key: cord-1018816-6g77rk4m authors: Mazzaferro, Sandro; Rocca, Anna Rachele; Bagordo, Domenico title: Waves of infection and waves of communication: the importance of sharing in the era of Covid-19 date: 2021-02-03 journal: J Nephrol DOI: 10.1007/s40620-021-00974-7 sha: 9123b261e1b076a5636f6e38bbf788d654a7243d doc_id: 1018816 cord_uid: 6g77rk4m nan questionnaire proposed by the Italian Society of Nephrology, that is described in detail elsewhere [6] . Data on SARS-CoV-2 infections were reported as aggregate numbers, while cumulative data were obtained through the analysis of patient flows between peripheral hospitals and centralized [T6] ) and included an average of 4,373 ± 355 patients, which represents a mean coverage of 92% of HD/PD patients in our region, based upon 2019 data [8] . Table 1 shows the number of patients surveyed at each time point, while Fig. 1 shows how point prevalence decreased from 0.59% at T1 to 0.13% at T5, but then climbed back up to 0.19% at T6. The death toll increased from 12 to 26 during the period of observation. Importantly, no deaths occurred in PD patients. Data on acute kidney injury (AKI) and on kidney transplant recipients were probably underestimated since the survey only included intensive care units where dialysis is managed by nephrologists, and transplant centres were not involved. As for healthcare workers, the number of SARS-CoV-2-positive cases increased to 13 between the first and second survey and then decreased, remaining stable at around 7. While the initial increase was likely due to the implementation of a testing policy among asymptomatic workers, afterwards, spread was limited by preventive measures such as the mandatory use of face masks for both patients and operators. Moreover, almost all centres adopted a telephone triage protocol to contact patients the day before their HD session or scheduled outpatient visit to avoid admission in case of symptoms. Finally, separate entrance and exit pathways were created, thereby avoiding overcrowding of patients and caregivers in small spaces, and furthermore, single-patient transports to the dialysis facilities were implemented. Testing among all health workers, regardless of symptoms, increased from 10% (April) to 42.2% (July) and 39.7% (October). The vast majority of HD and PD Centres Overall, from April to October, we recorded 79 positive cases among HD patients and 3 among PD patients, corresponding to a prevalence of SARS-CoV-2 infections of 1.88% in HD/PD. Of note, case fatality rate was confirmed to be high: 31.71%. When compared to the investigation by Quintaliani et al. [6] , our results indicate that during the "first wave" of the pandemic the limited diffusion of the virus among the general population of Lazio and the preventive measures that were taken allowed the prevalence of cases among HD and PD patients to be contained. The same is true even considering similar high risk healthcare settings, such as nursing homes, where outbreaks affected almost all the residents and attending staff [9] . Cooperation was the key to such remarkable results in containing the spread of infection among dialysis patients: in Lazio region, patients on chronic dialysis are treated by public or private Centres, the latter accounting for 58% of the facilities [8] . Over the course of our survey, all the participating nephrologists regularly received an up-to-date report which provided a regional picture of the ongoing SARS-CoV-2 situation. This form of cooperation allowed harmonization of efforts and practices, and, for the first time, both public and private institutions were enthusiastically involved. Indeed, previously, cooperation and communication among nephrology units had generally been limited to the bare minimum, while during the Covid-19 epidemic cooperation was characterized by precise and punctual feedback from all Centres. Over the last few months countless emails and telephone and video calls have shaped new waves of communication, giving rise to a nephrology network, which served as a hub for shared data and management strategies. Moreover, this experience clearly highlighted that more precise data collection is both feasible and necessary for better and more coordinated management of the clinical conditions that are still lacking common registries, such as AKI and kidney transplant recipients. Decidedly, "sharing is caring" and the experience of these challenging times has highlighted the role of this invaluable resource. Lavini Raffaella Ambulatorio Dialisi Italian Hospital Group Clinica Città di Clinica Villa Lessons from the experience in Wuhan to reduce risk of COVID-19 infection in patients undergoing longterm hemodialysis COVID-19 in hemodialysis (HD) patients: report from one HD center in Wuhan COVID-19 outbreak in a large hemodialysis center in Lombardy Italian Society of Nephrology COVID-19 Research Group (2020) Exposure to novel coronavirus in patients on renal replacement therapy during the exponential phase of COVID-19 pandemic: survey of the Italian Society of Nephrology Regional Dialysis and Kidney Transplant Registry Care home facilities as new COVID-19 hotspots: Lombardy Region (Italy) case study Acknowledgements Directors of the contributing Centres: Alfa- Conflict of interest Authors declare no conflict of interest for the content of this manuscript.