Reopening, second wave, and kidney disease

Originally posted here.


What if my area opens up?

You should still practice the same precautions of staying at home, wearing a facemask, hand washing, and social distancing.

Whether you have kidney disease, have a transplant, or are on dialysis, you are still at increased risk for infection and for worse complications if you catch COVID-19. Please be in close contact with your healthcare team, including your dialysis center or transplant center for further recommendations or instructions.

Visit the CDC for more information.

What if I need to go out in public?

Phase One and Phase Two According to the Whitehouse and CDC guidelines, vulnerable individuals, such as the elderly and people with kidney disease, should continue to shelter in place in Phase One and Phase Two. If you must go out in public, you should maximize physical distance from others. Note: a cloth face cover is not a substitute for social distancing.

Phase Three Vulnerable individuals, such as the elderly and people with kidney disease, can resume public interactions, but should practice physical distancing, minimizing exposure to social settings where distancing may not be practical, unless precautionary measures are observed. Note: a cloth face cover is not a substitute for social distancing.

You can find more information about going out in public during COVID-19 at Opening up America Again Guidelines and Centers for Disease Control (CDC).

Can I go out to eat?

Phase One Restaurants with sit-down dining can operate under strict physical distancing protocols. At risk individuals should heed federal guideline recommendations and shelter at home for Phase 1 , so going out to eat is not advisable.

Phase Two Restaurants with sit-down dining can operate under moderate physical distancing protocols. However, according to the Whitehouse and CDC guidelines, vulnerable individuals, such as the elderly and people with kidney disease, should continue to shelter in place in Phase Two, so going out to eat is not advisable.

Phase Three Restaurants with sit-down dining can operate under limited physical distancing protocols. However, according to the Whitehouse and CDC guidelines, vulnerable individuals, such as the elderly and people with kidney disease, can resume public interactions, but should practice physical distancing, minimizing exposure to social settings where distancing may not be practical, unless precautionary measures are observed. Therefore, going out to eat may not be advisable unless the restaura is still practicing strict physical distancing protocols. Please note that cloth face covers are not substitutes for social distancing. Find more information here about going out to eat Opening Up America Again Guidelines 

Can I travel?

Phase One and Phase Two The Opening Up America Again guidance recommends that people over the age of 65, who have kidney disease, on dialysis, or taking immunosuppression medication should stay home during Phase 1 and Phase 2. If you must travel you should adhere to CDC guidelines regarding travel.

Phase Three Vulnerable individuals, such as the elderly and people with kidney disease, can resume public interactions, but should practice physical distancing, minimizing exposure to social settings where distancing may not be practical, unless precautionary measures are observed. If you must travel you should adhere to CDC guidelines regarding travel. Safety measures for travel:

  • Practice physical distancing whenever possible

  • Wear facemasks or coverings in addition to physical distancing

  • Wash hands frequently and do not touch your face

  • Use a disinfectant wipe on all surfaces you touch (example: seats, seat belts, trays).

You can find more information about travel during COVID-19 at Opening Up America Again Guidelines and Centers for Disease Control (CDC).

Can I visit with friends and family?

Phase One and Phase Two People who are at high risk for severe illness from COVID-19 infection should refrain from engaging in any public interactions during the first 2 phases. Therefore, visiting with friends and family is not advisable. We also recommend that you seek advice from your healthcare team.

Phase Three According to the Whitehouse and CDC guidelines, vulnerable individuals, such as the elderly and people with kidney disease, can resume public interactions, but should practice physical distancing, minimizing exposure to social settings where distancing may not be practical, unless precautionary measures are observed. Therefore, visiting with friends and family may be possible using these precautions. We also recommend that you seek advice from your healthcare team. Please note that cloth face covers are not substitutes for social distancing. Read the White House guidelines here: Opening Up America Again Guidelines

What policies should I follow at work?

Employees Follow employer policies in accordance with Federal, State, and local regulations and guidance. Stay informed by industry best practices, regarding social distancing and protective equipment, temperature checks, and sanitation.

Employers Consider special accommodations for workers who are members of a vulnerable population according to the Opening Up America Again Guidelines.

Do not go to work if you have symptoms of COVID-19 and do not return to work until you are cleared by a medical provider.

Dangerous work environments According to the Occupational Safety and Health Administration (OSHA), if you believe working conditions are unsafe or unhealthful, you should bring the conditions to your employer’s attention, if possible. You may also file a complaint with OSHA concerning a dangerous work environment at any time.

You can find more information about worker safety and health during COVID-19 at Opening Up America Again Guidelines and Occupational Safety and Health Administration (OSHA).

What if I feel sick?

If you feel sick, follow these steps:

  • Stay home except to get medical care (including dialysis treatments)

  • Do not go to work or school

  • Contact and follow the advice of your healthcare provider

  • Separate yourself from other people

  • Watch your symptoms

If you have a fever, cough or other symptoms you might have COVID-19. Other COVID-19 symptoms may include chills, muscle pain, headache, sore throat, or new loss of taste or smell. Emergency warning signs include trouble breathing, persistent pain or pressure in the chest, new confusion or inability to arouse, bluish lips or face.

You can find more information about what to do if you feel sick on the Centers for Disease Control (CDC) website and the Opening up America Again Guidelines.

Should I get antibody testing for COVID-19?

You can ask your healthcare team, or check with local/state health departments, to help decide if you should receive an antibody test and if it can be done safely for people with kidney disease.

Serological tests detect antibodies in the blood when the body is responding to a specific infection, such as COVID-19. They are also known as antibody tests. These antibodies are produced when someone has been infected, so a positive result from this test indicates that person was previously infected with the virus.

Antibody tests can help clinicians and their patients find out if someone was previously infected with COVID-19. The information can help researchers figure out how much the virus has spread in a community and to see if people can donate convalescent plasma, which might help others sickened by COVID-19. However, research is ongoing to see if antibodies from a CVOID-19 infection can protect someone from reinfection and if this protection lasts.

Also, these tests can have limitations. For example, specificity (doesn’t detect non-target viruses) and sensitivity (true positive rate, meaning antibodies exist) of antibody tests may vary. The CDC is evaluating the performance of antibody tests in collaboration with the FDA and other federal organizations.

CDC page for more information FDA page for more information State and Territorial Health Departments Local Health Departments

What is herd immunity?

The CDC defines herd immunity as “protection from disease in a group, due to a large enough proportion of the population having immunity to prevent the disease from spreading from person to person.”

The idea is that if a large enough portion of a population is immune to a certain infection (either through recovery or vaccination) then transmission would slow and serve as a barrier for others without immunity.

However, a very large portion of the population would need to be immune to an infectious disease, such as COVID-19, in order for this to work. People who have recovered from an infection are usually protected from reinfection, based on what is known about other viruses (research is ongoing). However, many, many more people would need to be infected for this to possibly work, which would mean many more people would get sick and possibly die. This is why general recommendations and strategies have focused on social distancing (such as maintaining a distance of 6 feet from others, washing hands, and wearing facial covering) to reduce transmission as new treatments and vaccines are researched and developed.

What does it mean to build up immunity?

The immune system is the body's defense against infections. Part of this defense involves making antibodies to help keep the body protected from future infections. An antibody is made to protect against a certain virus or other germ.

It’s possible to build up protection or immunity by antibodies produced from an infection, such as with COVID-19, based on what is known about other viruses. However, this is a new virus and research is ongoing to see if antibodies from a COVID-19 infection can protect someone from reinfection and if this protection lasts.

Can I resume routine medical appointments?

You can contact your healthcare team to see if or when you can resume routine in-person medical visits. You can also ask if they offer remote visits, either through a smartphone app, Skype or other methods. If you need a certain treatment, vaccine, or test, then you should ask when it might be safer, or if you need to be there in person what precautions you might need to take (such as social distancing or facial covering).

Some states and locals are starting to slowly open up their stay-in-place orders. Other areas continue to maintain stay-in-place orders. These openings will be done slowly and in phases. Even if a certain area is starting to open up, vulnerable individuals are advised to stay at home as much as possible in these early phases, especially there are still new cases of COVID-19 in your area. Vulnerable individuals include the elderly and people with underlying health conditions including, but not limited to, high blood pressure, chronic lung disease, diabetes and kidney disease.

Opening up America Again Guidelines

Can I schedule elective procedures?

According to the White House and CDC Phase One and Phase Two guidelines, “elective surgeries can resume, as clinically appropriate, on an outpatient basis at facilities that adhere to CMS guidelines.” However, the guidelines also state that, vulnerable individuals, such as the elderly and people with kidney disease, should continue to shelter in place in Phase One and Phase Two. Therefore, you might be able to schedule an elective surgery, but you should seek the advice of your healthcare team based on the level of COVID-19 risk in your area.

Some hospitals or clinics might start allowing elective procedures, such as an endoscopy or knee replacement, if COVID cases are at a level where these procedures can be done safely and with a low infection risk. Others still might not allow them based on the level of COVID-19 risk in their area.

Either way, you should stay in touch with your healthcare team, and seek advice and express any questions or concerns.

Opening up America Again State and Territorial Health Departments Local Health Departments

What should I consider if I’m on dialysis?

First and foremost, you should know that you are still at increased risk for infection and for worse complications if you catch Covid-19.

You should continue to maintain the same precautions for hand washing, social distancing, staying at home, and wearing a facemask.

Please be in close contact with your dialysis center for any further recommendations or instructions.

Visit the CDC for more information.

What should I consider if I have a kidney transplant?

First and foremost, you should know that you are still at increased risk for infection and for worse complications if you catch COVID-19.

You should continue to maintain the same precautions for hand washing, social distancing, staying at home, and wearing a facemask.

Please be in close contact with your transplant center for any further recommendations or instructions.

Visit the CDC for more information.

What should I consider if I’ve been planning to receive a kidney transplant?

First and foremost, you should know that you are still at increased risk for infection and for worse complications if you catch COVID-19.

You should continue to maintain the same precautions for hand washing, social distancing, staying at home, and wearing a mask.

Please be in close contact with your transplant center for any further recommendations or instruction.

Visit the CDC for more information.

Do I still need to wear a mask?

Yes, you should still wear a face mask if you must go out for an essential reason such as a medical appointment or to get food or medicine. Whether you have chronic kidney disease, have a transplant, or are on dialysis, you are still at increased risk for infection and for worse complications if you catch Covid-19.

Therefore, you should still stay at home except for the most essential reasons.

Please be in close contact with your healthcare team, including your dialysis center or transplant center for further recommendations or instructions.

Visit the CDC for more information.

When will the US reopen? Updated May 7, 2020

Reopening America requires all of us to move forward together by practicing social distancing and other daily habits to reduce our risk of exposure to the virus that causes COVID-19. Reopening the country also strongly relies on public health strategies, including increased testing of people for the virus, social distancing, isolation, and keeping track of how someone infected might have infected other people. The Whitehouse and CDC guidelines for the Opening Up America Again is 3-phased approach based on the advice of public health experts. Under these guidelines, states will reopen one step at a time, rather than all at once. Governors are empowered to tailor the phased reopening to address the unique needs of their individual states, with phased openings at the statewide or county-by-county level. Phase 1 and Phase 2 According to the Whitehouse and CDC guidelines, vulnerable individuals, such as the elderly and people with CKD, should continue to shelter in place in Phase One and Phase Two. If you must leave your home adhere to CDC guidelines regarding travel. Phase 3 Vulnerable individuals, such as the elderly and people with CKD, can resume public interactions, but should practice physical distancing, minimizing exposure to social settings where distancing may not be practical, unless precautionary measures are observed. Employers may be able to make special accommodations for vulnerable individuals, for example continuing to work remotely at home or staggering shifts so fewer people are onsite at a given time. Many large and small venues will be open, including restaurants, movie theaters, places of worship, schools and camps, gyms, and more. Long-term care facilities and hospitals will also be open to visitors and elective surgeries will be scheduled. It’s important to remember that you are still at increased risk for severe disease should you become infected with COVID-19, so seek the advice of your healthcare team before engaging in any public interactions. Continue to practice good hygiene

  • Wash your hands with soap and water or use hand sanitizer, especially after touching frequently used items or surfaces.

  • Avoid touching your face.

  • Sneeze or cough into a tissue, or the inside of your elbow.

  • Disinfect frequently used items and surfaces as much as possible.

  • Strongly consider using face coverings while in public, and particularly when using mass transit.

Continue to adhere to State and local guidance as well as complementary CDC guidance, particularly with respect to face coverings.

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