Navigating COVID-19 reopenings if you are on dialysis

How important is it for you to have a physical connection with others, versus your risk of becoming infected with a potentially serious case of COVID-19? As some states and localities are reopening and loosening their shutdown restrictions, you have to negotiate with yourself for the safest outcome that still gives you some joy and connection to the outside world. As I tell my patients, there are ways to both be safe and have an enjoyable time. Here is some of the advice I give them:

Can I make plans with friends?

Suppose a friend invites you to dinner for the first time in months now that restaurants in your area are open again. You consider that this would likely be an inside event with other people close by, and you cannot wear your mask when you eat or drink. You decide that this is a risky activity, but it does not mean you have to say no to your friend altogether. An alternative suggestion you can offer might be to meet your friend at the park for a picnic where you each bring your own meal or snacks. You will still get to see your friend, but this way it will be done in a much safer environment than inside a restaurant.

What if those around me do not follow the rules and are not wearing a mask?

Instead of focusing on what other people are doing, you can choose to focus on what you can control in this situation. If you are going on a walk in your neighborhood and see a neighbor not wearing a mask, you can cross the street to maintain a comfortable social distance from them. You can put your focus on listening to an enjoyable podcast or make a call to a relative, or other things that bring joy to your life. These activities deserve your time, instead of spending your time getting frustrated with people who are not wearing their masks.

What can you do when you are anxious or stressed about COVID-19?

One of the simplest things you can do is take the time you are spending alone worrying and replace that time with something you enjoy. Changing your behavior can help you have more positive thoughts and improve your mood. If you notice that you are spending a lot of time alone in your home, it might even be helpful to create a schedule that focuses on doing things you like and connecting with others. Consider scheduling time to: talk on the phone with a relative, fly a kite in the park, go for walk or hike, play an online game with a friend, or send a letter to someone you know who is isolated in a nursing home.

Another way to destress is to find a relaxation technique that really works for you. Many people are intimidated by the thought of meditating, so you might want to start out with guided meditation — try downloading a free app for guided meditation on your phone. Breathing exercises could also be relaxing, or try aromatherapy or listening to music if you prefer those. Find what works for you and stick with it!

Still staying home? Use this time to reflect on your treatments.

Having some down time is a great opportunity to reevaluate what may be the best treatment option for you in your current situation. Since you are in control of this decision, you should weigh the positives and negatives of each dialysis modality. Peritoneal dialysis and home hemodialysis give you more independence and they offer you the alternative to dialyze from the safety of your home — something that could be especially beneficial right now or for future health emergencies. In-center hemodialysis is a better fit for you if you prefer a medical professional there to do your treatments and take care of you, or if you enjoy being around other people during treatment.

If you are not already on the kidney transplant waiting list, you could take this time to find out what you need to do to get on it. You could also spend time asking people in your network to become a living donor for you or starting a social media page dedicated to spreading the word about needing a donor. A kidney transplant is major surgery but you would no longer need dialysis for as long as your transplant lasts. This might be the best choice for you if you want to return to work or increase your quality of life. 

Choosing medical management — stopping dialysis and going on hospice care — is also a treatment option that is not often discussed, but it is available.

If you are considering changing your treatment modality, discuss your situation with your nephrologist, social worker and other members of your care team. Your care team can provide you with education, connect you to resources, help you problem-solve, advocate for you, and just listen when you need it. You are not alone! Please have the courage to reach out!