TY - JOUR
T1 - Clinical outcomes of COVID-19 in long-term care facilities for people with epilepsy
AU - ChAlfont keepS vulnerAble People safe (ASAP) Consortium:
AU - Balestrini, Simona
AU - Koepp, Matthias J.
AU - Gandhi, Sonia
AU - Rickman, Hannah M.
AU - Shin, Gee Yen
AU - Houlihan, Catherine F.
AU - Anders-Cannon, Jonny
AU - Silvennoinen, Katri
AU - Xiao, Fenglai
AU - Zagaglia, Sara
AU - Hudgell, Kirsty
AU - Ziomek, Mariusz
AU - Haimes, Paul
AU - Sampson, Adam
AU - Parker, Annie
AU - Helen Cross, J.
AU - Pardington, Rosemarie
AU - Nastouli, Eleni
AU - Swanton, Charles
AU - Crick COVID Consortium (CCC)
AU - Aitken, Jim
AU - Allen, Zoe
AU - Ambler, Rachel
AU - Ambrose, Karen
AU - Ashton, Emma
AU - Avola, Alida
AU - Balakrishnan, Samutheswari
AU - Barns-Jenkins, Caitlin
AU - Barr, Genevieve
AU - Barrell, Sam
AU - Basu, Souradeep
AU - Beale, Rupert
AU - Beesley, Clare
AU - Bhardwaj, Nisha
AU - Bibi, Shahnaz
AU - Bineva-Todd, Ganka
AU - Biswas, Dhruva
AU - Blackman, Michael J.
AU - Bonnet, Dominique
AU - Bowker, Faye
AU - Broncel, Malgorzata
AU - Brooks, Claire
AU - Buck, Michael D.
AU - Buckton, Andrew
AU - Budd, Timothy
AU - Burrell, Alana
AU - Busby, Louise
AU - Bussi, Claudio
AU - Butterworth, Simon
AU - Byott, Matthew
AU - Levi, Marcel
N1 - Funding Information: We are grateful to all people living at the Chalfont Centre for Epilepsy, St Elisabeth, The Meath and Young Epilepsy and their families. We are also grateful to all care staff working at the Chalfont Centre, St Elisabeth, The Meath and Young Epilepsy. We thank Professor David Goldblatt, Dr Louis Grandjean, and Dr Marina Johnson, for the support provided in arranging antibody testing for one of the caregivers, and interpretation of the results. This work was supported by Epilepsy Society, UK. It was undertaken at UCLH/UCL Comprehensive Biomedical Research Centre and at Great Ormond Street Hospital Biomedical Research Centre. Research in both sites is supported by the UK Department of Health's NIHR Biomedical Research Centres funding scheme. S Balestrini was supported by the Muir Maxwell Trust. Funding was also provided by MRC, European Union (Horizon 2020), and GSK. K Silvennoinen is supported by a Wellcome Trust Strategic Award (WT104033AIA). C Swanton is Royal Society Napier Research Professor. Part of this work was carried out at the Francis Crick Institute, which receives core funding from Cancer Research UK (FC001169), the UK Medical Research Council (FC001169), and the Wellcome Trust (FC001169). He receives funding from the European Research Council (ERC) under the European Union's Seventh Framework Programme (FP7/2007-2013) Consolidator Grant (FP7-THESEUS-617844), European Commission ITN (FP7-PloidyNet 607722), an ERC Advanced Grant (PROTEUS) from the European Research Council under the European Union's Horizon 2020 Research and Innovation Programme (grant agreement No. 835297), and Chromavision from the European Union's Horizon 2020 Research and Innovation Programme (grant agreement 665233). JW Sander receives research support from the Dr. Marvin Weil Epilepsy Research Fund and the Christelijke Verenigingvoor de verpleging van Lijdersaan Epilepsie, The Netherlands. None of the authors report conflicts in relation to this work. Funding Information: We are grateful to all people living at the Chalfont Centre for Epilepsy, St Elisabeth, The Meath and Young Epilepsy and their families. We are also grateful to all care staff working at the Chalfont Centre, St Elisabeth, The Meath and Young Epilepsy. We thank Professor David Goldblatt, Dr Louis Grandjean, and Dr Marina Johnson, for the support provided in arranging antibody testing for one of the caregivers, and interpretation of the results. This work was supported by Epilepsy Society , UK. It was undertaken at UCLH/UCL Comprehensive Biomedical Research Centre and at Great Ormond Street Hospital Biomedical Research Centre. Research in both sites is supported by the UK Department of Health’s NIHR Biomedical Research Centres funding scheme. S Balestrini was supported by the Muir Maxwell Trust . Funding was also provided by MRC , European Union (Horizon 2020) , and GSK. K Silvennoinen is supported by a Wellcome Trust Strategic Award (WT104033AIA). C Swanton is Royal Society Napier Research Professor. Part of this work was carried out at the Francis Crick Institute, which receives core funding from Cancer Research UK ( FC001169 ), the UK Medical Research Council ( FC001169 ), and the Wellcome Trust ( FC001169 ). He receives funding from the European Research Council (ERC) under the European Union’s Seventh Framework Programme (FP7/2007-2013) Consolidator Grant (FP7-THESEUS-617844), European Commission ITN (FP7-PloidyNet 607722), an ERC Advanced Grant (PROTEUS) from the European Research Council under the European Union’s Horizon 2020 Research and Innovation Programme (grant agreement No. 835297), and Chromavision from the European Union’s Horizon 2020 Research and Innovation Programme (grant agreement 665233). JW Sander receives research support from the Dr. Marvin Weil Epilepsy Research Fund and the Christelijke Verenigingvoor de verpleging van Lijdersaan Epilepsie , The Netherlands. Publisher Copyright: © 2020 Elsevier Inc.
PY - 2021/2/1
Y1 - 2021/2/1
N2 - 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.
AB - 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.
KW - Care Models
KW - Prevention
KW - SARS-CoV-2
KW - Surveillance
KW - Vulnerable people
UR - http://www.scopus.com/inward/record.url?scp=85100486961&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.yebeh.2020.107602
DO - https://doi.org/10.1016/j.yebeh.2020.107602
M3 - Article
C2 - 33279440
SN - 1525-5050
VL - 115
JO - Epilepsy and Behavior
JF - Epilepsy and Behavior
M1 - 107602
ER -