Coronavirus Disease 2019

All hospitals and emergency departments in Los Angeles County are experiencing an extreme surge of patients due to the COVID-19 pandemic. Dialysis centers should make every effort to avoid contributing to hospital overcrowding by continuing and maximizing outpatient dialysis and support for patients, including those who are clinically stable patients with COVID-19.

Thank you for your support and for all that you are doing to protect the health and well-being of your patients during these extraordinary times.

Over the past month, emergency department and hospital resources have been overwhelmed as hospitalizations have continued to increase in Los Angeles County. Many COVID-infected dialysis patients are being referred to emergency departments for care. Others are being held unnecessarily in hospitals because they are having difficulty returning to their usual dialysis sites to continue their care after discharge. It is critical that the entire healthcare community, including dialysis centers, consider all opportunities to decrease the strain on the County’s emergency and inpatient facilities.

• Do NOT send COVID-19 infected patients to the emergency department unless medically necessary (e.g., hypoxemia, dyspnea).
• Follow the recommended strategies for discontinuation of COVID-19 isolation precautions, per LAC DPH guidelines and CDC guidelines. Once a COVID-infected individual has completed their period of isolation, they should no longer be cohorted with other infectious COVID-19 patients. These spots/chairs can then be used for other individuals who are still requiring isolation for COVID-19
  • Do NOT use viral testing (RT-PCR or antigen) to discontinue isolation in infected individuals except for severely immunocompromised patients (ex: recent recipient of bone marrow transplant or CAR-T cell therapy). Patients can shed non-infectious viral RNA for an extended period of time after infection. Persons who have recently recovered from COVID-19 infection do not need to be re-tested for 90 days after onset of initial illness unless they develop new symptoms consistent with COVID-19 illness. Please see Patients with a History of Recent Recovery from COVID-19 for more information.
  • Providers should be aware that many patients with COVID-19 will continue to experience symptoms (such as fatigue) for months after their illness. As long as symptoms are improving, these individuals are no longer infectious 10 days after symptoms first appeared and at least 24 hours after last fever without use of fever-reducing medications. For patients with severe/critical COVID-19 disease or severe immunocompromise, the CDC recommends extending the duration of isolation to 20 days from illness onset.
• Review center staffing policies and consider adjusting staff ratios to maximize dialysis access for patients without compromising safe care.
• Consider extending operational hours to allow more patients to receive lifesaving dialysis (example: extending from 3 shifts to 4 shifts each day).

If your facility is experiencing staff shortages due to multiple employees being sick or unable to come to work, please submit personnel resource requests to Los Angeles County Department of Health Services - EMS Agency to request additional staff.

• Reddinet users – submit your request using the Resource Request module.
• Non-ReddiNet users – submit your request via laemsadutyofficer@dhs.lacounty.gov

The EMS Agency will distribute a list of medical van transportation companies so you can arrange transportation for your dialysis patients. If your patients continue to have difficulty finding transportation to a dialysis center, please submit a resource request to the Los Angeles County Department of Health Services - EMS Agency via ReddiNet or duty officer email and they will provide a list of ambulance companies that will transport dialysis patients.