Transcript: Hot Topics in Kidney Health episode 1x21
How kidney patients should protect themselves from COVID-19 in 2022
00;00;04;28 - 00;00;26;24
Intro
Welcome to Hot Topics and Kidney Health, brought to you by the National Kidney Foundation. Each episode we highlight the latest in kidney research. Bring you up to date news in kidney care, dispel myths and answer your kidney health questions. While many people feel like the world is headed back to normal, many kidney patients are feeling left behind. The National Kidney Foundation is here for you.
00;00;27;09 - 00;00;51;12
Intro
COVID 19 remains top of mind for those who are immunocompromised, and we're here to offer resources and support. On today's episode, our guests will answer your questions about how COVID 19 affects everybody. With kidney disease, whether you have a transplant, are on dialysis or in the early stages of CKD. We'll also discuss the latest treatments that are available and how to best protect yourself as life in the COVID era continues.
00;00;52;28 - 00;01;13;27
Patrick Gee
Hello. My name is Patrick Gee. I am a former peritoneal dialysis and in center hemodialysis patient. I'm currently five years into a kidney transplant. I received my kidney transplant on April the 21st, 2017, and I currently reside in North Chesterfield, Virginia.
00;01;14;10 - 00;01;29;13
Dan Weiner
Hello there. My name's Dan Weiner and I'm a nephrologist at Tufts Medical Center in Boston and I am the medical director of DCI Boston, one of the dialysis clinics located in Boston. Thank you for having me here today. And I'm very pleased to be working with the National Kidney Foundation.
00;01;29;18 - 00;01;34;15
Patrick Gee
My first question is, should I have my antibodies tested?
00;01;35;01 - 00;02;00;27
Dan Weiner
In terms of antibody testing? I think nobody knows what the utility of doing that is right now. The CDC does not recommend testing antibodies routinely in people. That stated, there are a lot of data from dialysis and transplant populations that show that knowledge of antibodies can be informative. It can give you a good idea of who has responded to vaccines, who has a functional immune system.
00;02;01;17 - 00;02;24;26
Dan Weiner
And more importantly, I think that can give you a good idea of who's going to get sick if they do get COVID. As we moved into this Omicron phase. A lot of times people with COVID are only having mild symptoms and sometimes people have severe and life threatening symptoms and it's really hard to know who is going to have very mild COVID and who actually could get really seriously sick from this.
00;02;25;09 - 00;02;52;14
Dan Weiner
And the antibody levels do seem to predict who is going to fall into each one of these groups much better than any other data that we have. So my conclusion on this answer is that we don't know for certain. I think it's a conversation you can have with your physician. I think that there may be a role for this, particularly in dialysis and transplant, which are the most vulnerable populations to COVID and where blood tests are done fairly routinely.
00;02;52;20 - 00;02;54;14
Dan Weiner
But again, it's not standard of care at this time.
00;02;55;01 - 00;03;25;05
Patrick Gee
How many boosters should I have? I've received a total of six. I've received the two initial Pfizer vaccines that are also because of my age group and because of my kidney disease, receive two boosters. And then as of April the 26th of this year, my transplant team felt that I should get the vaccine. So that was two shots.
00;03;25;05 - 00;03;27;01
Patrick Gee
So I've had a total of six.
00;03;27;15 - 00;03;49;28
Dan Weiner
That is another fantastic question. I think the first one we're talking about this, we have to define what's meant by a booster. So the for the mRNA vaccines, that's the Pfizer vaccine and the Moderna vaccine. These are two two dose vaccines in adults. So you get a first dose and then 3 to 4 weeks later, you get a second dose.
00;03;50;28 - 00;04;15;16
Dan Weiner
For populations that have immunocompromised and the CDC uses the term moderate to severe immunocompromised, you actually don't get a booster right away. You actually get a third dose. And the third dose counts as part of the initial vaccine series. So people with immuno compromised their initial vaccine series is a three dose series rather than a two dose series like it is for most of the population.
00;04;16;14 - 00;04;41;09
Dan Weiner
After the two or three dose series, people then can go on to get a first booster. And as of right now, you can get a second booster four months after the first booster. So in general, the booster recommendation right now is up to two boosters for anybody who has comorbid conditions or age over 50, this could amount to as many as five shots at the current time for people who are immunocompromised.
00;04;41;21 - 00;04;52;01
Patrick Gee
My next question is am I immuno compromised? If I'm in the early stages of CKD and what about if you're on dialysis?
00;04;52;10 - 00;05;22;09
Dan Weiner
So immunocompromised is really hard to define and we don't always know it based upon obvious characteristics of someone. There are certain things that are suggested, some is definitely going to be immunocompromised, such as somebody who has a kidney transplant and they're taking immunosuppressive medications to keep their transplant working. Those those people are definitely immunocompromised. People have serious immuno compromising illnesses like advanced AIDS, for example, HIV.
00;05;22;22 - 00;05;52;18
Dan Weiner
We know our immunocompromised. And there's some unusual, rare diseases that are commonly immunocompromised people who are on chemotherapy or immunocompromised. Then you have a whole group of other people where there's a lot less certainty for most people with early and even moderate stage CKD. So people stage one, stage two, stage three, they're probably not very immunocompromised unless they have another one of these conditions for transplant recipients.
00;05;52;18 - 00;06;32;15
Dan Weiner
They're probably all moderately to severely immunocompromised, where the biggest area of uncertainty plays is, is with the dialysis population. And you have some people who are getting dialysis who are immunocompromised, some people who are not immune compromised. And it's really hard to tell the difference between these based on usual clinical characteristics. So if I have somebody who have two people on vaccinating as a dialysis doctor in the dialysis unit, I'm not necessary going to be able to predict which of these two is going to respond to vaccine and and who isn't going to respond to vaccine based upon what I know about them.
00;06;33;22 - 00;07;10;10
Dan Weiner
We have a lot of experience with this actually in the dialysis. When we look at hepatitis B vaccination, this has been something that's been around for a long time. And every dialysis unit measures the antibody response to the hepatitis B vaccine. And when that antibody response drops, when it wanes, you immunize. This could be a role for actually checking antibodies in dialysis patients because we don't know who's going to have more rapid waning of their immunity and we don't know who's going to have that initial response to vaccine, which basically means we don't know who precisely is going to be moderately immunocompromised.
00;07;10;23 - 00;07;37;26
Dan Weiner
In my opinion, that's why there may be utility in checking antibody levels. And it's also why I at least defined all of the dialysis patients that I care for as being moderately immuno compromised upfront and gave them all a three dose initial vaccine against COVID. Because I thought that these are high risk individuals who are congregating. They're all coming together for those to do hemodialysis hemodialysis unit.
00;07;38;05 - 00;07;47;04
Dan Weiner
And I wasn't going to be able to tell who's going to get a response. So I made sure that we could optimize whatever response that were going to get with a three course initial vaccine.
00;07;48;05 - 00;07;53;01
Patrick Gee
Can you define and describe the differences between antibodies and vaccine?
00;07;53;05 - 00;08;37;03
Dan Weiner
Vaccines basically are given to make your body make antibodies. So vaccines stimulate the body any one of a number of ways, but they basically introduce usually a component of a virus. In the case of COVID or SARS-CoV-2, that the body then recognizes as foreign and makes an antibody to it. So vaccines lead to antibodies being present. When we have antibodies, you can actually get those in one of two ways or one of three ways you can be exposed to the virus itself and make antibodies can be exposed to a vaccine and create antibodies, or you can actually be given antibodies that are artificial or from someone else.
00;08;37;16 - 00;08;59;29
Dan Weiner
So the antibodies that are officially you may or may not have heard the term monoclonal antibodies. And these are antibodies that were created in the lab to treat people with COVID 19 early in the pandemic, people were given convalescent plasma. So these are people who had already had COVID to donate their plasma parts of their blood. The part of the blood that has antibodies in it.
00;09;00;11 - 00;09;14;23
Dan Weiner
And those antibodies would go to other people and would help fight off the virus that causes COVID 19. The key thing here is that vaccines lead to antibodies, and that's why they're protective. And having antibodies is what protects your body against severe infection.
00;09;14;23 - 00;09;37;00
Patrick Gee
What if you still do sit up, take it. Now, I have taken it because my transplant center recommended that I take it now. I knew I wanted to take it a while prior to that, but the availability of the vaccine was very limited.
00;09;37;21 - 00;10;15;26
Dan Weiner
That is a great question about as a shield. Every shield is an antiviral drug. It basically is directed against parts of the virus that causes COVID 19, the SARS-CoV-2 virus, against the spike protein. And it hangs around for a while. So it gives you prolonged protection against COVID 19. It can be used as a prophylactic or preventative agent, where the guidance is, is for people with moderate to severe immunocompromised to get this to prevent them from getting COVID over the next six months or so.
00;10;16;07 - 00;10;43;17
Dan Weiner
Or if somebody has a contracted case into the vaccine, they can get a shot to prevent them from getting COVID moving forward. There are some uncertain risks with this drug. So it's relatively it's obviously new. And in the initial paper, there is a potential small but significant increased risk of adverse events in people with cardiovascular disease or cardiac risk factors.
00;10;43;17 - 00;11;09;03
Dan Weiner
Again, this is a small risk, especially in the time of a surge. The risks associated with a shield are probably a lot lower than the benefit that somebody who's immunocompromised can get from taking it and get from preventing them from getting sick. With COVID in times of really low prevalence, that calculation between risks and benefits, it comes a lot less certain.
00;11;09;26 - 00;11;30;19
Dan Weiner
And if there is a risk with the drug and there's not a lot of COVID around, it may not be a good time to take that drug. I think particularly when you are looking at people who have kidney disease, we know that there is a lot of cardiovascular disease and a lot of cardiac risk factors in people with kidney disease.
00;11;31;10 - 00;11;56;12
Dan Weiner
In fact, kidney disease itself is a risk factor for cardiovascular disease. We know this well. So that kind of automatically puts people with kidney disease, especially those that have had advanced kidney disease like dialysis and transplant, potentially in a higher risk group with average. So of course, the counter with that is that people have had transplants and people who are receiving dialysis are also the people who are most immunocompromised.
00;11;56;27 - 00;12;38;11
Dan Weiner
So there's clearly a very difficult balancing act with this medication. Personally, in times of really high prevalence with a dangerous variant of COVID, I think that the benefits outweigh the risks and people who are immunocompromised. I also think that this is an area where maybe I would check some of these antibody levels if somebody is able to make antibody, if they're able to respond to vaccine and maybe they are not someone you would give ever shelter, because those antibody levels, the presence of the response to the vaccine doesn't mean that you can't get COVID, but what it means is that you're much less likely to get really sick from COVID, and that's really important.
00;12;38;11 - 00;12;45;26
Dan Weiner
And that may help guide my determination between who the balance between the risks and the benefits of this does.
00;12;46;03 - 00;12;51;15
Patrick Gee
What should someone do with kidney disease that tests positive for COVID 19?
00;12;52;02 - 00;13;13;28
Dan Weiner
I think the first thing to do if you test positive for COVID is not to panic in 2020. That may have been different. If we were talking in the spring of 2020. It's amazing how much we've learned in two years. It's equally amazing how much we don't know. But the first thing to do is not to panic. What we know right now, especially in people who are vaccinated, it is the vaccines really do work.
00;13;13;29 - 00;13;41;23
Dan Weiner
Vaccines are fantastic. They're incredible. They're miraculous. They don't prevent you from getting COVID because that's not how vaccines work. What they do is they prevent the virus that causes COVID from taking hold and really making you sick. So people who are vaccinated where they have an immune response tend to not get very sick from COVID. Again, that doesn't mean that you are going to get some body aches and upper respiratory symptoms and things like that.
00;13;42;17 - 00;14;13;01
Dan Weiner
It just like any other virus, it can make you feel pretty. I mean, medical term pretty crummy, but if you're vaccinated, the chances of you getting very sick from COVID are relatively low. I think the second thing to do for people with kidney disease, because people who have kidney diseases are generally a lot more vulnerable, is to notify your health care provider, whether it's your primary care doctor or if you are someone who gets dialysis, the dialysis facility, some of the transplant at your transplant.
00;14;13;01 - 00;14;35;03
Dan Weiner
Doctor, I would definitely take the next step and notify that person or that team of people immediate for earlier and moderate stage. CKD is a good likelihood that you may not do anything, especially if you're vaccinated and you only have very minimal symptoms. That's stated. If you have other risk factors or other problems or you're starting to get fevers, you're starting to feel worse.
00;14;35;03 - 00;14;58;29
Dan Weiner
There are a lot of treatment options that we'll talk about in a minute or two. For people with transplant, you have a lot lower threshold for treating them because even with vaccination, there's a certain degree of immunocompromised and some greater vulnerability. And the transplant teams or infectious disease specialist may be able to advise on the right treatment for that person at the right time.
00;14;58;29 - 00;15;30;11
Dan Weiner
For people who are getting dialysis, you have the additional wrinkle that most of these people go to hemodialysis units. And so you're congregating with a lot of other people who are also potentially immunocompromised. And there you're notifying the dialysis unit not only to be able to engage in treatment for yourself, but to also make sure that precautions can be taken in order to prevent you from spreading COVID to other people, other dialysis patients you may be surrounded or the staff who are moving from dialysis patient to dialysis patient.
00;15;31;00 - 00;16;02;00
Dan Weiner
And that's a really important aspect there. So if you test positive, I think you shouldn't be shy about calling a health care professional and letting them know. And that person is hopefully going to advise you as to what sort of options you have to treat this for earlier stage CKD there's also the option of tax levied. This is not an option in dialysis patients and it can be problematic and people who are kidney transplant recipients because it interacts with some of the medications.
00;16;03;07 - 00;16;08;07
Dan Weiner
But for earliest CKD, I think that's something that is pretty widely and very safely.
00;16;08;28 - 00;16;13;21
Patrick Gee
What should I do if someone close to me test positive for COVID 19?
00;16;14;02 - 00;16;45;05
Dan Weiner
That's a great question and that can be really scary, especially if it's somebody who is a care partner who is helping you with home therapies and other issues like that. I think the first thing is don't panic. I think that especially if you're vaccinated, the risks of getting sick are much lower. And it really emphasizes the importance for for population of people with kidney diseases to get vaccinated to protect against these various circumstances.
00;16;45;22 - 00;17;07;14
Dan Weiner
If somebody close to you test positive, you're going to try to physically distance as best possible. This may mean going to separate rooms. If it's somebody who lives with you, trying to have some one person stay downstairs, one person stay upstairs, have as much contact as possible. Outdoors, outdoors is a very safe area in terms of avoiding spread of virus.
00;17;07;19 - 00;17;31;20
Dan Weiner
Outdoors is big and there's breezes and wind and things just don't get trapped around. I also think that if that's the case, it's important to be vigilant, to see if you're going to end up also contracting COVID. And the reason to be vigilant about this is that there's also a lot of treatments that are available if you do get COVID.
00;17;32;24 - 00;18;00;25
Dan Weiner
This includes for people with earlier stage CKD medications like Paxil, Avid, and for people with later stage CKD. If they get symptoms or have concerns or other high risk factors, things like monoclonal antibody and remdesivir that can be used to treat. But the most important thing is not to panic. And the second most important thing is to remember you're not expected to know the answers to all of this stuff, and that's why your medical teams are for today.
00;18;00;25 - 00;18;14;06
Dan Weiner
You can call your doctor for or call the dialysis unit for or call the transplant team for and ask them what you should do. Because I can guarantee you that at this point in the pandemic, pretty much every health professionals answer to this question already.
00;18;14;06 - 00;18;19;16
Patrick Gee
Thank you. If I have or develop long COVID, how can I best take care of myself?
00;18;20;14 - 00;18;46;07
Dan Weiner
That is a great question. If I knew the answer to that question, I would be a very successful researcher and doctor right now. And it gets into the question of what exactly even is long COVID and obviously as people who have prolonged symptoms after having an acute episode of COVID 19. But it's a difficult diagnosis to make and I think it's a particularly difficult diagnosis to make.
00;18;46;07 - 00;19;13;03
Dan Weiner
And people who have a chronic disease, like chronic kidney disease, if you take people who are treated with dialysis, the symptoms associated with their kidney failure and their dialysis treatments aren't really all that different from symptoms that people report with long COVID and differentiating between these is going to be really difficult. I think the best thing that somebody can do if they have symptoms consistent with long COVID, this is to try to do their best to take care of themselves.
00;19;14;05 - 00;19;31;14
Dan Weiner
I think staying engaged, trying to exercise and move around as much as possible, find a good diet. All of the things that we advise for anybody who has chronic kidney disease would also be true for somebody who has symptoms of Long-Covid.
00;19;31;24 - 00;19;36;25
Patrick Gee
What preventative therapies or treatment are available if I get COVID 19.
00;19;37;03 - 00;20;02;09
Dan Weiner
So there's a whole lot more treatments available now than there were in early 2020. And there are some treatments that actually have proven benefits and proven effectiveness. I think. I mean, use the word preventative and I mean that highlights treatment one, two, three, four and five on the list here, which is vaccination, vaccination, vaccination, and then vaccination and vaccination.
00;20;02;09 - 00;20;27;10
Dan Weiner
There's no better treatment out there than making sure that you are vaccinated and boosted according to current guidelines and staying up to date with those guidelines. Vaccines can't prevent you from getting COVID 19, but what they can do and what they can do is amazing. Effectiveness is prevent you from getting really sick from COVID 19. And that's really the most important step.
00;20;28;02 - 00;20;47;26
Dan Weiner
If you do get COVID and symptoms are very minor and you're vaccinated, a lot of times you don't have to do anything if you have other risk factors or you're starting to get other symptoms. There are some treatment options that are available for people who have earlier stage kidney disease, even down into late stage three, maybe even early stage four.
00;20;48;03 - 00;21;14;27
Dan Weiner
Although I think the cutoff is is GFR 30. Actually, that can be an option. That's an antiviral drug that is very effective at preventing COVID from becoming severe and it's been used very widely. There are a lot more reports these days of sort of a rebound or a return of symptoms several weeks after taking parts of it. Again, though, people haven't been very sick, haven't been hospitalized, sick in that particular situation, however.
00;21;14;27 - 00;21;41;10
Dan Weiner
So that's a good option for people with much more advanced kidney disease, including those receiving dialysis. The primary options at that point are probably monoclonal antibody therapy. So these are manufactured antibodies against COVID that can help your body fight off. The infection is usually given via an injection and you have to go to a facility to get that or they're home services that can give that to you.
00;21;41;14 - 00;22;13;02
Dan Weiner
The other treatment is a drug called Remdesivir, which is another antiviral, and this has been used widely in advanced CKD in dialysis there early on with some concern that remdesivir of the Remdesivir itself, but the carrier that it was mixed with in order to be able to inject it, could be bad for people with kidney disease. This has been looked at moderately well and it seems that the doses that people will get if they're getting three doses, remdesivir are really not very high and shouldn't be associated with any toxicity.
00;22;13;09 - 00;22;36;01
Dan Weiner
So this also presents another good option for treatment. These are all outpatient treatments. Obviously, if you're sick, if you're having trouble breathing, shorter breaths, lots of symptoms coming to the hospital. There are other treatments that can be offered. High dose steroids are sort of the mainstay for serious respiratory illness associated with COVID. And there are a lot of other options in the hospital.
00;22;36;20 - 00;22;57;20
Dan Weiner
And if you are sick, you should definitely get further attention because there are options that even if you're only a little bit sick, it's worth reaching out to your your physician or your care team to see what other options you can access as an outpatient that can hopefully prevent you from getting into trouble and from needing more aggressive or intensive care, moving down the road.
00;22;58;15 - 00;23;32;06
Patrick Gee
Yeah, because I can relate to everything that you just talked about in March of 2020, both my wife and I contracted COVID. For me, it took approximately four times for me to actually get tested. Every time I would go back to my transplant center to get tested, they kept telling me I wasn't sick enough even though I had the initial runny nose fever, chest congestion and cough.
00;23;32;23 - 00;23;55;22
Patrick Gee
The fever wasn't hard enough. And it got to the point on the fourth time believe my fever was at 103.6 or something like that before they was like, okay, well let's go ahead and test you. By the time I got my test, I had to end up waiting ten days for the results. In between that time, my wife went to the hospital.
00;23;55;22 - 00;24;22;15
Patrick Gee
She was sent back home saying that all she had was the flu. Two days later, I took her back. She was admitted for pneumonia and then the next day she tested positive for COVID 19. She stayed in the hospital for six days. So by the time she was released, I was told at that particular time that the only treatment for kidney transplant recipients was hydroxychloroquine.
00;24;23;09 - 00;24;53;13
Patrick Gee
I really did not want to take it. But when my transplant nephrologist was like, Well, we looked at the patients in Seattle, Washington, we looked at the patients in New York and then Columbia University, I believe, did a research study. It was the only thing available. So they gave me a seven day prescription for hydroxychloroquine. On that eighth day, things started getting worse.
00;24;53;13 - 00;25;26;04
Patrick Gee
I started suffering with chronic fatigue, had joint pains, palpitations, very dizzy, lethargic. I couldn't eat, you know, I was just a ball of confusion. And after probably about five days of this, my nephrologist was like, Well, I'm going to put you in the hospital. We're going to run some tests to see what's going on. When I got out, they said, Well, at this point we really don't know what to do, so we are just monitor you.
00;25;27;01 - 00;25;57;12
Patrick Gee
Then I went into long COVID after that and I stayed in long, cold until January the fifth, 2021. So long COVID, I believe like 291 days. Still having brain fog, still being fatigue, even to the point that they diagnosed me with p m or post exertional malaise. So now I have good days and bad days. I have days when I'm very energetic.
00;25;57;25 - 00;26;05;17
Patrick Gee
Then I have those days where they'll have enough staff to get out of the bed. So now I have to learn how to pace myself.
00;26;05;29 - 00;26;41;04
Dan Weiner
It's amazing how much we've learned about COVID since spring 2020. I mean, we've learned that hydroxychloroquine doesn't do anything, ivermectin doesn't do anything, and really focusing in on some of the amazing things that we do have and things that were developed so quickly is where things are. I think if we had it to do over again, the biggest I mean, the United States in the whole world, I mean, there are many successes here in dealing with such a shock to the system this this pandemic and some failures as well.
00;26;41;04 - 00;26;44;03
Dan Weiner
The biggest failure, I think, like you talked about, was the lack of testing.
00;26;44;07 - 00;27;25;20
Patrick Gee
Yes. Because in the kidney community, it was so many people that was afraid. And one of the things that we harped was nobody is including us in clinical trials. And it was it caused the panic. You know, one of the first things I learned when I got my kidney transplant was to wear a mask. Any time that I was in a large group of people or even when I travel, you know, to wear a mask to keep Clorox wipes with me, to wipe down all surfaces and stuff.
00;27;25;20 - 00;27;55;29
Patrick Gee
So, you know, when Kogut first started, we went to the mass. That was the big deal for kidney patients. The problem was when we start hearing about the development of vaccines and we were including in the clinical trials, it it really kind of vexed a lot of patients out there. I mean, through them into some serious fears and panics that was going on out there.
00;27;55;29 - 00;28;16;28
Patrick Gee
And then really nobody looked at the the behavioral health piece, you know, how COVID 19 really mentally, emotionally ward down kidney patients. So, yeah, I certainly agree on that. We've come a long way, but initially it was just a really scary time.
00;28;17;02 - 00;28;48;08
Dan Weiner
Initially, it was very hard for me. I'm lucky enough to not have kidney disease not being immunocompromised. I know, though, seeing people with this all the time that I wore masks a lot longer than many of the people around me did when going into public places. Again, not necessarily so much to protect myself because I wasn't worried about myself as much once I was already vaccinated, but rather for two reasons to help protect other people and protect people when I'm coming to work.
00;28;48;16 - 00;29;11;13
Dan Weiner
But also just to show support with because I know that there are people out there who still have to wear masks, who may not have a response to vaccines, who may be immunocompromised or more vulnerable and I think there's there's a good time to stand together as we confront something so new and novel and dangerous and somewhat scary.
00;29;11;19 - 00;29;44;18
Patrick Gee
Yeah, I certainly agree. You know, I'm really grateful for a lot of the population. I kind of understand that. But then when you get into like the politics of wearing a mask and folks get hated for wearing a mask versus non mask, whereas I mean, it is, you know, it's just kind of ridiculous to kind of argue about an individual's health and, you know, wearing a mask and not wearing a mask and stuff like that.
00;29;45;00 - 00;30;14;28
Patrick Gee
And then I can also remember the the banter with vaccinate Asians. I know some of my friends and colleagues who have kidney disease, who wanted to get the vaccines, were not able to get the vaccine because of recommendations from their physicians. And I have a couple of friends now who actually caught COVID and weren't vaccinated, and now they are feeling some regret.
00;30;14;28 - 00;30;32;10
Patrick Gee
So they themselves don't know what to do to protect themselves. So I know this may be a tough question, but if there's any recommendations that you can certainly give for those particular people, that would be much appreciated.
00;30;32;15 - 00;30;55;08
Dan Weiner
I'm not sure if I can say it often enough. Like I said before, I mean, there were some failures in the pandemic, but there were successes as well. And the vaccines, the many vaccines in particular are incredible successes. The fact we had a new technology and you were able to prove it safe and effective and get it to market and millions and millions of people in nine months.
00;30;55;14 - 00;31;26;28
Dan Weiner
That's absolutely amazing. And I can't emphasize enough to people that I see whether they're people with kidney disease, people who know people with chronic disease, which is every single person in the country, how important it is to get vaccinated and getting vaccinated. In my opinion, it's about protecting yourself, sure. But it's also about doing the right thing for the members of your community because you never know who's going to be out there, who is not going to be able to fight off an infection.
00;31;27;03 - 00;31;37;19
Dan Weiner
And you're protecting your area, protecting your neighbors and your friends and your community and your colleagues by doing this. And I think that's one of the most generous thing that people can do, even if they themselves are at low risk.
00;31;37;19 - 00;32;19;06
Patrick Gee
Yeah, I really appreciate that. Do you have any suggestions for patient advocates and what we can continue to do when it comes around this particular topic? Because, you know, we all are aware of the impact now of the before and be very and even with every field. And I think when I had my doses of every shield that made sick shots that I've had, the two original ones, I've had all the boosters and then the every sale only to find out that every cell doesn't have a lot of protection against the variant.
00;32;19;06 - 00;32;59;29
Patrick Gee
But there are still a number of folks out here that are not vaccinated. And I'm just wondering, what can we do? We've shared our stories. We share the trials and tribulations. We're lucky to be here. Even though we lost friends and families. But what can we do as patient advocates, patient ambassadors with the National Kidney Foundation to be able to go and talk to those that may be a little stubborn or talk to folks that may be a little hesitant because they just may not understand the science.
00;33;00;04 - 00;33;01;18
Patrick Gee
They may not agree with it.
00;33;01;26 - 00;33;46;28
Dan Weiner
I think that's one of the hardest questions to emerge in the last two and a half years. And it's not an easy one to answer, I think where I've had the most success in convincing people who are vaccine hesitant to go ahead and get vaccines. And this is focusing more on the general population. I'll talk about the Guinea population in a second is by making it not about them, by making it about their elderly parents or their grandparents or again, their neighbors or their friends and saying, you know, this is yeah, you make you may feel crummy for a day after getting a vaccine, but you may be saving your grandmother's life here.
00;33;46;28 - 00;34;14;15
Dan Weiner
And that that tradeoff, that realization that what they're doing is not necessarily to help themselves, but to to help society and to help others sometimes can also make a difference, I think, in terms of other factors and other individuals, one of the things that we saw, particularly with the Dallas, is population that when you bring vaccines to the Dallas population, you have a lot better uptake of vaccines.
00;34;14;22 - 00;34;37;24
Dan Weiner
And that was shown really nicely. People don't necessarily like to have to take two or three extra steps to get vaccines, to wait in line, to go to a store, to book a reservation. And the easier that you can make it, the more likely that someone is to get vaccinated. The other thing with doing it in a dialysis unit is that there are a lot of trusting relationships already in the dialysis unit.
00;34;38;09 - 00;35;05;17
Dan Weiner
Somebody who I'm seeing as a dialysis clinician who I'm seeing once a week, forever, I have a lot better chance of having a meaningful discussion about vaccination with them than does watching somebody on TV or going into a CVS, especially if they're hesitant. So if we can get rid of the barriers, bring vaccine to people and administer them in trusted environments, that can make a huge difference.
00;35;06;05 - 00;35;20;05
Dan Weiner
Trying to extend those findings to the general population is a little bit harder. But I think also trying to use trusted relationships and empowering those relationships to promote vaccination is something that we can do.
00;35;20;25 - 00;35;51;27
Patrick Gee
Yeah, thank you for sharing that. And my last question has to do with health equity and just trying to get more folks who are at risk to participate in clinical trials. So again, as patient advocates going out into the community and, you know, even kind of thinking about but clinical trials 40, 50, 60 years ago and there's still a lot of mistrust out here.
00;35;51;27 - 00;36;11;22
Patrick Gee
What would you suggest that patients can do to kind of do kind of help make clinical trials more diverse and more inclusive for everybody, especially when it comes to treatments for COVID 19 or anything else that may arise in the future.
00;36;12;01 - 00;36;42;10
Dan Weiner
I think you said it exactly. It's all about trust. It's all about trust. So I think it's really important that people, regardless of their background, have the opportunity to build trusting relationships with clinicians and clinical researchers, that if you can build those trusting relationships, you can enroll people in clinical trials, you can inspire them to do clinical trials and hopefully have a vision and that this is going to help all communities.
00;36;43;01 - 00;37;09;29
Dan Weiner
But you raise an exceptionally important point both underrepresentation, a specific demographic groups and trials and underrepresentation of people with specific conditions and trials. One of the things that we have discovered is that none of this stuff was tested in people with kidney disease, especially with advanced kidney diseases, dialysis, transplant. And you have people who are incredibly vulnerable because they have comorbid conditions.
00;37;10;18 - 00;37;34;28
Dan Weiner
And these are the people who should the most data in. And unfortunately, you have the least aid and the least knowledge as to how to treat them and therefore the fewest options. And again, making sure that even coming into a pandemic that you have strong, trusting relationships between health care providers and communities is going to make every step in the future better.
00;37;34;28 - 00;37;41;04
Dan Weiner
I think it all starts at individuals and small relationships that then becomes societal.
00;37;41;11 - 00;37;46;07
Patrick Gee
But thank you so much for answering those questions. Truly appreciate it and.
00;37;46;07 - 00;37;51;26
Dan Weiner
Thank you for inviting me to do so. And I'm thrilled to actually have this opportunity.
00;37;52;17 - 00;38;14;08
Intro
As with every episode, we want to give a shout out to a kidney patient. Celebrating a major milestone. Ashley is celebrating the ten year anniversary of receiving the gift of life from her cousin, Jennifer. Congratulations on being a decade kidney strong. Ashley. Thank you for listening. Make sure to rate and review us on Apple Podcasts, Stitcher, Spotify or wherever you listen to podcasts.
00;38;14;23 - 00;38;57;22
Intro
You can also email us directly with your comments and suggestions and KFI podcast at Kidney Talk. We hope you'll join us next time. And from all of us and chaos. We wish you good health.