Exclusive: Huge covid death rate among vulnerable patients who have to travel to hospital

UK Renal Registry data shows that, from March to November 2020, 3.3 per cent of all in-centre haemodialysis patients have died from covid (662 deaths out of a population of 20,000). This figure compares to a death rate of approximately 0.7 per cent in all those aged over 80 and 1.8 per cent in over 90s.

Although the government classifies dialysis patients as clinically extremely vulnerable to covid-19, not all patients are able to receive dialysis at home and those receiving inpatient treatment still need to travel to dialysis clinics, either in main hospital buildings or smaller satellite clinics, three times a week.

At present the Joint Committee on Vaccine and Immunisation covid-19 vaccine prioritisation list ranks all dialysis patients at priority level four, alongside all other shielding patients and those aged over 70. Priority one covers all care home residents and staff, while priority two covers all over 80s and frontline health workers.

The Renal Association wrote to Public Health England and JCVI over the weekend to ask for a change in vaccine prioritisation but, at the time of writing, has not received a response. The fact the patients have to regularly visit healthcare sites may also mean they are practically well-suited to vaccination (see box below).

One of the most ‘effective health interventions ever’

Graham Lipkin, consultant nephrologist and president of the Renal Association, told HSJ: “The risk of infection [for] in-centre dialysis patients is very high and their mortality is very high as they have serious illness but cannot shield like other CEV patients.” This is because they have to travel to and from hospital for the dialysis.

Dr Lipkin added: ”The kidney community and NHS England together have gone through every lens to try and protect this group, from covid screening to transporting these patients on their own rather than in groups, but we are losing three to five people a day. We want these patients to be brought up to the highest vaccine prioritisation group as their risk from covid is the same if not higher than people in nursing homes.”

He added the vaccine could be one of the most “effective health interventions ever” for this group as the Renal Association has estimated vaccinating between 35-50 people who are receiving inpatient dialysis “could save one life”.

A recent report, published in the journal PLOS One in October, also said the dialysis death rate is “likely higher than nursing home residents”. 

Wei Shen Lim, covid-19 chair for JCVI, told HSJ: “The JCVI’s advice on covid-19 vaccine prioritisation was developed with the aim of preventing as many deaths as possible. As the single greatest risk of death from covid-19 is older age, prioritisation is primarily based on age.

“It is estimated that vaccinating everyone in the priority groups would prevent around 99 per cent of deaths from covid-19”.

An NHS spokesperson said: “Renal networks support co-ordination of care for patients who need access to dialysis either in hospitals or in dedicated facilities, and covid is also a cause of higher need for certain renal services. National guidance was published with [National Institute for Health and Care Excellence] and each areas has policies in place to ensure infection control measures cover travel to units and the care delivered in the unit.”