COVID-19 response in a long-term care facility for people with epilepsy

Luisa Delazer; Noah Pressler; Simona Balestrini; Fenglai Xiao; Lisa M Clayton; Jonny Anders-Cannon; Rebecca Salvatierra; Ian Henry; Sanjay M Sisodiya; Josemir W Sander; Matthias J Koepp

doi:10.1002/epi4.12940

COVID-19 response in a long-term care facility for people with epilepsy

Epilepsia Open. 2024 Apr 9. doi: 10.1002/epi4.12940. Online ahead of print.

Authors

Luisa Delazer^{1

2

3}, Noah Pressler⁴, Simona Balestrini^{1

2

5}, Fenglai Xiao^{1

2

6}, Lisa M Clayton^{1

2}, Jonny Anders-Cannon¹, Rebecca Salvatierra¹, Ian Henry¹, Sanjay M Sisodiya^{1

2}, Josemir W Sander^{1

2

6

7}, Matthias J Koepp^{1

2}

Affiliations

¹ Chalfont Centre for Epilepsy, Chalfont St Peter, Bucks, UK.
² Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK.
³ Department of Neurology, Epilepsy Center, Ludwig Maximilians University, Munich, Germany.
⁴ University of Nottingham, Medical School, Nottingham, UK.
⁵ Neuroscience Department, Children's Hospital A. Meyer IRCSS, University of Florence, Florence, Italy.
⁶ Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.
⁷ Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands.

PMID: 38593277
DOI: 10.1002/epi4.12940

Abstract

Objective: To assess asymptomatic rates and severity of SARS-CoV-2 infection in people with epilepsy and their healthcare workers in a long-term care facility which had implemented weekly surveillance testing between April 2020 and June 2022.

Methods: Questionnaires focused on objective and subjective COVID-19 symptoms for people with epilepsy residing in and their healthcare workers at the Chalfont Centre for Epilepsy in June 2022. Demographic information, comorbidities, and seizure frequency were gathered from medical records. We also collected responses on objective and subjective COVID-19 symptoms from healthcare workers who participated in a prospective study assessing the reaction to COVID-19 vaccinations (SAFER).

Results: Fifty-five out of 89 (62%) residents tested positive at least once on weekly PCR testing for SARS-CoV-2 during the period of interest; 20 of those (37%) were asymptomatic. In comparison, of those 63 healthcare workers who tested positive at least once on weekly testing during the same period, only four (6%) were asymptomatic. Of the 159 healthcare workers who also participated in the SAFER study, 41 tested positive at least once, and seven (17%) were completely asymptomatic during infection with SARS-CoV-2.

Significance: People with epilepsy living in a long-term care facility were more likely to present with asymptomatic SARS-CoV-2 infections than healthcare workers at the same facility. Despite possible bias in the reporting of subjective symptoms due to management-by-proxy, there is no evidence that vulnerable people living in an epilepsy long-term care facility showed reduced resilience towards infections.

Plain language summary: People with epilepsy living in care home facilities had a surprisingly high degree of asymptomatic infections with SARS-CoV-2. Very few residents had severe or fatal outcomes. This is in stark contrast to the widely reported bad outcomes for people without epilepsy in other care homes. People with epilepsy reported significantly less symptoms than their healthcare workers. No changes in seizure frequency during or after infection were observed.

Keywords: SARS‐CoV‐2; asymptomatic rate; fatality ratio; seizures.