LAUSR

In the last 6 months, starting from China and the Eastern Countries and spreading to Europe and the United States, a new strand of Coronavirus, SARS-CoV-2, is challenging healthcare systems world-wide [1]. The clinical course of the infection may vary from a more frequent asymptomatic condition to a mild and non-specific respiratory syndrome to, fortunately less frequent, generalized and violent inflammatory response needing ICU assistance, mechanical ventilation and sometime renal replacement therapy [1, 2]. Based on the data so far available, taking into account the possible bias related to different methods of collecting and categorizing data among the various Countries, the lethality index of the SARS-CoV-2 infection would seems not so high. Nevertheless, the fast speed of diffusion with a high rate of patients needing hospitalization and the resulting health system overload, compelled the involved Nations to adopt strict containment strategies with economic consequences that will last for many years in the future. In the absence of any specific therapies or vaccines, the containment strategies are basically oriented to achieve dilution in time of new cases and, as a consequence, to enable the health system to better handle the most demanding ones (Fig. 1) [3]. Anyway, the strategies to control the disease spreading may be very complex, due to the lack of precise knowledge about the natural history of the disease and the presence of non-documented asymptomatic or oligo-symptomatic cases, which may spread the infection and probably account for more than 80% of the total infected individuals [4, 5]. As expected, mortality is much higher in the elderly with multiple comorbidities. In this context some populations, such as dialysis patients, may have a very high prevalence and death rate for COVID-19, since they combine older age, malnutrition, cardiovascular disease, diabetes, lung disease and less efficient immune system with the need for dialysis treatment in overcrowded settings where many patients, nurses, physicians and support staff are present at the same time. A number of articles focusing on recommendations to contain the spread of infection in dialysis patients, have been released [2, 6, 7], anyway, very few reports on the real degree of diffusion of the infection and its outcome in this specific population and among people working in dialysis facilities have been published so far. Yiqiong Ma [8], from the Department of Nephrology Renmin Hospital of Wuhan University, reported 37 COVID19 positive among 230 HD patients and four cases among 33 staff members (16% of the patients and 12% among the personnel respectively). In the 37 COVID -19 positive patients, 6 (16.2%) died. Although CT images of the chest showed the ground glass like changes, symptoms were mild, and none was admitted to ICU. The Authors underline that none of them died because of COVID-19. About 15 days later, after increasing protection measures, the universal screening and the isolation of the infected cases, the risk of infection was under control and no new cases were observed. Cheng Li [9], from the Department of Blood Purification Center, Wuhan No.1 Hospital, Wuhan China, in a preprint report documents a wider experience from the same region where the pandemic started. The report records 66 out of 627 HD patients certainly infected (10.5%), and 24 cases “suspected” (i.e. the diagnosis was made just on clinical ground). The Authors treat the “suspected” cases as if they were real positives, thus, based on this assumption, the infection prevalence rate was 14.3% (90/627). The Authors do not report if the mortality rate between the two subgroups (proven infected and suspected ones) was different, however, putting it all together the mortality rate was 13.3% (12 patients out of 90 with confirmed or suspected infection). Since these two reports come from the same area of China and both the hospitals most likely use the same * Giuseppe Rombolà [email protected]