How we mitigate and contain COVID-19 outbreak in hemodialysis center (HD): lessons and experiences

Hemodialysis patients are particularly vulnerable to infection and may exhibit greater variations in clinical symptoms and infectivity. HD patients are susceptible to infection for the following reasons: (1) HD patients need frequent shuttle around hospital and residence to receive dialysis 2 to 3 times per week, which increases the risk of COVID-19 transmission. (2) HD patients often need care from family members or caregivers. If one of them was infected, they could transmit to all those close contact individuals. (3) HD center is a relatively open space with personnel like medical staff and facility workers, patients themselves, and family members, a large number of people gathered in HD center posing a risk of clustering potential infection transmission. (4) HD patients infected with COVID-19 lacked typical clinical symptoms such as fever, cough, or other respiratory symptoms, and typical ground-glass image of the lungs by CT scan. They appeared asymptomatic or mild symptoms. Their chest CT imaging often demonstrated acute exudative lesions, lung consolidation, or interstitial changes. These factors increased the difficulty for medical workers in identifying and diagnosing COVID-19 infection in HD patients. These are the reasons why COVID-19 is quickly spreading in HD center.