To the editor

We read with interest the study by Thaunat et al. that identified significant excess mortality attributed to coronavirus disease 2019 (COVID-19) among dialysis patients.¹ Indeed, the COVID-19 pandemic has provided the impetus for the introduction of strategies to optimize protection of hemodialysis patients from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).² Outside the pandemic setting, however, patients with chronic kidney disease have significantly higher risk of nosocomial acquisition of other common respiratory-viral infections (RVIs), with increased mortality and length-of-stay.³ Implementation of protective strategies against COVID-19 on renal units may reduce health care–associated-RVI (HA-RVI) as a positive consequence.

From January to December 2020, a COVID-19 containment strategy was implemented at the largest tertiary hospital in Singapore, with a 20-station inpatient dialysis center, a large renal inpatient service, and a renal transplant program. Universal masking and visitor screening were implemented⁴; symptomatic patients were segregated in a dedicated dialysis room, with staff using personal protective equipment. All symptomatic inpatients were tested for SARS-CoV-2 and common RVIs via multiplex polymerase chain reaction.

The incidence of HA-RVI during the pandemic dramatically decreased to 0.5 cases per 1000 admissions (1 case, 2186 admissions), compared with 21.7 cases per 1000 admissions (70 cases, 3223 admissions) over the previous 2 years (incidence rate ratio, 0.02; 95% confidence interval, 0.001–0.13; P < 0.001). Notably, zero episodes of HA-RVI were recorded from February to December 2020 (Figure 1 ). There was no significant difference in the proportion of inpatients tested for common RVIs (26.5%, 581 of 2186 admissions tested during the pandemic; vs. 28.8%, 929 of 3223 admissions tested prepandemic; odds ratio, 0.89; 95% confidence interval, 0.77–1.08; P = 0.07). Despite managing ≥1600 COVID-19 cases, there was no nosocomial acquisition. Infection prevention measures introduced for COVID-19 mitigate HA-RVI among renal inpatients and should be continued postpandemic.

Figure 1

Rates of health care–associated respiratory viral infections (HA-RVIs) among renal inpatients at a Singaporean tertiary hospital, before and during coronavirus disease 2019 (COVID-19) pandemic. (a) Trends in HA-RVIs among renal inpatients (January 2018–December 2020). (b) Number of renal inpatients and number of patients tested for respiratory viral infections (RVIs) at a Singaporean tertiary hospital (January 2018–December 2020). (c) Layout of renal inpatient unit and enhanced infection prevention measures introduced during the COVID-19 pandemic. PCR, polymerase chain reaction; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2.