May 6, 2020

Governor Ron DeSantis State of The Capitol 400 S. Monroe St. Tallahassee, FL 32399-0001

Scott A Rivkees, M.D. State Surgeon General Florida Department of Health 4052 Bald Cypress Way Tallahassee, FL 32399

Dear DeSantis and Surgeon General Rivkees:

We write out of concern for the 40,000 Floridians with end-stage renal disease who are at heightened risk during the ongoing pandemic. On behalf of these patients and their caregivers, we seek information about what specific steps the Florida Department of Health is taking to ensure that access to dialysis treatment is not disrupted.

The Centers for Disease Control and Prevention recommend community mitigation strategies to protect individuals at heightened risk from COVID-19 transmission, including those with chronic kidney disease undergoing dialysis. This population is among the most vulnerable to severe illness because they suffer from weakened immune systems and often must put themselves at risk several times a week by leaving their homes for dialysis treatment. In some cases, missing even one treatment can lead to serious medical complications and even death. People living with chronic kidney disease also face heightened risk due to higher rates of comorbidities such as diabetes and cardiovascular disease.

Alarmingly, a growing number of physicians are warning that COVID-19 may cause kidney damage and can exacerbate health conditions in patients with existing kidney problems. Specialists estimate that 20 to 40 percent of I.C.U. patients with the novel coronavirus suffered kidney failure and required dialysis. A surge in such cases is leading to shortages of machines, supplies, and staff required for dialysis. It is critical that Florida maintain this supply chain because experts anticipate that more Americans will develop kidney problems as a result of the pandemic and any disruption to the regular dialysis treatment would be disastrous.

There have been reports that states are struggling to secure life-saving equipment and supplies like dialysis machines, ventilators and personal protective equipment. We urge you to protect vulnerable Floridians with chronic kidney disease and those who may develop kidney problems resulting from COVID-19 by ensuring Florida has access to a sufficient stream of dialysis machines and related supplies.

Additionally, we respectfully request answers to the following questions:

1. Are you tracking the availability of machines and fluid required to dialyze patients and skilled nurses needed to deliver care to patients with kidney failure? 2. Have you taken any steps to acquire dialysis machines and supplies? If not, why? 3. Are you tracking the availability of PPE, including disposable facemasks, at dialysis centers? 4. Are you tracking the extent of kidney damage and the use of dialysis treatment in confirmed coronavirus patients? 5. Have you taken any steps to ensure that dialysis patients who may not be able to afford or access alternatives to public transportation can safely reach their dialysis treatment centers? 6. Are you working to secure ambulance transport to and from dialysis treatment for patients who have contracted, or are suspected of having contracted, Covid-19, and who do not have safe transportation alternatives? If so, are you monitoring the availability of PPE for personnel transporting ESRD patients? 7. Are you developing guidelines for health-care providers to prioritize care for certain patients if faced with a scarcity of resources? If so, please provide a copy of this guidance. 8. Are you collecting data on the rate of COVID-19 infections and deaths among patients on dialysis? If so, please provide city- and county-level infection and mortality rates for this population. 9. What, if any, steps have you taken to ensure that dialysis patients can safely continue to access treatment?

Thank you for your attention to these issues. We look forward to your response.

Sincerely,

______Frederica S. Wilson Member of Congress

/s/

Val B. Demings Ted E. Deutch Member of Congress Member of Congress

Alcee L. Hastings , Jr. Member of Congress Member of Congress

Debbie Mucarsel-Powell Donna E. Shalala Member of Congress Member of Congress

Darren Soto Member of Congress Member of Congress