COVID-19 Outbreak: Tips for transplant patients and those on immunosuppressants

What is COVID-19?
It is a virus that causes a respiratory illness which can be mild for some and very severe for others.

What are the signs & symptoms of a COVID-19 infection?
Common symptoms include fever (temperature ≥ 37.5°C), cough, sore throat and shortness of breath. Some people also have gastrointestinal symptoms like tummy aches and diarrhea. Those with more severe disease may have constitutional symptoms like fatigue and muscle ache.

If you are on immunosuppressants, your symptoms may be different and possibly more severe. Inform your doctor EARLY if you do not feel well.

How is COVID-19 spread?
Person-to-person spread is the main way of disease transmission. This occurs between people in close contact with one another (<2 metres), or through respiratory droplets when an infected person coughs or sneezes.

It may be possible to acquire COVID-19 by touching surfaces and then touching your face.

When do these symptoms start?
Symptoms can start anywhere between 2 days to 2 weeks following exposure to the virus.

Who is at risk of getting very sick from COVID-19?
Data so far shows that adults > 60 years old and people with chronic medical conditions such as diabetes mellitus, chronic kidney disease and heart disease tend to have a more severe illness.

How to prevent COVID-19 infection?
1. Good Hand Hygiene
• Wash your hands with soap & water for at least 20 seconds (sing “Happy birthday” twice); or
• Use an alcohol-based hand sanitizer that contains ≥60% alcohol.
• Clean your hands before & after touching your face, after touching public surfaces in a public place.

2. Clean & Disinfect surfaces
• Routinely clean frequently touched surfaces such as tables, door knobs, light switches, drawer handles, water taps, cell phones, toilets.

3. Practice Social Distancing
• Keep a distance of at least 2 meters between yourself and others in public areas.

What should we avoid?
1. Do not stop or reduce your immunosuppressants without consulting your doctor.

2. Avoid frequent contact between patients & health care workers. Call your Transplant Physician, nephrologist or clinic if you feel unwell. Do not turn up in the clinic unannounced.

3. Avoid touching your face as much as possible. Wash your hands right after touching your face.

4. Avoid touching frequently-used public areas eg. lift buttons, door handles, handrails. Use a tissue if you must touch something, then dispose of the tissue.

5. Avoid crowds, especially in poorly ventilated areas.

What to do if you fall sick?
If unwell, call your Transplant Physician, nephrologist or clinic & speak to them. They will decide, after talking to you, if you need to go in to the clinic/hospital.

If you need to visit your doctor, they will plan ahead to identify you if you have fever or symptoms of a respiratory tract infection. Wear a mask before leaving your home.

Ensure you have an adequate supply of meds at home. If you have a caregiver, plan ahead to determine who can care for you should your caregiver fall sick.

Take home message
1. Be aware of warning signs of COVID-19 and have available your doctor’s contact for early medical help.

2. Have an adequate supply of medications at home.

3. Play your part with good hand hygiene and social distancing.

This article is contributed by Dr. Angeline Goh, Senior Consultant Nephrologist and Kidney Transplant Physician practicing at Mount Elizabeth Hospital, Singapore.

She has more than 20 years of experience in clinical medicine, and has spent more than 10 years caring for kidney transplant recipients and donors. Her subspecialty interest lies in Kidney Transplantation. Throughout her career, she has facilitated more than 100 Living Donor Kidney Transplants.

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