The Government of India opened up COVID-19 vaccination for those above 60 years of age and for those above 45 years with a comorbidity such as diabetes, hypertension, Kidney Disease etc. The number 45 was rather surprising. It is not even a round number like 50 or 60. I wonder if there is any scientific basis to that number.
Experts have called for vaccination to be opened up for all Hemodialysis patients. The following graphic shows why:
(Source: Kidney International, prepared by Dr. Aakash Shingada)
- Dialysis patients cannot stay at home because they need to visit the Dialysis Centre 3 times a week
- Data shows they are 5 to 20 times at higher risk of contracting the Novel Coronavirus than the rest of the population
- Once they contract the virus, their mortality rate is 10 to 430 times higher than the rest of the population
- Apart from the direct risks associated with COVID-19, if we don't vaccinate them, they are likely to reduce their dialysis frequency, increasing their mortality risk.
The above graphic is based on data from several countries. The International Society of Nephrology has issued this urgent Call to Action to prioritise all dialysis patients in COVID-19 vaccination.
We, at NephroPlus, recently analysed data related to this. Our findings are being published in an upcoming edition of the reputed International Journal, Kidney International Reports, and you can see a pre-publish version here. The following are our findings.
- COVID-19 prevalence among dialysis patients is about 20 times higher than the healthy population
- Among those who got infected, almost 99% were admitted to hospital with a mean stay of 12 days
- Mortality among those infected was about 23%, mortality among those > 55 years of age was 3 times higher than those <30 years old
- Mortality of the general population (not infected with COVID0 increased by about 3% over that of the previous year because of various reasons like reduction of dialysis frequency, moving or shutting down of some centres because of government takeover of hospitals, etc.
All this data is worrying as Dialysis patients have two things going against them. One is their increased risk of exposure to the novel Coronavirus in high-risk hospital environments. Second is their inherent kidney disease that causes their outcomes to be poorer if they contract the disease.
It is therefore very important that the Government prioritises them over even other people with comorbidities such as Diabetes and Hypertension because of their increased exposure.
One simple way of doing this is to allow Dialysis Centres to administer these vaccines. Centre administration can maintain proper records of whom they are vaccinating on similar lines that healthcare facilities are doing currently.
The Health Secretary of the Government of India, Rajesh Bhushan, said recently that there is absolutely no shortage of vaccines. In fact, vaccine doses are being wasted in what is nothing short of criminal in these times.
Why are we allowing states to waste vaccine doses when dialysis patients are dying unnecessarily? For what are we trying to control distribution of this critical, life-saving, injection? We've achieved enough goodwill now with Vaccine Maitri. We can stop exporting now and no one will change their opinion about India. Let us keep the doses within the country and vaccinate our most vulnerable.
The last twelve months have been among the most challenging for our dialysis patients. Some have lost the fight as the added burden was just too much to shoulder. Yet others have soldiered on, believing that the problems will end soon. Now that we have a solution to the problem, let us not deprive them of access to it for unfathomable reasons.
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