(180) Changes in the patient call volume and call characteristics to an epileptologist during the COVID-19 pandemic

Rationale: COVID-19 (Coronavirus Disease 2019) is the infectious respiratory disease caused by SARS-COV 2 virus (Severe Acute Respiratory Syndrome coronavirus 2). On March 11,2020 The World Health Organization (WHO) declared COVID-19 a pandemic considering the over 118,000 cases of the coronavirus illness in over 110 countries. In order to control the spread of COVID-19, heath care authorities recommended isolation of sick persons, quarantine for those who may been exposed to the virus and social distancing. Social distancing also referred to as physical distancing meant keeping space between people. A distance of at least six feet (two meters) was recommended. Hospitals implemented drastic changes to prepare for the surge of COVID-19 patients. In New York City, hospitals canceled elective surgeries, closed in-patient epilepsy units and all outpatient clinics. Patients were discharged from the hospitals. Beds especially ICU beds and other resources such as ventilators were reserved for COVID-19 patients. Physicians working in these hospitals were advised to adopt telemedicine in order to primarily maintain continuity of care for their existing patients. The changes in patient call volume and call characteristics to an epileptologist during the COVID-19 pandemic were reviewed.

Methods: All patient calls to the epileptologist during the period from January 11 through February 29, 2020 (total 60 days) were reviewed and compared to calls from March 15 through May 15, 2020 (total=60 days). Total calls received and call characteristics (urgent vs. non-urgent) were analyzed. Non-urgent telephone calls included calls regarding medication side-effects and calls unrelated to patient’s primary seizure diagnosis. Calls regarding break-through seizures and status epilepticus were classified as urgent.

Results: Call volume significantly declined during the period (March 15-May 15) when the pandemic was most active in New York City. Prior to the pandemic there was an average of ten calls (urgent and non-urgent) per day. During the period of the pandemic this decreased to an average of one call (urgent and non-urgent) per day. There was a decline in non-urgent telephone calls both during and after office hours. A decline in urgent telephone calls was also noted. There was an increase in calls related to patient concerns about epilepsy and COVID-19. Call characteristics included concern whether epilepsy increased susceptibility to COVID-19 disease and request from essential workers (police officer, mass transit employee) for a doctor’s note to excuse them from work.

 

Conclusions: During the “active” phase of the COVID-19 pandemic, a significant decline in call volume to the epileptologist occurred. Even patients who suffered break-through seizures and seizure clustering did not call the epileptologist. Patients who needed in-person evaluation and management for seizure clustering, multiple break-through seizures, suspected seizures declined to come to see the epileptologist at his in-hospital faculty practice office. The likely cause for decrease in call volume and change in call characteristics was fear of contracting COVID-19 infection in the hospital setting. It is hypothesized that epilepsy patients were likely more compliant with anti-seizure medications during the pandemic. Leading up to the pandemic the epileptologist prescribed oral lorazepam or intranasal midazolam to be used as seizure rescue medication to patients with poorly controlled epilepsy. This might be the cause of the low volume of urgent calls. Lessons learned from the COVID-19 pandemic should guide future care of epilepsy patients including the use of seizure rescue medications and providing a safe office and hospital environment to maintain their continuity of care.

Funding: Please list any funding that was received in support of this abstract.: None