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

Abstract

COVID-19 (coronavirus disease 2019) is the infectious respiratory disease caused by SARS-COV 2 virus (Severe Acute Respiratory Syndrome coronavirus 2). The World Health Organization (WHO) declared COVID-19 a pandemic on March 11th, 2020 [[1]Cucinotta D. Vanelli M. WHO declares COVID-19 a pandemic.Acta Biomed. 2020; 91: 157-160Google Scholar]. In New York hospitals introduced drastic changes to manage the surge of COVID-19 patients. Most outpatient clinics were canceled. Rapid adoption of telemedicine allowed continuity of care of existing patients while protecting health healthcare workers from infection. The changes in patient telephone call volume and call characteristics to an epileptologist during the COVID-19 pandemic were reviewed. All patient calls to the epileptologist during the period from Jan 1st through Feb 29th, 2020 (total 60 days) were reviewed and compared to calls during the period from March 15th through May 15th, 2020 (total = 60 days). Total calls received and call characteristics (urgent Vs. non-urgent) were analyzed. Non-urgent telephone calls included calls regarding possible medication side-effects and calls unrelated to patient’s primary seizure diagnosis. Calls regarding break-through seizures and status epilepticus were classified as urgent. Call volume significantly declined during the period (March 15th–May 15th) when the pandemic was most active in New York City. Prior to the pandemic there was an average of 10 calls (urgent and non-urgent) per day. During the period of the pandemic this decreased to an average of 1 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 (Table 1).Table 1Change in call volume and call characteristics during the COVID-19 pandemic.Call volume and characteristicsBefore the pandemic (Jan 1st –Feb 29th, 2020) Total = 60 daysDuring the pandemic (Mar 15th-May 15th, 2020) Total = 60 daysNo of calls (call volume)Average 10 calls/day (urgent plus non-urgent).Average 1 call/day (urgent and non-urgent). Decline in calls both during and after office hours.Call characteristicCalls regarding possible medication side-effects and calls unrelated to patient’s primary seizure diagnosis (non-urgent calls)Increase in calls related to patient concerns about epilepsy and COVID-19.Calls regarding break-through seizures and status epilepticus (urgent calls)Increase in calls related to concern whether epilepsy increased susceptibility to COVID-19 disease.Increase in calls with requests from essential workers (police officer, mass transit employee) for a doctor’s note to excuse them from work. Open table in a new tab During the “active” phase of the COVID-19 pandemic, a significant decline in call volume to the epileptologist was noted. Even patients who suffered break-through seizures and seizure clustering were not calling the epileptologist. Patients who needed in-person evaluation and management for seizure clustering, multiple break-through seizures, suspected seizures declined to come and see the epileptologist at his in-hospital faculty practice office. The likely cause for decrease in call volume and change in call characteristics was the fear of contracting coronavirus infection in the hospital setting. It is hypothesized that epilepsy patients were likely more compliant with their anti-seizure medications during the pandemic. Leading up to the pandemic the epileptologist prescribed either oral lorazepam or intranasal midazolam to be used as seizure rescue medication to his patients with poorly controlled epilepsy. This too 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. NKS conceived, drafted and revised the manuscript.