Kidney health for all: preparedness for the unexpected in supporting the vulnerable

Abstract

As the rate of natural disasters and other devastating events caused by human activities increases, the burden on the health and well-being of those affected by kidney disease has been immeasurable. Health system preparedness, which involves creating a resilient system that is able to deal with the health needs of the entire community during times of unexpected disruptions to usual care, has become globally important. In the wake of the COVID-19 pandemic, there is a heightened awareness of the amplification of negative effects on the renal community. Paradoxically, the complex medical needs of those who have kidney diseases are not met by systems handling crises, often compounded by an acute increase in burden via new patients as a result of the crisis itself. Disruptions in kidney care as a result of unexpected events are becoming more prevalent and likely to increase in the years to come. It is therefore only appropriate that the theme for this year’s World Kidney Day will focus on Kidney Health for All: preparedness for the unexpected in supporting the vulnerable. As the rate of natural disasters and other devastating events caused by human activities increases, the burden on the health and well-being of those affected by kidney disease has been immeasurable. Health system preparedness, which involves creating a resilient system that is able to deal with the health needs of the entire community during times of unexpected disruptions to usual care, has become globally important. In the wake of the COVID-19 pandemic, there is a heightened awareness of the amplification of negative effects on the renal community. Paradoxically, the complex medical needs of those who have kidney diseases are not met by systems handling crises, often compounded by an acute increase in burden via new patients as a result of the crisis itself. Disruptions in kidney care as a result of unexpected events are becoming more prevalent and likely to increase in the years to come. It is therefore only appropriate that the theme for this year’s World Kidney Day will focus on Kidney Health for All: preparedness for the unexpected in supporting the vulnerable. The United Nations Office for Disaster Risk Reduction defines a disaster as “a serious disruption of the functioning of a community or a society at any scale due to hazardous events interacting with conditions of exposure, vulnerability and capacity, leading to one or more of the following: human, material, economic and environmental losses and impacts.”1United Nations Office for Disaster Risk ReductionTerminology: disaster.https://www.undrr.org/terminology/disasterDate accessed: August 20, 2022Google Scholar The global incidence of natural disasters is increasing, with the rate of disasters growing by at least 10-fold in one report from 1960 to 2020,2Institute for Economics & PeaceEcological threat report 2021: understanding ecological threats, resilience and peace, Sydney.https://www.visionofhumanity.org/global-number-of-natural-disasters-increases-ten-times/Date accessed: August 20, 2022Google Scholar with attendant increases in mortality, injuries, diseases, and disabilities. In 2021, natural disasters affected 101.8 million people worldwide, accounted for over 10,000 deaths, and caused approximately USD$252 billion in economic losses.3Centre for Research on the Epidemiology of Disasters2021 disasters in numbers.https://www.cred.be/publicationsDate accessed: August 20, 2022Google Scholar In the same vein, at the end of 2021, 89.3 million people worldwide were forcibly displaced from their homes because of conflicts, violence, or fear of persecution and human rights violations, totaling more than twice the 42.7 million individuals displaced a decade ago and the most since the World War II.4The UN Refugee AgencyGlobal trends: forced displacement in 2021.https://www.unhcr.org/globaltrends.htmlDate accessed: August 20, 2022Google Scholar Disasters disproportionately affect those living in developing nations or low-income communities. The United Nations explains that the loss of capital assets and infrastructure such as schools can cause the poor to fall into “poverty traps,” which are multigenerational setbacks that can be very difficult to escape.5The United Nations Health ChronicleEconomic recovery after natural disasters.https://www.un.org/en/chronicle/article/economic-recovery-after-natural-disasters#:∼:text=The%20economic%20damage%20caused%20by,education%20infrastructure%20that%20disrupts%20schoolingDate accessed: December 2, 2022Google Scholar Disasters also mostly harm groups that experience intersectional social disadvantages such as a low socioeconomic status and ethnic/racial discrimination.6Iwai Y. Holdren S. Rosen L.T. Hu N.Y. Narrative trajectories of disaster response: ethical preparedness from Katrina to COVID-19.Med Humanit. 2022; 48 (e8)Crossref PubMed Scopus (4) Google Scholar Governments have a responsibility to uplift these groups during disaster response and recovery to ensure that existing inequalities are not exacerbated. With such a scale of impact on the community, there is a clear need to better plan and prepare for disasters of all scales in an attempt to minimize the effects that disruption to daily life brings to health and well-being. Natural disasters come in many forms, so it is important to understand the basics of common disasters to develop a versatile preparedness strategy. Floods are the most common type of natural disaster, affecting over 2 billion individuals globally from 1998 to 2017.7World Health OrganizationFloods.https://www.who.int/health-topics/floodsDate accessed: August 19, 2022Google Scholar Floods occur when dry land is submerged by a large influx of water such as heavy rainfall and pose a threat in areas close to a coast or body of water. Tropical cyclones such as hurricanes and typhoons are another common water-based natural disaster, affecting an estimated 726 million people from 1998 to 2017.8World Health OrganizationTropical cyclones.https://www.who.int/health-topics/tropical-cyclonesDate accessed: August 19, 2022Google Scholar Cyclones require moist air and wind to form, and thus occur in the Atlantic, Pacific, and Indian oceans. Earthquakes are a sudden land-based natural disaster characterized by the ground shaking and landslides. Earthquakes typically occur in areas atop a fault line in the Earth’s crust and have impacted over 125 million people from 1998 to 2017.9World Health OrganizationEarthquakes.https://www.who.int/health-topics/earthquakesDate accessed: August 19, 2022Google Scholar One especially dangerous byproduct of earthquakes are tsunamis, which are fast-rising waves with powerful currents that can cause significant damage to coastal areas. Natural disasters that are highly localized to certain regions of the world include volcanic eruptions, of which 75% occur along a belt in the Pacific Ocean known as the “Ring of Fire,”10National Geographic SocietyRing of Fire.https://education.nationalgeographic.org/resource/ring-fireGoogle Scholar and blizzards, which are common in Antarctica and the northern regions of Asia, Europe, and North America.11Allaby M. Blizzards. Facts on File, 2008Google Scholar Unexpected events outside of natural disasters can also cause major distress and occur at different levels of society. National and international events to prepare for include war, famine, and infectious disease outbreaks. Although war and famine may be initially predictable, they can be difficult to prepare for as they last for an extended period and can affect millions of people at once. The coronavirus pandemic is a timely example for the need for worldwide preparedness; one study finds that an inadequate response to coronavirus disease 2019 (COVID-19) likely resulted in around 200 thousand avoidable deaths in the United States in 2020 alone.12Sachs J.D. Karim S.S.A. Aknin L. et al.The Lancet Commission on lessons for the future from the COVID-19 pandemic.Lancet. 2022; 400: 1224-1280Abstract Full Text Full Text PDF PubMed Scopus (237) Google Scholar Disastrous unexpected events can also occur on a more local scale. Unexpected road closures, power and internet outages, and interruptions to water supplies can not only be a nuisance in a person’s day-to-day life but also be life-threatening. One study found that road closures and infrastructure disruptions during marathons increased the risk of death from heart attacks, as many people en route to hospitals were unaware of these closures beforehand.13Jena A.B. Mann N.C. Wedlund L.N. Olenski A. Delays in emergency care and mortality during major U.S. marathons.N Engl J Med. 2017; 376: 1441-1450Crossref PubMed Scopus (50) Google Scholar Regardless of the scale of the event, it is important to prepare for unexpected events outside of natural disasters. In the wake of the COVID-19 pandemic, significant work is being done to better understand and improve health system preparedness and resilience. It was clear that those with noncommunicable diseases (NCDs) were more likely to develop serious illness and die, as the needs of providing and prioritizing ongoing complex care for this patient cohort were deprioritized in favor of acute health responses. There is a real need for health care systems and jurisdictions to develop more resilient systems. Reflecting on the lessons learnt from Ebola, Kruk et al.14Kruk M.E. Myers M. Varpilah S.T. Dahn B.T. What is a resilient health system? Lessons from Ebola.Lancet. 2015; 385: 1910-1912Abstract Full Text Full Text PDF PubMed Scopus (395) Google Scholar note that resilient health systems are able to deliver everyday benefits and positive health outcomes for all, not only during a crisis but also in its aftermath. The term “resilience dividend” indicates improved performance in both bad times and the good.14Kruk M.E. Myers M. Varpilah S.T. Dahn B.T. What is a resilient health system? Lessons from Ebola.Lancet. 2015; 385: 1910-1912Abstract Full Text Full Text PDF PubMed Scopus (395) Google Scholar The main recommendations from the Lancet COVID19 commission succinctly outline 3 high-level areas for health system development: (i) strengthening national health systems and increasing investments in primary health care and public health; (ii) national pandemic preparedness plans; and (iii) financing for sustainable development and green recovery plans. Clearly, with the complexities of kidney disease and NCDs as a whole, health system resilience requires overarching multisystem policies and frameworks by which we can adequately prepare for and recover from high consequence shocks. A framework for public health emergency preparedness (PHEP) that can easily be adapted and applied universally is key, enabling countries or health systems to more easily modify existing plans to suit the type of disaster and environment. Conventionally, health emergency responses did not include kidney or NCD care. During the COVID-19 pandemic, people living with NCDs faced worse outcomes than those without.15Nikoloski Z. Alqunaibet A.M. Alfawaz R.A. et al.Covid-19 and non-communicable diseases: evidence from a systematic literature review.BMC Public Health. 2021; 21: 1068Crossref PubMed Scopus (59) Google Scholar With regard to kidney disease, a study conducted by the End-Stage Renal Disease National Coordinating Center found that deaths among patients with kidney failure exceeded the expected numbers by 6953–10316 during the early phases of the COVID-19 pandemic, and excess mortality was also observed in a subgroup analysis of patients receiving solid organ transplants.16Ziemba R. Campbell K.N. Yang T.-H. et al.Excess death estimates in patients with end-stage renal disease–United States, February–August 2020.MMWR Morb Mortal Wkly Rep. 2021; 70: 825-829Crossref PubMed Scopus (26) Google Scholar,17Clarke J.A. Wiemken T.L. Korenblat K.M. Excess mortality among solid organ transplant recipients in the United States during the COVID-19 pandemic.Transplantation. 2022; 106: 2399-2407Crossref PubMed Scopus (12) Google Scholar A retrospective cohort study in England also found that patients with chronic kidney disease faced a high 1-year mortality risk burden during the COVID-19 pandemic.18Dashtban A. Mizani M.A. Denaxas S. et al.A retrospective cohort study predicting and validating impact of the COVID-19 pandemic in individuals with chronic kidney disease.Kidney Int. 2022; 102: 652-660Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar There is an increasing understanding that disruptions during these periods expose people living with NCDs to greater consequences, including death. A framework of PHEP has been developed by a Canadian team of researchers that is empirically derived, end-user informed, and further refined to ensure practice and policy relevance for local/regional public health agencies. This framework captures the complexity of the system required19Khan Y. O'Sullivan T. Brown A. et al.Public health emergency preparedness: a framework to promote resilience.BMC Public Health. 2018; 18: 1344Crossref PubMed Scopus (121) Google Scholar and ensures that clinical care for pre-existing chronic disease is available and preserved because of the PHEP’s interconnectedness and flexibility (Figure 1) The annotated figure identifies the areas for preparedness specific to kidney disease, all integrated under a system-wide response. Ensuring early identification and integration of kidney care needs in the preparedness phase and confirming essential supplies and supply chain for medicines and technologies, as well as developing robust and personalized plans for patients, are all essential in handling early disaster phases. Furthermore, it is clear that responses to disasters must integrate kidney disease in initial assessments by mapping kidney disease services provision and focusing service delivery on primary care. Also, critical support of workforce requirements and management of mental health issues in patients and staff are central. Evaluation needs to be ongoing, both during the crisis and in the recovery, exploring ways to improve at all opportunities and addressing identified gaps. A key component of PHEP, especially highlighted by the “Community Engagement,” “Collaborative Networks,” and “Communication” touchpoints described below, is the importance of disseminating accurate and accessible information to the public. An increasingly powerful approach for distributing information quickly and to a large audience is the use of digital technologies and social media. Digital media tools such as online blogs and medical forums have been great resources for posting timely information and critical updates about the status of a public health emergency. Social media platforms like Facebook, YouTube, Twitter, WhatsApp, and are highly accessible for with a and millions of to health care and use social media to with and patients, and it is clear that digital will be the for providing kidney health information for an important is to ensure that about public health not via these digital Ensuring accurate and information for disaster preparedness is the of or will be an in Governments and can the of by with social media to in the development of that and by strengthening policies that or online to and accessed: December 2022Google Scholar Clearly, kidney disease management in disaster not but be of any PHEP local and international renal and as well as patient have a in patients with kidney disease their care and are during with health and is One such preparedness among is this framework described by et Y. O'Sullivan T. Brown A. et al.Public health emergency preparedness: a framework to promote resilience.BMC Public Health. 2018; 18: 1344Crossref PubMed Scopus (121) Google Scholar which essential that have touchpoints integration with other health services can service delivery for patients This framework high-level of a health system that all of care both during and in the recovery from a of the of or in the community. It also to and countries as in The of the are as and to are integrated and including essential areas in the health and and support for the renal community, including power supply and the many of the health care developing a the of due in public health preparedness that NCD care. and and and are to the this developing and and recovery levels in the system and other such as clinical care emergency care or the It interconnectedness and outside public and community and are and the community and the public health agencies. This the resilience of the Ensuring patient and preparedness is of critical important to understand the for the and to and the information that Risk analysis and social risk such as or may have a disaster at risk and more vulnerable. This to all patients with kidney disease, be it chronic kidney disease, acute kidney or transplant and be robust to information to key and the community. It awareness in as the main of and early and of to health and the This increases a systems approach to many such as health and community health and practice to for response and and also practice and plans to and in the on and for systems and infrastructure to of and and staff the social infrastructure for the need and in preparedness, including to support patient need and be clear and with information to awareness the and the public to deliver information public or or providing for the health care use of social with important and early to and is during and it is to other of PHEP like and A critical of is understanding the patient One study patient during disasters and found that major and with the Y. A. et and disasters among patients with type a J 2022; PubMed Scopus Google Scholar Evaluation resilience in the system and is to recovery and on are a with to disasters. 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Full Text Full Text PDF PubMed Scopus Google Scholar The COVID-19 pandemic has further highlighted that for patients with kidney disease is especially with regard to patients who require complex and in a system with patients with hospitals most of their to patients with acute only those patients with other who were with care to and care. In an online was conducted in to study the effects of the COVID-19 pandemic on the at the S. et al.Covid-19 in and kidney transplant retrospective analysis of J 2022; PubMed Scopus Google Scholar With of patients from outside greater and on of public of the patients or for The study further that the of requirements to and a significant impact on patients and their In the due to the COVID-19 pandemic were With 3 of public or was patients on the of and to for often in medical to and there was an of As in the effects of to a of and R. 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