Covid- 19 for Liver Transplant Recipients
March 30, 2020
What is COVID-19 ?
COVID-19 is a respiratory disease caused by SARS-CoV-2 virus (novel Coronavirus). It is a RNA virus, identified in December 2019 in Wuhan, China and possibly got transmitted to human beings from an animal source. Since it is a new virus, our immune system is not fully equipped to fight this enemy. In many individuals, it just passes off like a “flu illness” but it can be severe in selected population with low immunity.
What are the symptoms of COVID-19 ?
- The common symptoms of COVID 19 are acute onset fever, cough, sore throat, sneezing and breathlessness. These patients have reported fatigue, body aches and loose stools. Remember that breathlessness, low oxygenation, loss of consciousness/lethargy, cold extremities and absent urine output are suggestive of serious COVID 19 infection and is a medical emergency.
- Many adults can be asymptomatic or have only mild symptoms, but they can still infect others similar to individuals having severe symptoms. Someone who is in the incubation period can also transmit the virus.
Who all are at risk ?
This virus respects no boundaries of age, gender, nationality or ethnicity.
As per the literature available, the majority of patients may be asymptomatic or only develop mild symptoms. Older patients and those having chronic diseases (diabetes, hypertension, cancer, chronic lung disease) and those who are immune deficient (post-transplant or on chemotherapy) are more susceptible to COVID-19 compared to healthy individuals.
How does the virus spread ?
The main routes are droplets (someone sneezing, coughing) and also through surfaces contaminated by the virus. Study says the virus can persist for hours to days on the contaminated surfaces emphasising the importance of hand hygiene. Other possibility is through faecal shedding of the virus, particularly in asymptomatic carriers.
How to protect yourselves from COVID 19 ?
- No definite drugs are available to combat COVID 19 right now. Vaccine trials are in the early stages and the scientific world is striving hard for an early solution to this problem.
- Washing hands with soap and water: This is highly recommended against COVID 19, Should be done for atleast for 20 seconds. Remember washing with plain water is not very effective.
- Hand sanitizer: If soap and water is not available. Look for one that is 60% or higher alcohol-based.
- Social distancing (at least 1 metre) : This is the only practical way to reduce COVID 19 spread. Aim is to reduce close contact with other individuals even if they appear healthy. This means staying home as much as possible and avoiding public places where close contact with others is likely. On any signs of a respiratory infection or risky exposure, the person and the co- habitants should isolate themselves for a period of 14 days and get themselves tested as per the country’s government policy. Don’t get tempted by seeing some “law breakers” going out, you are harming yourselves and everyone else by doing that.
- Some simple tips to be followed : Patients should cough and sneeze into a tissue (dispose safely thereafter) or into their arm or elbow, not into their hands. Maintain personal hygiene. No handshakes please. Gestures like “ Namaste” are more scientific especially in the current scenario.
- If you or any of your family members are working in areas where possible COVID 19 exposure is present (medical personnel, researcher, staff in screeing areas, airport staff) or coming home after going through a crowded area, please take a shower, wash your clothes, clean your bags, cell phones, etc before interacting with other family members.
- Try to avoid ‘face touching’ as much as possible (we know it is an irresistible urge but is the need of hour). Simple steps like these makes a huge difference. Wearing a mask is important as it prevents/minimises ‘face touching’ and is recommended in patients on immunosuppression. While using a mask, remember not to touch the inside while tying and untying the mask. Change a wet mask as soon as possible.
What to do if you or your family member has symptoms of COVID-19 or a viral flu?
Remember that all “‘flu’s” are not COVID-19. However, any flu-like condition can’t be taken lightly in the current scenario. In such instances, it is important to physically isolate the individual having symptoms. The patient and the co-habitants should wear masks. Ensure good hydration and monitor the symptoms. Inform your transplant team immediately, so that they can advise you regarding the need for a hospital visit. Please remember that in the current scenario, hospitals are likely to be inundated with patients with flu-like symptoms. The safest place for a person with flu-like symptoms is actually his/her home. However, if any symptoms are worsening, then a careful assessment by a doctor and treatment in a hospital may be the safest option. Your doctor will be able to advise you regarding the best option.
What to do with the immunosuppressive medications?
- Never stop or change your immune-suppression medications without informing your transplant team. Any sudden change in these medications can place the liver graft at risk and complicate treatment. Remember, your physician has the experience of treating many such similar case scenarios and will advise you if any change is required. Following a recommendations from an unreliable internet source is not a good idea.
- Given the uncertainty regarding the current lockdown situation, please ensure that you have sufficient medications for at least a month.