[High prevalence of asymptomatic COVID-19 in haemodialysis: learning day by day in the first month of the COVID-19 pandemic]. / Alta prevalencia de COVID-19 asintomático en hemodiálisis. Aprendiendo día a día el primer mes de pandemia de COVID-19.

Dialysis patients are a risk group for SARS-CoV-2 infection and possibly further complications, but we have little information. The aim of this paper is to describe the experience of the first month of the SARS-CoV-2 pandemic in a hospital haemodialysis (HD) unit serving the district of Madrid with the second highest incidence of COVID-19 (almost 1,000 patients in 100,000h). In the form of a diary, we present the actions undertaken, the incidence of COVID-19 in patients and health staff, some clinical characteristics and the results of screening all the patients in the unit. We started with 90 patients on HD: 37 (41.1%) had COVID-19, of whom 17 (45.9%) were diagnosed through symptoms detected in triage or during the session, and 15 (40.5%) through subsequent screening of those who, until that time, had not undergone SARS-CoV-2 PCR testing. Fever was the most frequent symptom, 50% had lymphopenia and 18.4% <95% O2 saturation. Sixteen (43.2%) patients required hospital admission and 6 (16.2%) died. We found a cluster of infection per shift and also among those using public transport. In terms of staff, of the 44 people involved, 15 (34%) had compatible symptoms, 4 (9%) were confirmed as SARS-CoV-2 PCR cases by occupational health, 9 (20%) required some period of sick leave, temporary disability to work (ILT), and 5 were considered likely cases. CONCLUSIONS: We detected a high prevalence of COVID-19 with a high percentage detected by screening; hence the need for proactive diagnosis to stop the pandemic. Most cases are managed as outpatients, however severe symptoms are also appearing and mortality to date is 16.2%. In terms of staff, 20% have required sick leave in relation to COVID-19.

High prevalence of asymptomatic COVID-19 in hemodialysis: Daily learning during first month of COVID-19 pandemic

Dialysis patients are at risk for SARS-CoV-2 infection and possibly with more complications than other individuals;however, the information available is scarce. The objective of the present work is to describe the experience during the first month of the SARS-CoV-2 pandemic in a hemodialysis (HD) unit from a hospital in Madrid serving the 2nd district with the highest incidence of COVID-19 (almost 1,000 patients in 100,000 inhabitants). The information presented includes the actions carried out, the incidence of COVID-19 in HD patients and in health personnel, clinical characteristics and the result of a screening of all patients from the HD unit. At the beginning, we had 90 HD patients: 37 (41.1%) had COVID-19, of which 17 (45.9%) were diagnosed by symptoms detected in the triage or during the HD session, and 15 (40.5%) were diagnosed in a subsequent screening of patients in whom the diagnostic test by PCR-SARS-CoV-2 had not been done previously. The most frequent symptom was fever, 50% presented lymphopenia and in 18.4% the O2 saturation was <95%. Hospital admission was required in 16 patients (43.2%) and 6 died (16.2%). We found that contagion was clustered in turns of HD sessions and also in patients using collective transportation. Out of the 44 staff personnel, 15 (34%) presented compatible symptoms and 4 (9%) had SARS-CoV-2 diagnosed by PCR performed by the personnel health service, 9 (20%) required some transitory sick leave (TSL) and 5 were considered probable cases of Covid-19. Conclusions We detected a high prevalence of COVID-19 with a high percentage being diagnosed by screening and therefore it is necessary to be proactive in the diagnosis to stop the pandemic. Most patients positive for COVID-19 are being managed on an outpatient basis, although severe cases may occur and the mortality so far is 16.2%. Regarding the staff, 20% have required TSL in relation to COVID-19. Resumen Los pacientes en diálisis son un grupo de riesgo de sufrir la infección por el SARS-CoV-2 y posiblemente de tener más complicaciones, pero la información con la que contamos es escasa. El objetivo de este trabajo es describir la experiencia del primer mes de pandemia por SARS-CoV-2 en una unidad hospitalaria de hemodiálisis (HD) que atiende al 2.o distrito madrileño con más en incidencia de COVID-19 (casi 1.000 pacientes en 100.000habitantes). Se presenta mediante un diario las acciones llevadas a cabo, la incidencia de COVID-19 en pacientes y en el personal sanitario, algunas características clínicas y el resultado de un cribado entre todos los pacientes de la unidad. Al inicio, teníamos 90 pacientes en HD: 37(41,1%) han tenido COVID-19, de los que 17 (45,9%) fueron diagnosticados por síntomas detectados en el triaje o durante la sesión y 15 (40,5%) en un cribado realizado a posteriori en los que no se había hecho test diagnóstico por PCR-SARS-CoV-2 hasta ese momento. El síntoma más frecuente fue la fiebre, el 50% presentó linfopenia y el 18,4% saturación de O2<95%. Precisaron ingreso hospitalario 16 (43,2%) y 6 fallecieron (16,2%). Encontramos un agrupamiento de contagio por turnos y también en aquellos que usaban transporte colectivo. En cuanto al personal, de las 44 personas involucradas, 15 (34%) presentaron sintomatología compatible y 4 (9%) tuvieron PCR SARS-CoV-2 positiva determinada por Salud Laboral, 9 (20%) precisaron algún periodo de incapacidad laboral transitoria (ILT), y 5 fueron considerados casos probables. Conclusiones Detectamos una elevada prevalencia de COVID-19 con un elevado porcentaje detectado por cribado y por tanto la necesidad de ser proactivos en el diagnóstico para detener la pandemia. La mayoría están siendo manejados de forma ambulatoria, aunque también aparecen cuadros graves y la mortalidad hasta ahora es del 16,2%. En cuanto al personal, un 20% ha precisado ILT en relación con COVID-19.