key: cord-0923071-uu9dhgid
authors: Gu, Y.; Wang, Y.; Zhou, J.; Deng, Y.; Shao, F.
title: How do Hemodialysis Center Prevent the Secondary COVID-19 Transmission in Poverty-Stricken Rural Region of China: Eperiences and Strategies
date: 2021-03-12
journal: nan
DOI: 10.1101/2021.03.09.21252639
sha: 2706c967f42e943b2703721e94477126c0aa5567
doc_id: 923071
cord_uid: uu9dhgid

The COVID-19 pandemic has caused an evolving public health crisis and challenged the medical system globally, especially in the rural-stricken regions. There is concern about the spread of coronavirus in regions with lower education level, weaker health systems and underdeveloped economy. The risk of viral transmission in HD center is elevated because of the densely-populated and high mobility in an enclosed environment.This paper demonstrated the main experiences and strategies of preventing secondary COVID-19 transmission in a HD center from a poverty-stricken rural region in China. Data of subjects including 17 medical workers and 249 patients were collected from the HD center in Huangchuan County People's Hospital, Xinyang, China from February to April 2020. It is the first paper to provide the experiences and strategies about preventing COVID-19 secondary transmission in HD center for poverty-stricken rural region.

The novel coronavirus disease (COVID-19) pandemic has caused an evolving public health crisis and challenged the medical system globally, especially in poverty-stricken region (1) . The susceptibility of COVID-19 infection in hemodialysis (HD) patients is increased because that they are of older age and have other health issues including decreased immune function, diabetes, hypertension lung diseases and so on. As the COVID-19 is insidious and highly infectious, it is prone to cause cluster transmission. There is increased risk of viral transmission in HD center as a densely-populated, high mobility and enclosed environment. There was a COVID-19 outbreak occurred in the HD center of Renmin Hospital, Wuhan University (2) .

This study demonstrated the experiences and strategies of preventing secondary COVID-19 transmission in a HD center from a poverty-stricken rural region in China.

Data of subjects including 17 medical workers and 249 patients were collected from the HD center in Huangchuan County People's Hospital from February to April 2020. The study was approved by the local institutional review board, and informed consents were obtained from all participants.

All subjects underwent chest computed tomographic (CT) scans and hematological examination for screening. Real-time reverse transcriptase polymerase chain reaction (RT-PCR) for SAR-CoV-2 detection were performed using nasopharyngeal swabs for suspected cases.

All rights reserved. No reuse allowed without permission. perpetuity. preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in The HD center had actively screened all patients for potential exposure to confirmed/suspected COVID-19 case daily according to the information from local Center for Disease Control and Prevention. On day 1, patient 1 was found that lives in the same village with the new confirmed case on that day and closely contacted with the people who was exposed to the confirmed case. Patient 1 had mild cough, no elevated temperature, no sore throat or gastrointestinal symptom, and was informed for chest CT and hematological examination. On day 2, patient 1 was diagnosed as a were diagnosed as suspected cases. From day 4 to day 7, all of the HD patients, medical workers, accompanying family members and cleaners were then screened, and patient 4 was diagnosed as suspected case.

On day 2, all of the staff in the HD center were screened and isolated from their families in a hotel for 2 weeks. Their daily work continues normally.

The characteristics of the study cohort were summarized in Table 1 .The main preventive experience and strategies of HD center during the COVID-19 epidemic are All rights reserved. No reuse allowed without permission. perpetuity. preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in transmission in HD center.

As a poverty-stricken rural region, the per capita disposable income in the reported area was 1,962 USD (4). The described HD center is the only HD center in this area. Even though the education level in medical workers and HD patients is low, the active screening in HD center from this hospital prevented the secondary COVID-19 transmission. Similarly, during the 2015 MERS-CoV outbreak in Korea, although 116 patients were exposed to MERS-CoV in HD units, but strict patient surveillance and appropriate isolation measures prevented secondary transmissions (5).

In poverty-stricken rural region, the lack of protective awareness in asymptomatic carriers or patients with mild symptoms due to the low education level might lead to the further spread of coronavirus which can cause overwhelmed local medical system. Therefore, the implementation of active screening and identification of COVID-19 confirmed/suspected case in HD center is important in poverty-stricken rural regions.

This study was limited as a single-centered study with small sample size. Future multi-centered studies are needed for establish strategies for preventing secondary transmission in HD center from poverty-stricken rural region. 3. Accompanying family members are restricted.

Active screening 1. Work with the local CDC for daily screening of HD patients who is potential exposed to confirmed/suspected case, and then inform them to get relevant test as soon as possible;

2. Before entering the HD section, the patients' temperature are measured, ask if there is potential exposure to COVID-19 case and any respiratory or gastrointestinal symptoms.

finding confirmed/suspected case

COVID-19) situation report-51

Medical workers and cleaners are isolated from their families in the hotel for 14 days

PPE in medical workers during the treatment of confirmed/suspected COVID-19 HD patients: goggle, medical isolation suit, isolation gown, N95 respirator and surgical mask, surgical glove, surgical cap, rubber shoes

PPE in medical workers during the treatment for non-confirmed/non-suspected COVID-19 HD patients: face screen, isolation gown, surgical mask, latex glove, surgical cap, shoe covers. confirmed COVID-19 HD patient is treated in isolation ward. After RT-PCR test is negative and the symptoms is relieved, patient then is observed and received HD in isolation ward for another 14 days

For the HD patients who was in the adjacent bed of confirmed/suspected case within the past 14 days, the relevant test are carried out as soon as possible. If it's necessary

Self isolation at home during non-HD time

Reduce the hospital detention time, and the time of non-HD in the hospital is less than 30 minutes. Abbreviations: HD, hemodialysis; PPE, personal protective equipment; CDC, Center for Disease Control and Prevention

All rights reserved. No reuse allowed without permission. perpetuity. preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in The copyright holder for this this version posted March 12, 2021. ; https://doi.org/10.1101/2021.03.09.21252639 doi: medRxiv preprint