Clinical outcomes of COVID-19 in long-term care facilities for people with epilepsy

Abstract

In this cohort study, we aim to compare outcomes from coronavirus disease 2019 (COVID-19) in people with severe epilepsy and other co-morbidities living in long-term care facilities which all implemented early preventative measures, but different levels of surveillance. During 25-week observation period (16 March-6 September 2020), we included 404 residents (118 children), and 1643 caregivers. We compare strategies for infection prevention, control, and containment, and related outcomes, across four UK long-term care facilities. Strategies included early on-site enhancement of preventative and infection control measures, early identification and isolation of symptomatic cases, contact tracing, mass surveillance of asymptomatic cases and contacts. We measured infection rate among vulnerable people living in the facilities and their caregivers, with asymptomatic and symptomatic cases, including fatality rate. We report 38 individuals (17 residents) who tested severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-positive, with outbreaks amongst residents in two facilities. At Chalfont Centre for Epilepsy (CCE), 10/98 residents tested positive: two symptomatic (one died), eight asymptomatic on weekly enhanced surveillance; 2/275 caregivers tested positive: one symptomatic, one asymptomatic. At St Elizabeth's (STE), 7/146 residents tested positive: four symptomatic (one died), one positive during hospital admission for symptoms unrelated to COVID-19, two asymptomatic on one-off testing of all 146 residents; 106/601 symptomatic caregivers were tested, 13 positive. In addition, during two cycles of systematically testing all asymptomatic carers, four tested positive. At The Meath (TM), 8/80 residents were symptomatic but none tested; 26/250 caregivers were tested, two positive. At Young Epilepsy (YE), 8/80 children were tested, all negative; 22/517 caregivers were tested, one positive. Infection outbreaks in long-term care facilities for vulnerable people with epilepsy can be quickly contained, but only if asymptomatic individuals are identified through enhanced surveillance at resident and caregiver level. We observed a low rate of morbidity and mortality, which confirmed that preventative measures with isolation of suspected and confirmed COVID-19 residents can reduce resident-to-resident and resident-to-caregiver transmission. Children and young adults appear to have lower infection rates. Even in people with epilepsy and multiple co-morbidities, we observed a high percentage of asymptomatic people suggesting that epilepsy-related factors (anti-seizure medications and seizures) do not necessarily lead to poor outcomes.

Keywords: Care Models; Prevention; SARS-CoV-2; Surveillance; Vulnerable people.

Fig. 1

Chalfont Centre for Epilepsy (CCE) map, with enlarged illustration of the repurposed COVID-19 care unit. CCE houses 98 people who live in seven units of 1–4 self-contained flats. Outbreaks were observed in six of the seven units (represented as circles in different colors), with two of the ten positive individuals that developed symptoms of COVID-19 (red numbers in red circles). Enlarged on the right of picture, Sir William Gowers Centre (SWGC), the repurposed COVID-19 care unit, with six single rooms and eight beds ward repurposed for individuals who tested positive (red area), and twelve beds for suspected residents who could not be isolated in their care homes (yellow).

Fig. 2

Timeline across centres Chalfont Centre for Epilepsy (CCE) (A) and St. Elizabeth’s (STE) (B). This includes all symptomatic residents tested positive (red circle CCE 1–2; purple circle STE 1–4), asymptomatic tested positive (red outlined yellow circle CCE 3–10; purple outlined yellow circle STE 5–6), symptomatic caregiver (red outlined gray diamond CCE 1) who was asymptomatic when tested positive again during surveillance (red outlined yellow diamond CCE 1) after eight negative tests; selected symptomatic staff at CCE (black outlined gray diamond CCE 2–7, self-isolating but not tested); symptomatic caregivers at STE tested positive (purple outlined gray diamond STE 1–13), and asymptomtic staff tested positive (red outlined yellow diamond CCE 1–2; purple outlined yellow diamond STE 14–16). Staff are presented in the unit where they regularly worked, arrows connect staff who are also household contacts at CCE. Timings represent date of symptom onset (symptomatic individuals), or date of self-isolation from work (staff members, who were not PCR tested), gray columns represent date of enhanced surveillance.