An update on COVID-19 for kidney transplant recipients

Darren Yuen MD FRCPC

It is hard to believe that we are reaching the 3 year mark of the COVID-19 pandemic. Since December 2019, the medical community has made some remarkable advances in our understanding of this virus, and how we can prevent and treat it. Since so many changes have happened over these 3 years, we thought we would review some important points.

The bad news: COVID-19 is probably here to stay

Despite massive efforts to contain the virus, most experts have come to the conclusion that COVID-19 is here to stay in Canada for the foreseeable future. It is likely that SARS-CoV2, the virus that causes COVID-19, will be mostly a seasonal infection, with the fall and winter months seeing an increase in infections. In the spring and summer, COVID-19 will still be around, but probably at lower levels as we all spend more time outdoors.

The good news: We have new ways to prevent and treat COVID-19

In the first wave of the pandemic, the number of COVID-19 infections in our kidney transplant community, and in the province at large, were actually quite low compared to the numbers of infections we are seeing in 2022. However, transplant patients who got COVID-19 in 2020 were often getting quite sick, needing hospital and even ICU admission. During that scary time, more than half of our transplant patients who contracted COVID-19 needed to be admitted to the hospital, and roughly 1 in 5 patients died.

Now let’s fast forward to 2022. The number of infections we are seeing every day is much higher than in 2020, but transplant patients who get COVID-19 are rarely sick enough to be admitted to the hospital, and very few people are dying.

The game changer: vaccines

What happened in between 2020 and 2022 that has made things so much safer for our transplant patients? The main advance has been vaccines. Roughly 80% of St. Michael’s Kidney Transplant patients have received 3 COVID-19 vaccine doses, with at least 50% having 4 doses. We have learned that these vaccines, while not perfect at preventing COVID-19 infections, are very good at protecting against severe infection. What does this mean? It means that getting vaccinated protects against needing to be hospitalized, going to the ICU, and dying with COVID-19. This is the key lesson we have learned: the more vaccine doses you have, the more likely you, as a transplant patient, are protected against getting very sick with COVID-19. While vaccination might not provide a lot of protection against COVID-19 infection in general, what matters the most is that it will protect you against severe infection.

Are vaccines safe?

The simple answer to this question is yes. COVID-19 vaccines have been tested in a huge number of against COVID-19 infection. Evusheld is not a vaccine, but rather is made up of protective antibodies that fight off the SARS-CoV2 virus. It is given as two injections, one injection in each buttock. Basically, doctors and scientists realized that transplant patients produce fewer antibodies in response to vaccines, and so they decided to give transplant patients a “top-up” of antibodies made in the lab. This is what Evusheld is. Evusheld was designed against the original SARS-Cov2 virus, and so it might lose some of its protective capabilities with the newer Omicron subvariants that are arising. We will keep you updated on whether Evusheld will still be effective, but for now we (and Ontario Health) are recommending getting Evusheld every 6 months.

What should I do if I test positive for COVID-19?

The key is to get a rapid antigen test as soon as you develop possible symptoms of COVID-19. The most common symptoms include: fever, chills, sweats, cough, runny nose, sore throat, diarrhea, and low energy. If you test positive, call the Kidney Transplant clinic as soon as possible, as there are new COVID-19 treatments, but they must be started within 7 days of symptom onset. If it is a weeknight, you can call us the next day. If it is a weekend, go to your local Emergency Room. Of course, if you develop shortness of breath or are feeling very ill, always go to your local hospital’s ER.

Summary

people (including transplant patients) around the world, and their safety has been shown time and time again. When one weighs the risk of severe COVID-19 infection in people who are undervaccinated, there is no question that getting vaccinated is the safer option.

Are there other advances we should know about?

In addition to vaccines, a new drug called Evusheld has been released that was shown to protect

The bottom line is that we have learned a great deal about COVID-19, and have developed effective ways of preventing severe COVID-19 infection, and treating infections when they happen. Although COVID-19 is here to stay, we are much better prepared now to protect you against this virus. Stay tuned for more updates!