Facing new set of risks
hospital visit.
Her doctors’ office is open and observing social distancing practices, and Texas has started a phased reopening, but she said she plans to stick to telemedicine appointments, even if it means missing or postponing her quarterly blood work.
“I know that that comes with the risk of not getting all of my labs done,” she said. “But especially because Texas is so lax about it, I just don’t feel safe going outside or being in a place where I know there might be a lot of people.”
Many clinics, including the Joslin Diabetes Center in Boston, have transitioned to conducting routine visits, such as those to discuss lab results or refill prescriptions, over the phone or by videoconference. But the center is still prepared to see people in-person when necessary.
If, for example, a person with diabetes experiences changes in eyesight — such as floaters and blurry or obstructed vision — those could be caused by a burst blood vessel and must be treated immediately to prevent loss of vision, said Dr. Robert Gabbay, the chief medical officer and senior vice president of the center.
Other critical services have continued, with enhanced safety precautions. The Centers for Disease Control and Prevention estimates that about 15% of American adults, or about 37 million people, have chronic kidney disease. About 500,000 with endstage renal disease need to visit dialysis clinics three times a week for hemodialysis treatments that filter waste and extra fluids from their blood. A much smaller number of patients undergo nightly peritoneal dialysis treatments at home using a catheter in their abdomens.
Skipping some of those appointments could lead to complications like high potassium levels in the blood or heart failure that would require hospitalization, said Dr. Joseph Vassalotti, the National Kidney Foundation’s chief medical officer.
“In this time, when people are trying to stay home most of the time and pay attention to social distancing, we do have to emphasize the importance of dialysis treatments as being part of maintaining health,” he said.
It’s not clear when people with underlying health conditions will be able to return to their normal routines. Several states, including California, have started to loosen restrictions under their stay-athome orders, but there are still gaps in testing and contact-tracing capacity. Without a vaccine, epidemiologists estimate that about 70% of a population would need to contract COVID-19 to develop herd immunity and protect everyone else, but it’s not clear how long immunity would last, if it exists at all.
Abu-Samrah said she’s also hoping for a vaccine, and after seeing people in her area and nearby Huntington Beach push back against stay-at-home orders, she’s not sure she’ll feel at ease once the state reopens. And if she does get scheduled for a kidney transplant soon, she’s worried the anti-rejection medication she’d need to take would weaken her immune system more than her nightly peritoneal dialysis treatments at home.
“You’re going to have to pick and choose, I guess,” she said.