Clinical outcomes of SARS-CoV-2 pandemic in long-term care facilities for people with epilepsy: observational study
Authors: Balestrini Simona , Koepp Matthias J , Gandhi Sonia , Rickman Hannah M , Shin Gee Yen , Houlihan Catherine F , Anders-Cannon Jonny , Silvennoinen Katri , Xiao Fenglai , Zagaglia Sara , Hudgell Kirsty , Ziomek Mariusz , Haimes Paul , Sampson Adam , Parker Annie ,   for The Meath, Nastouli Eleni , Swanton Charles ,   for the CCC, Sander Josemir W , Sisodiya Sanjay M ,   for the ASAP Consortium
Published: June 2020

Objectives

COVID-19 is spreading in long-term care facilities with devastating outcomes worldwide, especially for people with chronic health conditions. There is a pressing need to adopt effective measures prevention and containment of in such settings.

Design

Retrospective cohort study assessing the effect of enhanced surveillance and early preventative strategies and comparing outcomes for people with severe epilepsy and other comorbidities

Setting

Three long-term care facilities: Chalfont Centre for Epilepsy (CCE), St. Elisabeth (STE), and The Meath (TM) with different models of primary and specialist care involvement, in the United Kingdom

Participants

286 long-term residents (age range 19–91 years), 740 carers who had been in contact with the residents during the observation period between 16 March and 05 June 2020.

Interventions

Early preventative and infection control measures with identification and isolation of symptomatic cases, with additional enhanced surveillance and isolation of asymptomatic residents and carers at one site (CCE)

Main outcome measures

Infection rate for SARS-CoV-2 among residents and carers, asymptomatic rate and case fatality rate, if available.

Results

During a 12-week observation period, we identified 29 people (13 residents) who were SARS-CoV-2 positive with confirmed outbreaks amongst residents in two long-term care facilities (CCE, STE). At CCE, two out of 98 residents were symptomatic and tested positive, one of whom died. A further seven individuals testing positive on weekly enhanced surveillance had a completely asymptomatic course. One asymptomatic carer tested positive after contact with confirmed COVID-19 patients in another institution. Since 30 April 2020, during on-site weekly enhanced surveillance all 275 caregivers tested repeatedly negative. At STE, three out of 146 residents were symptomatic and tested positive, a fourth tested positive during hospital admission for symptoms not related to COVID-19. Since April 6, 2020, 105/215 carers presenting with typical symptoms for COVID-19 were tested, of whom 15 tested positive. At TM, testing of symptomatic carers only started from early/mid-April, whilst on-site testing, even of symptomatic residents, was not available until recently.

During the observation period, eight of 80 residents were symptomatic but none was tested. Twenty-six of 250 carers were symptomatic and were tested, of whom two tested positive.

Conclusions

Infection outbreaks in long-term care facilities for vulnerable people with epilepsy can be quickly contained, but only if asymptomatic cases are identified through enhanced surveillance at individual and care staff level. We observed a low rate of morbidity and mortality which confirmed that preventative measures with isolation of suspected and confirmed cases of COVID-19 can reduce resident-to-resident and reverse resident-to-carer transmission.