COVID-19

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Aims

The aim of this page is to provide links to reliable sources of information and to our local unit protocols. We have a separate page providing information about COVID-19 for patients with kidney disease.

 

High-risk groups

In Scotland, “shielding” is no longer advised and so this terminology should be avoided.  Preference now is to refer to “highest-risk group”.   It is important to keep an accurate list of this group (e.g. for management of local outbreaks / prioritisation of booster vaccination).  Guidance about / for this highest risk group is published by the Scottish Government.

How to add a patient to the “highest-risk list”:  E-mail covid.highrisk@nhslothian.scot.nhs.uk and provide: forename, surname, address, postcode and high-risk group (and helpful to also give CHI).

 

Vaccination

Fantastic leaflet giving information for health professionals working with kidney patients (June 2022).

PHS are promoting the following key messages:

  • For kidney patients, getting fully vaccinated against COVID-19 is the best way to protect against serious disease, being admitted to hospital or dying as a result of COVID-19 infection.
  • It’s important kidney patients have all the recommended doses of the COVID-19 vaccine, because they may get less protection from the vaccine than the wider population.
  • Getting all the recommended doses of the COVID-19 vaccine helps increase the level of protection for kidney patients as they may not have generated a full immune response to the first two doses.

The JCVI priority groups for Covid vaccination are given here.  A more up-to-date list of priority vaccination groups in Scotland is given here.

How to help patients in relation to the COVID-19 vaccine:

  • Direct people to www.nhsinform.scot/covid19vaccine for up-to-date information about COVID-19 vaccination.
  • Reassure your patients that community vaccination clinics will be safe and welcoming. Appointments can be made online at www.nhsinform/vaccinebooking or by calling the national vaccination helpline on 0800 030 8013. People can check their local Health Board’s website or social media for up-to-date local vaccination clinic information.

How to request ad hoc vaccination appointments:  E-mail loth.covidvaccenquiries@nhslothian.scot.nhs.uk and provide: name, CHI, contact telephone number.

 

Treatment of COVID-19

High-risk patients eligible for additional treatments can access these by phoning the local Covid team – see NHS Inform.  The phone number for Lothian is 0300 790 6769.

Treatments are now well-established (e.g. see NICE guidelines – link below).  Early anticipatory care planning is vital for ALL patients.  Complete NHS Lothian Treatment Escalation Plan (TEP) on Trak.  The ISARIC 4C score can be an adjunct in prognostication.  All patients should be given the opportunity to participate in RCTs (such as RECOVERY).

Many patients with kidney disease are eligible for treatment with neutralising monoclonal antibodies (nMABs): both in hospital and in the community.  Non-hospitalised patients will be prioritised if they meet the following criteria:

  • recipient of kidney transplant (including failed transplants within 12 months) who received B-cell depleting therapy within 12 months or were not vaccinated prior to transplantation or have an additional substantial risk factor
  • non-transplant patients who have received a comparable level of immuosuppression
  • CKD4 or 5 (eGFR < 30) even without prescribed immunosuppression

In NHS Lothian, non-dialysis patients eligible for these treatments will be identified and offered treatment via Public Health Scotland or enrolled in the PANORAMIC trial.  Dialysis patients eligible for IV Sotrovimab will receive this at the end of dialysis treatment, usually in the WGH facility (see unit protocol below).

Treatment in kidney disease

No major modification required to standard treatment.  RAS inhibitors (ACEi / ARBs) should be continued.

 

Information for patients

See our page on patient information about COVID-19 and the Kidney Care UK site.  Having CKD – particularly CKD4/5 – or an organ transplant increases the risk of death from Covid-19.  See OpenSAFELY, ISARIC and QCOVID studies (links below).  Talking about risk in the context of “normal” annual risk of death may be helpful (see David Spiegelhalter’s BMJ paper).  When talking about masks, see this great visual representation of how effective masks are at preventing droplet spread.

 

Unit Protocols

Almost all of the relevant guidance can be found here; much of it is specific for NHS Lothian.

 

External links

Core guidance

 

Society guidelines

 

Education & further information

 

Epidemiology and data visualisation

 

Core trials / papers

Observational:

Interventional:

 

Acknowledgements:  The author of this page was Rob Hunter. It was first published 17 March 2020. The date it was last modified is shown in the footer.

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