Coronavirus (COVID-19) and Transplant Patients
Last Updated 9/13/2021
Navigating COVID-19 as an Immunocompromised Individual
Coronavirus (COVID-19) is spread mainly from person-to-person. Older adults and people with suppressed immune systems or other chronic medical conditions seem to be at higher risk for more serious reactions. Because of this increased risk for transplant, kidney, liver, and other patients, it is especially important for our community to take preventative actions to protect ourselves. The American Society for Transplantation (AST) recommends these actions to reduce your exposure:
Receive the COVID-19 vaccine, as well has having household members and caregivers receive the vaccine to reduce risk.
Continued adherence of all transplant recipients to protective measures such as masking and social distancing is recommended regardless of vaccination status.
For pre-transplant patients, vaccination completion at least 2 weeks prior to transplantation if possible. For post-transplant patients, vaccination beginning as early as 1-3 months after transplantation. This can be individualized based on immunosuppression.
A third dose of mRNA vaccine in patients who have received two previous doses of mRNA vaccine, as approved by the FDA. We encourage a conversation between the provider and the patient which considers the patient’s individual situation.
Fall and winter celebrations typically include large gatherings of families and friends, crowded parties, and travel that may put people at increase risk for COVID-19.
If you will be hosting a celebration, follow CDC tips for hosting gatherings. Below are some additional considerations for hosting a holiday celebration:
Host outdoor activities rather than indoor activities as much as possible. If hosting an outdoor event is not possible, and you choose to host an indoor event, avoid crowded, poorly ventilated, or fully enclosed indoor spaces.
Increase ventilation by opening windows and doors to the extent that is safe and feasible based on the weather.
Host activities with only people from your local area as much as possible.
Limit numbers of attendees as much as possible.
Provide updated information to your guests about any COVID-19 safety guidelines and steps in place to prevent the spread of the virus.
Provide or encourage attendees to bring supplies to help you and others stay healthy. For example, extra masks (do not share or swap with others), hand sanitizer that contains at least 60% alcohol, and tissues.
If you are planning in-person holiday gatherings with people outside of your household, consider asking all guests to strictly avoid contact with people outside of their households for 14 days before the gathering.
CDC recommends that people wear masks in public settings, like on public and mass transportation, at events and gatherings, and anywhere they will be around other people.
Wear masks with two or more layers to stop the spread of COVID-19
Wear the mask over your nose and mouse and secure it under your chin
Masks should be worn by people two years and older.
Masks should NOT be worn by children younger than two, people who have trouble breathing, or people who cannot remove the masks without assistance.
Do NOT wear masks intended for healthcare workers, for example, N95 respirators.
CDC does not recommend the use of gaiters or face shileds. Evalution of these face covers is ongoing but effectiveness is unknown at this time.
DON'T put the mask around your neck or up on your forehead.
DON'T touch the mask, and, if you do, wash your hands or use hand sanitizer to disinfect.
Information from https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/how-covid-spreads.html.
Stay home if you feel sick or have any symptoms such as fever, cough, sore throat, body aches, headache, chills. IMPORTANT NOTE: If you are on dialysis, you should NOT miss your treatments. Contact your clinic if you feel sick or have any concerns.
Avoid others who are sick. Limiting face-to-face contact with others as much as possible.
Cover coughs and sneezes with a tissue, then throw it in the trash can. If you don't have a tissue, cough or sneeze into your upper sleeve, not your hands.
Wash hands often with soap and water for at least 20 seconds; especially after going to the bathroom, before eating, and after blowing your nose, coughing or sneezing. If you don't have soap and water, use hand sanitizer with 60%-95% alcohol.
Clean things that get touched a lot, like door handles, very often.
Avoid touching your face, especially your nose and mouth.
Wear a face mask when going to public places where social distancing may be difficult to maintain (e.g., grocery stores and pharmacies). For a guide to using and making face masks, click here
The American Transplant Foundation was honored to be able to provide an opportunity for members of our community to come together to ask our co-founder, Dr. Larry Chan, and a Transplant Leadership Council member, Dr. Bill Wise, questions about how COVID-19 is effecting our transplant community. If you would like to listen to the recording, please click here.
IMPORTANT NOTE: Everyone’s situation is unique. Contact your specialist who is knowledgeable on your specific situation and can provide personalized recommendations. Doctors can give general advice, but contact your doctor for advice special to your situation. The American Transplant Foundation is not offering any medical advice.
Q: Can people who are asymptomatic transmit the virus?
A: You can still shed the virus before you show symptoms, which can take up to 14 days. Once you have been infected, you can carry and transmit the virus for 10 days-3 weeks, which is why we want to limit exposure as much as possible.
Q: How long does it take for symptoms to appear once infected?
A: It has been shown that someone who has been infected with the virus can take up to 14 days to exhibit symptoms. The Median is usually 3-6 days, but it varies based on the individual.
Q: Should transplant patients stop taking their immunosuppressants?
A: No. If you stop taking medication without proper advice you run the risk of rejection and can make them at even higher risk for infection. In patients who already have the virus, the general advice is to modify medication, but doctors will help with this. Bottom Line: don’t change your medication without seeing a healthcare provider.
Q: Are organ donors at a higher risk?
A: Generally no, because most donors are in good health to begin with and there is no increased risk for infection. Take the same precautions as the average individual.
Q: Does COVID-19 Attack the Kidneys?
A: When you have any infection, if it escalates to a severe infection it can begin to affect different organs. COVID-19 primarily affects the lungs, but if it gets more severe it may affect the kidneys.
Q: Is asthma an underlying disease?
A: Yes. Asthma is considered an underlying respiratory condition that makes an individual more susceptible to the virus.
Q: Are heart transplant recipients at extra risk?
A: All transplant recipients are receiving immunosuppressants. Degree of medication varies based on transplant, but all recipients should take extra precaution.
Q: Should transplant recipients wear masks when going into public places?
A: It depends on comfort level and availability. You should wear a mask if you are sick or going to an area where other people may be sick.
Q: Should I have an extra 30-day supply of my medications?
A: Yes. Patients should have extra medication just in case they can’t go outside or into a public place. It is a good idea to have extra 30-60 days of medication. Doctors should be able to work with you if you need a special prescription to obtain more medication.
Q: Is home care a good idea as opposed to at a transplant center?
A: In general, home care might be a good idea if available and if your insurance provider supports it. Make sure the home health worker is in good health. There will be less exposure at home than going to a transplant center.
Q: Should I still attend my dialysis treatments?
A: If you are a dialysis patient, it is important that you do NOT miss your treatments. All facilities should be taking proper precautions to protect patients from the virus. If you are concerned, feel free to reach out to your dialysis center to ensure they are taking proper precautions. If you feel sick, please be sure to tell a member of your healthcare team so they can prepare accordingly.
Q: I am awaiting a transplant. Could I get COVID-19 from my donor?
A: The risk of acquiring COVID-19 from organ donation is low. Donors are being screened for COVID-19 symptoms and exposure history, including travel. Many organ procurement organizations are testing some or all donors for COVID-19. Living donors who have been to high-risk areas or exposed to someone diagnosed or being evaluated for COVID-19 infection are generally being asked to postpone donation for 14 to 28 days after returning. Also, living donors are being asked to not travel to high-risk areas for at least 14 days before donation and monitor for symptoms.
Source: ATF Community Support Webinar featuring Dr. Larry Chan and Dr. Bill Wise
Transplant recipients have been strongly advised to telework/work from home or take leave, for at least 30 days when the situation will be reassessed. This is also suggested for family members so they do not expose the transplant recipient.
If the transplant recipient or family member feels that they MUST stay physically in the workplace (which is discouraged), please advocate for maximal social distancing. This includes doing all meetings as virtual meetings or calls, doing excellent and frequent hand hygiene, and avoiding use of public transportation to get to the workplace.
If there is an isolated office space that you can use for the duration, that is safer than a room full of cubicles. Disposable masks are not all that protective, although they will cut down on some droplet transmission. It is recommended that disposable masks be used by transplant recipients in any public places and the workplace, as well as hospital waiting rooms, but that the best option right now is to be out of the workplace and sheltering at home for at least 30 days.
Consult with your physician about your current options. If your physician feels like you need to be working remotely or taking a leave of absence, they can write you a letter to share with your employer based on your specific situation. Here is an example of what your physician could include but it will need to be adjusted based on your specific situation. This is just a starting point.
If you are experiencing symptoms and feel you need to be seen by your doctor, call your healthcare provider before your appointment. Tell your health provider that you are concerned about being exposed to COVID-19. Some offices also offer TeleHealth, which could help you avoid any unnecessary contact.
If you are a dialysis patient, it is important that you do NOT miss your treatments. If you feel sick, please be sure to tell a member of your healthcare team. The National Kidney Foundation has up-to-date information on clinic closings and emergency resources. The CDC and American Society of Nephrology have also provided guidance to dialysis centers to help them identify and handle suspected cases of COVID-19 and to minimize exposure to other patients. If you're concerned, here are some questions you can ask the staff at your center:
- Can I wait in my car instead of in the waiting room?
- What should I do if I have any flu-like symptoms?
- Can you provide a mask for me to wear during my treatment?
- What procedures do you have in place if you suspect a patient at the center may have COVID-19?
- How will you inform patients of any emergency information?
- Where will I receive dialysis if I get sick?
Check out this 3-Day Emergency Diet Plan. It does not take the place of dialysis but can reduce the waste that builds up in your blood in an emergency were you unable to get your treatment.
Listen to what COVID-19 means to kidney patients by watching this presentation by Alan Kliger, MD, with the American Society of Nephrology (ASN) and Shannon Novosad, MD with the Centers for Disease Control and Prevention (CDC),
Guidance for post-transplant patients
If you are a post-transplant patient, due to your need for immunosuppressive drugs, you may be at a higher risk for becoming seriously ill from COVID-19. If you feel sick, please be sure to tell a member of your healthcare team. If you're concerned, here are some questions you can ask the staff at your center:
- What should I do about having medications on hand?
- If I am feeling sick, should I contact my primary care doctor?
- If I am feeling sick, should I contact the transplant center?
- Should I wear a face mask when I need to have labs?
Guidance for pediatric patients
So far, it is not well understood whether pediatric kidney disease patients are at a higher risk for more serious illness, but pediatric nephrologists recommend following the advice from the CDC that has been issued for the elderly, especially if they are receiving immunosuppressive drugs.
While taking the precautions listed above, it is also important to have a plan in the case that you do get sick with COVID-19:
- Talk with family and caregivers
- Establish how you will stay in touch if you need to be isolated
- Know important contacts:
- Dialysis facility
- Medical providers
- Care providers
- Determine who can provide care to you if your caregiver gets sick
If you feel sick or think you might have been exposed:
- Call your dialysis or transplant center and primary care providers to let them know your symptoms.
- This will help them appropriately prepare for your treatment or appointments.
- Know when to get emergency help by looking for the following symptoms:
- Difficulty breathing or shortness of breath
- Persistent pain or pressure in the chest
- New confusion or inability to arouse/drowsiness
- Blueish lips or face
Stress associated with the outbreak of COVID-19 is normal and may be different for each individual. Stress may include:
- Fear about your own health or about the health of someone you care about
- Difficulty sleeping or changes in sleep patterns
- Changes in eating patterns
- Difficulty concentrating
- Chronic health problems can worsen
- Increased use of alcohol, tobacco, or other drugs
Things you can do:
- Give yourself a break from news and social media
- Take care of yourself
- Deep breathing or meditation
- Eat healthy, well-balanced meals
- Get plenty of sleep
- Find time to relax and unwind
- Find time to do things you enjoy
- Connect with others and discuss how you are feeling
For more tools for managing stress and anxiety check out these free apps:
Calm - App for Meditation and Sleep
Headspace - Mindfulness for your everyday life
Innerhour - Find time for self-care
Moodpath - Your Mental Health Companion
Learn more about helping children manage their stress and anxiety here.
Here are some call lines for questions regarding COVID-19:
- Colorado Health Emergency Line for Coronavirus: 1-877-462-2911
- Colorado Crisis Services: 1-844-493-8255
- 2-1-1 is a confidential and multilangual service connecting people to vital resouces across the state
- CO-HELP (303-389-1687) is Colorao's general help line for any questions regarding COVID-19; it's available in multiple languages
Feeling down or blue? Check out these articles on how to feel like a better you!
If there is a virus outbreak in your area and you need to decrease your risk of getting sick, it's important that you have shelf-stable food (foods that last a long time without spoiling, such as canned foods) in your home. It's important to prepare now by stocking up 2-3 weeks' worth of healthy, kidney friendly foods, fresh water, and medicines. This will help reduce your risk of infection by allowing you to avoid crowded spaces like grocery stores and pharmacies.