Aftermath of fortnightly universal testing for severe acute respiratory corona virus-2 infection in maintenance in hemodialysis patients

ABSTRACT

BACKGROUND AND AIMS: Asymptomatic maintenance hemodialysis patients with SARS-COV-2are missed with pre-dialysis screening without testing. The possible ideal strategy of testing each patient before each shift with RT-PCR was not feasible. We aimed to study the effectiveness of fortnightly screening with RT-PCR for SARSCoV-2 in curbing transmission. METHOD: Between July 1, 2020, and September 30, 2020, all 273 patients receiving hemodialysis were subjected to fortnightly testing for SARS-Cov-2 in the unit to detect asymptomatic patients. The cost and effectiveness of universal testing in preventing transmission were analyzed using Susceptible-Infectious-Removed (SIR) modeling assuming R0 of 2.2. RESULTS: Of 273 MHD patients, 55 (20.1%) got infected with SARS-CoV-2 over three months. Six (10.9%) were symptomatic, and 49 (89.1%) asymptomatic at the time of testing. Six (10.9%) asymptomatic patients develop symptoms later;and 43 (78.2%) remained asymptomatic. A total of 7(6.1%) HCWs also tested positive for the virus. With an assumption of R0 2.2 and isolation of symptomatic patients only, all 273 patients could have been affected by September 30, 2020;with the isolation of both symptomatic patients and those testing positive after pre-dialysis screen, only 52 (19%) infections could have been prevented. However, at the end of the study period, 218 (80%) patients remained uninfected of SARS-CoV-2. Fortnightly universal testing is cost-effective, and SIR modeling proved effective in preventing person-to-person transmission. CONCLUSION: Repeated universal testing in maintenance hemodialysis patients detected 89% of asymptomatic SARS-CoV-2 patients over three months and appeared to be an effective strategy to prevent person-to-person transmission in the dialysis unit.