Abstract:
BACKGROUND: End-stage-renal-failure (ESRF) patients attending clustered out-patient
dialysis are susceptible to SARS-CoV-2 infection. Comorbidities render them
vulnerable to severe COVID-19. Although preventative and mitigation strategies are
recommended, the effect of these are unknown. A period of “potential-high-infectivity”
results if a health-care-worker (HCWs) or a patient becomes infected.
AIM: We describe and analyze early, universal SARS-CoV-2 real time reverse transcription
polymerase chain reaction (RT-PCR) tests, biomarker monitoring and SARS-CoV-2
preventative strategies, in a single dialysis center, after a positive patient was identified.
METHODOLOGY: The setting was a single outpatient dialysis center in Johannesburg, South
Africa which had already implemented preventative strategies. We describe the
management of 57 patients and 11 HCWs, after one of the patients tested positive for
SARS-CoV-2. All individuals were subjected to RT-PCR tests and biomarkers (NeutrophilLymphocyte Ratio, C-reactive protein, and D-Dimer) within 72 h (initial-tests). Individuals
with initial negative RT-PCR and abnormal biomarkers (one or more) were subjected to
repeat RT-PCR and biomarkers (retest subgroup) during the second week. Additional
stringent measures (awareness of viral transmission, dialysis distancing and screening)
were implemented during the period of “potential high infectivity.” The patient retest
subgroup also underwent clustered dialysis until retest results became available RESULTS: A second positive-patient was identified as a result of early universal RT-PCR
tests. In the two positive-patients, biomarker improvement coincided with RT-PCR
negative tests. We identified 13 individuals for retesting. None of these retested
individuals tested positive for SARS-CoV-2 and there was no deterioration in median
biomarker values between initial and retests. Collectively, none of the negative individuals
developed COVID-19 symptoms during the period “potential high infectivity.”
CONCLUSION: A SARS-CoV-2 outbreak may necessitate additional proactive steps to
counteract spread of infection. This includes early universal RT-PCR testing and creating
further awareness of the risk of transmission and modifying preventative strategies.
Abnormal biomarkers may be poorly predictive of SARS-CoV-2 infection in ESRF
patients due to underlying illnesses. Observing dynamic changes in biomarkers in RTPCR positive and negative-patients may provide insights into general state of health.
