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Editorial
. 2022 Oct 31;4(5):253-258.
doi: 10.35772/ghm.2022.01050.

Implementation of two novel schemes for patients on dialysis as a response to the COVID-19 surge in Tokyo

Keisuke Naito  1 , Kan Kikuchi  2 , Yu Watanabe  1 , Tomoyo Narita  1
Affiliations
Editorial

Implementation of two novel schemes for patients on dialysis as a response to the COVID-19 surge in Tokyo

Keisuke Naito et al. Glob Health Med. .

Abstract

The Japanese government recommended hospitalization of patients on dialysis once they tested positive because of their high COVID-19 mortality rate and definite need for periodic dialysis. However, after experiencing the Delta variant surge, strategic changes towards outpatient care for mild or asymptomatic cases, along with strengthening emergency preparedness were needed. Facing the Omicron surge, the Tokyo Metropolitan Government introduced two novel schemes: i) a temporary medical facility with a dialysis center for infected patients on hemodialysis, which started admitting patients on dialysis on January 20, 2022, to provide additional bed capacity and access to hemodialysis and ii) a transportation scheme for patients who need travel to maintenance dialysis facilities from their homes, which was introduced on February 5. The Tokyo Metropolitan Government, cooperating with some nephrology experts, announced these schemes and urged local dialysis facilities to change strategies, providing information regarding infection prevention measures and treatments in online seminars on February 3 and 7. Consequently, promoting outpatient care did not lead to an increase in the case fatality ratio (CFR) in patients on dialysis with COVID-19 in Tokyo during the first Omicron surge (January 7 to February 10, 8.2%; February 11 to March 31, 5.5%). Furthermore, after an additional online seminar on July 20, the CFR dramatically declined in the second Omicron surge (July 8 to September 8, 1.2%). Implementation of public health intervention and careful communication with local dialysis facilities were both crucial to the strategic changes. To maintain essential health services, emergency preparedness should be cultivated during regular times.

Keywords: emergency preparedness; maintaining essential health services; policy.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.
Schematic images of the temporary medical facility with the dialysis center (A) and the transportation scheme for patients on dialysis (B). Figure 1A illustrates how the temporary medical facility with the dialysis center could provide an additional capacity of beds between hospitals and homes. Figure 1B shows the scheme of transportation of patients needing dialysis from their homes to maintenance dialysis facilities (mainly clinics) or other temporary medical facilities.
Figure 2.
Figure 2.
Weekly new positive cases and deaths in patients on dialysis from January to early September 2022 in Tokyo. The weekly number of reported deaths (bar) and new positive cases (dotted line) is shown from the beginning of the first Omicron surge to the second surge. The temporary medical facility with the dialysis center started admitting patients on dialysis on January 20, 2022 and the transportation scheme started on February 5, and they were subsequently announced on February 3 and 7. Four periods for calculating the case fatality ratio are indicated. Data were derived from weekly cumulative data released by the Task Force Committee. The number of weekly new positives (deaths) was calculated by comparing the cumulative numbers of positives (deaths) in consecutive weeks.
See this image and copyright information in PMC

References

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