Efficacy and Safety of Hospital-Based Group Medical Quarantine for Dialysis Patients Exposed to Coronavirus Disease 2019

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Efficacy and Safety of Hospital-Based Group Medical Quarantine for Dialysis Patients Exposed to Coronavirus Disease 2019

The COVID-19 pandemic posed unique challenges for vulnerable populations, particularly patients undergoing hemodialysis (HD). These individuals face heightened susceptibility to severe outcomes due to frequent travel between homes and dialysis centers, prolonged exposure in shared treatment spaces, and underlying comorbidities. This study evaluates the efficacy and safety of a novel hospital-based group medical quarantine (H-GMQ) strategy implemented at Peking University People’s Hospital in Beijing, China, to manage 143 HD patients potentially exposed to SARS-CoV-2.

Background and Context

The case triggering this intervention involved a 78-year-old female HD patient hospitalized for uremia. While receiving regular dialysis for six months, she developed a fever on January 30, 2020. However, COVID-19 was only confirmed on February 17, 2020, after her daughter and son-in-law—who had visited her without masks—tested positive. This delayed diagnosis raised concerns about viral transmission within the dialysis center. Given the high-risk nature of HD patients, immediate action was necessary to prevent an outbreak.

Traditional quarantine approaches, such as home isolation or hotel-based quarantine, were deemed unsuitable. Hemodialysis (HD) patients require frequent dialysis sessions, making home isolation impractical. Hotel quarantines lacked the medical infrastructure to manage acute complications commonly seen in this population. Consequently, the hospital devised H-GMQ, a structured quarantine model combining infection control, continuous medical supervision, and psychological support within a dedicated hospital wing.

Implementation of H-GMQ

Taskforce and Workflow Development

A multidisciplinary taskforce (TF) was established to oversee the quarantine. Subgroups addressed specific areas: infection control, emergency response, psychological support, nutrition, and logistics. Emergency protocols were developed for:

  1. Infection Prevention: Separate quarantine zones, mandatory masking during transportation and dialysis, and stringent personal protective equipment (PPE) for staff.
  2. Medical Surveillance: Twice-daily temperature checks, symptom monitoring, and nasopharyngeal RT-PCR testing for SARS-CoV-2. Suspected cases underwent repeat testing and chest CT scans.
  3. Dialysis Management: Patients received treatments in staggered shifts within dedicated halls to minimize cross-exposure.
  4. Emergency Preparedness: Protocols for managing comorbidities, such as cardiovascular events, were pre-established.

Patient Cohort and Baseline Characteristics

The 143 quarantined patients had a median age of 61 years, with 65.7% being male. Median dialysis vintage was 6.5 years, and 62.9% had undergone maintenance HD for ≥5 years. Comorbidities included coronary artery disease (17.5%), diabetic nephropathy (18.9%), and hypertension (11.2%). Twelve patients were classified as high-risk due to direct adjacency to the index case during dialysis sessions (Table 1).

Outcomes and Key Findings

Infection Control Efficacy

During the 14-day quarantine:

  • RT-PCR Testing: All patients tested negative for SARS-CoV-2 at baseline and follow-up. Three patients developed fever but tested negative on retesting, with normal chest CT findings.
  • No Secondary Transmission: Despite prolonged exposure in the dialysis center, no new COVID-19 cases emerged. This success was attributed to preexisting infection control measures (e.g., universal masking before symptom onset) and restricted mobility of the index patient, who was bedridden.

Management of Medical Emergencies

Two critical events occurred:

  1. Acute Congestive Heart Failure: One patient developed respiratory distress and pulmonary edema. Prompt diuresis and hemodynamic stabilization were achieved using pre-established protocols.
  2. Myocardial Infarction: Another patient presented with chest pain and elevated troponin levels. Immediate antiplatelet therapy and hemodynamic monitoring led to stabilization.
    Both cases highlighted the advantage of H-GMQ in providing rapid, hospital-level care for dialysis-related complications.

Physiological and Psychological Stability

Patients’ physiological parameters remained stable:

  • Dry Weight: Slight reduction (65.5 ± 12.1 kg vs. 65.7 ± 12.2 kg; P<0.01).
  • Vital Signs: Mild elevations in heart rate (78.7 ± 10.7 vs. 74.4 ± 10.1 bpm; P<0.001) and blood pressure (systolic: 155.8 ± 18.4 vs. 153.7 ± 17.8 mmHg; diastolic: 77.3 ± 13.6 vs. 76.0 ± 12.6 mmHg; P=0.03 for both), likely due to pandemic-related anxiety.

Psychological evaluations using the Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) revealed no worsening of mental health compared to pre-pandemic scores (December 2019):

  • SAS: 41.0 ± 9.0 vs. 41.0 ± 9.0 (P=0.95).
  • SDS: 47.1 ± 11.3 vs. 46.7 ± 11.9 (P=0.71).
    Regular counseling by the psychosocial team mitigated anxiety, emphasizing the importance of integrated mental health support in quarantine settings.

Discussion

Success Factors of H-GMQ

  1. Infection Control Infrastructure: The hospital’s rigorous nosocomial infection protocols, including mandatory masking and spatial segregation, prevented cross-transmission.
  2. Timely Medical Response: Predefined workflows enabled rapid management of emergencies, avoiding delays associated with external referrals.
  3. Psychological Resilience: Continuous support counteracted isolation-related stress, underscoring the need for holistic care models.

Comparative Advantages Over Alternative Models

Unlike Fangcang shelter hospitals, which focus on isolating mild COVID-19 cases, H-GMQ prioritizes high-risk, non-infected populations requiring specialized care. This approach bridges the gap between outpatient management and hospitalization, ensuring continuity of care for chronic conditions.

Limitations and Future Directions

While promising, H-GMQ requires significant hospital resources, limiting scalability in resource-constrained settings. Future studies should explore cost-effective adaptations, such as hybrid home-hospital models or telemedicine integration.

Conclusion

The H-GMQ model demonstrated efficacy in containing COVID-19 transmission among HD patients while safely managing complex comorbidities. Its success hinged on coordinated workflows, rapid emergency response, and psychosocial support. This strategy offers a blueprint for dialysis centers and similar high-risk settings to balance infection control with essential medical care during pandemics.

doi.org/10.1097/CM9.0000000000001862

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