ECT and COVID: Perspective From The UK and Ireland

Out on Pubmed is this paper:

Effects of the COVID-19 pandemic on provision of electroconvulsive therapy.

Braithwaite R, Chaplin R, Sivasanker V.BJPsych Bull. 2021 May 12:1-4. doi: 10.1192/bjb.2021.43. Online ahead of print.PMID: 33977894

The abstract is copied below:

Aims and method: COVID-19 has had a heavy impact on healthcare provision worldwide, including delivery of electroconvulsive therapy (ECT). A survey was completed in the UK and Republic of Ireland in April and July 2020 by 95 and 89 ECT clinics respectively.

Results: In April 2020, 53% of the clinics provided only emergency treatment and 24% had closed. Reasons included unavailability of anaesthetists, infection control measures and staff sickness. Restrictions persisted in July, with disruption to an estimated 437 individuals' treatment and poor outcomes, including clinical deterioration and readmission.

Clinical implications: Risk stratification, longer clinic sessions, improvements in ventilation, regular virus testing, pragmatic staff rostering and availability of personal protective equipment will protect against service disruption in subsequent waves of the pandemic.

Keywords: COVID-19; Electroconvulsive therapy; anaesthesia; coronavirus; mental health.

The psf is here.

And from the text:

The resultant loss of productivity has been devastating for many patients. It has led to services variously cancelling all ECT or prioritising only the sickest patients; some clinics have stopped out-patient treatment. Widespread cessation of continuation and maintenance ECT has led to recurrence of severe illness, and delays in initiating acute courses have resulted in worse patient outcomes, particularly in life threatening illness. Admissions and even formal detentions in hospital have occurred or been lengthened as a consequence.

...It would be all too easy, with the benefit of hindsight, to criticise decisions made at the outset of the pandemic to redeploy anaesthetists, en masse, in anticipation of a surge in ICU usage of far greater magnitude than ultimately occurred. But it is important that the same situation does not recur and that staff are pulled from delivering ECT only if ICUs have a genuine need for the personnel and careful consideration of the balance of negative outcomes concludes that such action is unavoidable. PPE must be kept available. Lastly, the need to lengthen or widen ECT lists into afternoon sessions or on more days of the week must be seriously considered by healthcare providers, with job planning and prioritisation of staffing for ECT services made to facilitate this.

This survey, from the ECT Accreditation Service (ECTAS), adds to the ECT COVID literature database. It underscores the similarity of recent challenges faced by ECT services around the world.

The details will be of interest to many ECT practitioners, to compare with their own experience. Worth a full read, ~10 minutes.