COVID-19 doesn't just attack lungs. Doctors now know the virus can damage other organs, including kidneys. Patients already suffering from kidney disease are especially vulnerable. The pandemic is shining a light on how patients are treated for kidney failure, and whether there are safer alternative.
Among those patients is Germaine Crawford of Randolph, who started to worry about coronavirus when it became difficult to breathe.
"So I go to the emergency room and I explain to them my situation,” Crawford said. “And they tested me for COVID-19, and I tested positive for it."
Crawford has a list of health problems — including kidney failure — as a result of diabetes that wasn't managed well when he was younger, he said. He received treatments at a dialysis center three times a week for four hours at a time, hooked up to a machine that performs the blood-filtering function his kidneys should be doing.
Crawford said he's sure he got the virus at the dialysis center.
"I heard everybody in my section contracted the virus, except one person," he said.
Doctors are taking a closer look at how some dialysis patients are treated in the age of COVID-19.
"COVID just really highlights the need for home dialysis," said Dr. Lauren Stern, a nephrologist, or kidney specialist, at Boston Medical Center.
Stern said dialysis centers are the antithesis of social distancing.
"It's just like chair after chair after chair, and there's lots of techs, lots of nurses there, social workers, there's dietitians," she said. “I mean, it's just a place that's just full of people. And you have to be on top of each other in order to care for the patient."
Many dialysis patients live in nursing homes, which only adds to Stern’s concern. More than 60 percent of Massachusetts’ COVID deaths have been in nursing homes.
"One of my fears was, ‘Oh, my God, what if what if a patient of mine, you know, gets it in the dialysis unit, is asymptomatic and then brings it back to a nursing home?’" Stern said.
Companies running dialysis centers say the facilities are safe and protocols are in place to prevent the spread of coronavirus, including requiring patients and staff to wear masks.
But the COVID crisis has prompted a renewed push to move toward an alternative to outpatient dialysis centers like the one Germaine Crawford visits.
Nephrologist Dan Weiner of Tufts Medical Center said more patients should be doing dialysis at home. One way that’s done is called peritoneal dialysis — a type of dialysis that’s generally performed in the home by putting fluid into people’s adbodmens. It’s not an option for every patient. But Weiner said it has benefits.
“Most notably in the time of COVID, that you don’t need to come to a hemodialysis facility,” Weiner said. “But also, it’s a lot more gentle therapy. It may be better in people who have heart failure, and chronically low blood pressure. And people don’t feel as washed out or tired afterwards.”
Also, it’s generally cheaper than visiting a dialysis center.
Earlier efforts to encourage a shift toward more home dialysis haven’t made much of an impact. President Trump signed an executive order last July designed to move more people to home dialysis.
"Right now, only 12 percent of patients on dialysis receive care at home,” Trump said in a speech at the time. “My executive order will change that and reduce cost, transform care and greatly improve the quality of life for kidney patients all across our nation."
Nearly a year later, that plan has yet to go into effect, in part because of push-back from the industry over penalties dialysis centers would face if they didn’t meet goals for moving patients to home care.
Now, the COVID crisis is adding urgency to the issue.
Because the virus attacks the kidneys, there was a shortage of dialysis machines in ICUs in New York City. Boston hospitals took note of that and scrambled to get enough machines on hand for the surge here. Doctors told WGBH News they’re confident they have enough machines on hand if there’s a second wave of the pandemic.
But keeping regular dialysis patients safe from coronavirus continues to be a concern. In response to the pandemic, dialysis centers created special outpatient shifts and units to handle COVID-positve patients. Germaine Crawford received treatments in one for several weeks after being released from the hospital. Now he’s back at his regular dialysis shift. And he’s not sure home dialysis would work for him.
"I would need somebody here to help me out, set up. All that stuff,” Crawford said. “Do I like going to dialysis? No. Do I have to go to dialysis? Yes."
Dr. Stern at Boston Medical Center said trained caregivers can help patients with home dialysis. But that kind of assistance isn’t covered by Medicare, Medicaid or private insurance, and that coverage is not included in the President's executive order. Stern said she'd like to see that change.
