe in transplant recipients compared to healthy people; however, other viruses often cause more severe disease in people whose immune system is low, such as transplant recipients. For this reason, it is important to take precautions to prevent infection.

Infection occurs mostly through close, direct contact with someone who is carrying the virus.

People are thought to be most contagious when they have symptoms, BUT some people may carry the virus even if they are not showing symptoms or only mildly ill.It may be possible to catch the virus from a surface that an infected person touched if they touched their nose or mouth without washing their hands before placing them on the surface (like door handles, tabletops, etc.).The chances of being infected depend on whether there are infected individuals surrounding the transplant recipient.


Q: Are there any travel restrictions for transplant recipients?

A: COVID-19 has now been declared a pandemic, which means it is found in most areas of the world. Please visit the CDC website for information regarding the number of infections across the globe. For the most up-to-date travel advisories, please visit the U.S. Department of State website.


We currently recommend that transplant recipients:

  • Follow public health recommendations for social distancing.

  • Stay home as much as possible and put distance between you and other people if you must be out.

  • Do not travel to areas with high amounts of the circulating virus.

  • Should try to avoid crowds, especially if you live in an area where COVID-19 is being seen.


The level of risk varies by country and area, and it is changing quickly.

It is best to postpone nonessential travel, particularly to countries where access to medical care may be limited. We also highly suggest that transplant recipients’ immediate household contacts should postpone non-essential travel to areas that are considered high risk. All travel plans should be discussed with your transplant provider before your travel.

Travel restriction recommendations are likely to change over time. Check frequently for updated recommendations:

Centers for Disease Control and Prevention (CDC)World Health Organization (WHO)In Canada


Q: My family member just returned from an area with high COVID-19 activity. What should I do?

A: It is best to avoid contact for 14 days with individuals who returned from an area where they could have been exposed to COVID-19. If the individual remains healthy after 14 days, contact can be resumed.

If avoiding contact is not possible, it is recommended to:

  • Practice frequent handwashing or hand sanitizer use.

  • All household members should avoid touching their eyes, mouths, and noses.

  • Try to limit your contact with the family member.

  • Maintain as much separation as possible.

  • Cough and sneeze etiquette should be practiced (see figure below).




Q: Should transplant recipients wear a mask or avoid public places?

A: The benefit of wearing masks in public is controversial even for transplant recipients. It is unknown if wearing a mask will help prevent infection. Most surgical masks are not tight-fitting, and aerosols can get through. However, they may prevent you from touching your nose and mouth. Transplant recipients should avoid overcrowded situations.


If you have a fever and are coughing and sneezing, you should:

  • Tell your transplant center

  • Put on a mask when you go out in public, to the hospital, or a transplant clinic.

Overall, if you choose to use a mask to prevent any spread of infection, it is recommended to choose a surgical mask (DO NOT use an N95 mask), and use it combined with good hand hygiene.



Q: What should I do if I have flu-like/respiratory symptoms?

A: There are many different causes for fever, cough, shortness of breath, and flu-like symptoms.

If you have (1) not traveled to high-risk areas in the last two weeks or (2) you have not been in contact with someone who has COVID-19 (for example someone who has recently returned from a country or area with high COVID-19 activity and is ill), and if COVID-19 is not present in your community, it is unlikely you have COVID-19.

Currently, in North America, influenza and several other respiratory viruses are circulating as well. If you believe you have COVID-19 based on your travel or contact history, or if there is a community spread of COVID-19, call your transplant team for further instructions. If you have a cough or fever and access to a mask, place a surgical mask on (refer to figure above titled “The N95 Versus the Surgical Mask”) when in public to avoid the spread of infection to anyone else.

If you have only mild symptoms your transplant center may not want you to come to the clinic, so talk with your transplant center FIRST before coming to a hospital or clinic.


Q: What should I do if a family member/co-worker is diagnosed with COVID-19?

A: If a close contact is diagnosed with or suspected of having COVID-19, he/she should avoid all further contact with the transplant recipient. The transplant recipient or their family members should let their transplant coordinator know that they have been in contact with someone diagnosed with COVID-19. The transplant recipient should be monitored for symptoms and contact their transplant coordinator if they develop fever, cough or shortness of breath.

Currently, there is no approved vaccine or medication to treat or prevent infection, but clinical trials are in development.


Q: How can I get tested to see if I have COVID-19?

A: At this moment, testing for the virus that causes COVID-19 can only be done by public health authorities or through select institutions. Many institutions have limited testing at this time, although this may change. If you believe you have COVID-19, call your transplant team for further instructions.


Q: Is it safe for me to go to the hospital for appointments?

A: The risk of acquiring COVID-19 in hospitals in the United States and Canada is still very low. Healthcare facilities are evaluating patients for the risk of COVID-19, and if the suspicion is high, those patients are being isolated. Additional protective measures may be instituted as the outbreak progresses, including delaying routine visits for well transplant recipients who are at least several months post-transplant. Please contact your transplant team for further instruction.


Q: What can I do to prepare for an outbreak of COVID-19 in my area?

A: We recommend that you be mindful of what is happening in your community by checking the local public health reports.


Some other things to consider:

  • Avoid crowded areas and sick individuals

  • Wash hand frequently

  • Ensure you have enough supplies and medication

If possible, have at least 2 weeks of your medicines remaining at all times.


Check to see if your insurance allows for 90-day supply rather than a 30-day supply. If your insurance supplies 30 days at a time, do not wait until the day before to refill, but refill a week in advance each time.


Consider having medicines:

  • Mailed to your home

  • Using a pharmacy drive-thru

  • Having your caregiver pick up your medicines from the pharmacy to avoid crowded places


Q: I am awaiting a transplant. Could I get COVID-19 from my donor?

A: The risk of acquiring COVID-19 from organ donation is low. Donors are being screened for COVID-19 symptoms and exposure history. Living donors who have been to high-risk areas or exposed to someone diagnosed or being evaluated for COVID-19 infection are generally being asked to postpone donation for 14 to 28 days after returning. Some organ procurement organizations are testing some or all donors for COVID-19.

Also, living donors are being asked to not travel to high-risk areas for at least 14 days before donation and monitor for symptoms. Information about recent travel and possible exposure is also asked about deceased donors to help determine if it is safe to use them for organ and tissue donation.


Q: Where can I get up-to-date information about COVID-19?

A: The CDC and WHO are working hard to maintain up to date information about the spread of COVID-19 including changing conditions in the United States.

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