There is a benefit of home therapies that we’ve never talked about. I’ve been a bit hesitant to bring it up because when you consider the worst case scenario … well the worst case scenario is very bad. Very, very bad. I go back and forth on how likely it is … and for this year or next year the chances are low. However, if you talk about the chance of a pandemic happening over a span of time - in the next 20 years - then I think you have to consider the risks. So yes I’ve been thinking about the implications of a pandemic – bird flu or something else.
A pandemic would be very bad for people on dialysis. Extremely bad. Many of us have compromised immune systems which magnifies the clinical risk of getting sick but more than that incenter dialysis populations are vulnerable in a logistical sense, not just a clinical sense. Incenter dialyzors have to congregate three times a week. We rely on a functioning supply chain. We rely on the commitment of care givers.
Based on scenarios being discussed there may be periods - a week or weeks – when people will be afraid. Patients and staff afraid to go to dialysis units. For everyone from transporters to delivery personnel (people who bring us all of the supplies) fear may disrupt their willingness to work.
It is almost unimaginable. But as vulnerable as dialyzors are, we can be less vulnerable by thinking and talking about what responses we could offer. I think we’ll be better off if we consider the worst now, while we have time to prepare.
What could we do? I think we’d have to talk about switching people in mass to PD – how could that be done? At some point you’d have to think about inducing diarrhea to create a bridge over a short interruption in service. Are there other ways to create bridges over short term disruptions?
I have a beef with a lot of the reporting on the potential for a pandemic. It is hard to get a solid idea of the probabilities of a worse case scenario. Should we give it as much or less consideration as we do other natural disasters – from earthquakes to ice storms – or is this something beyond what has been seen and what is prepared for?
One thing I think we can say is that people on home therapies are in a better position to make it through either a pandemic of flu or a pandemic of fear. If either fear or flu becomes widespread incenter dialyzors will be vulnerable. A concrete thing we can all do is make sure dialyzors are on the radar screen of groups planning for a pandemic. Now would be a good time for each of us in our own communities, to write pandemic work groups, task forces and other local planning efforts ask them to make sure dialyzors are on the list of things to think about.