COVID-19 Guidance - FAQs & Webinar Series
Looking for Dravet-specific advice on coping with COVID-19? This resource provides the answers to Frequently Asked Questions, developed in consultation with our Medical Advisory Board, chaired by Professor Helen Cross, and links to our ongoing webinar series.
As with any general medical guidance it is important to consult with your clinician before starting, stopping or changing individual treatment plans. This guidance is correct to the best of our knowledge at the time of publication (Wednesday 26th August). However, we are mindful this is a rapidly evolving context and guidance may change as more information becomes available.
Q1: Is it safe for my child/adult with Dravet Syndrome to return to school/care settings?
The government’s shielding policy paused on 1st August 2020 based on there being fewer coronavirus cases in the community. For as long as shielding is paused, all children in education, including those who remain on the new shielding list, can return to school at a reduced risk and are expected to do so at the start of the new term unless:
- they have been advised to shield again by the government after 1st August 2020
- or if anyone in your household has to self-isolate due to COVID-19 symptoms during the school term.
Overall, according to available evidence to date (26.08.20), young children with little or no significant comorbidities appear to be at little risk. However, their parents and grandparents will be at higher risk.
Specific advice for children with Dravet Syndrome should be on a case-by-case basis. Dravet Syndrome is a spectrum condition, therefore, the extent to which each individual child/adult is at risk of COVID-19 infection will vary.
A ‘risk’ assessment needs to be based on the underlying comorbidities that an individual with DS has at the current time. For example, the presence of significant scoliosis with an impact on respiratory function and a history of frequent chest infections. A decision around whether the individual requires further shielding (and the implications of this for schooling) should be discussed by the family with the lead clinician/neurologist weighing up those risks.
For more ‘back to school’ advice, developed specifically for parents/carers of children with serious health needs, please see this helpful resource from Wellchild UK. Although this is aimed at children, many points are relevant for adults returning to residential homes or day centres. A ‘back-to-school’ webinar is also available to watch on video playback here.
Further detailed guidance for how the COVID-19 measures will affect children and young people with special educational needs and disabilities (SEND) is also available from the IPSEA website, click here.
Please note, each nation in the UK has its own detailed governmental guidance for back-to-school, with some differences in approach between nations. Click on the links for more information: Scotland, England, Wales and Northern Ireland.
Q2: What if is there is a second lockdown, will we need to resume shielding?
If there is a local outbreak or “second wave” of COVID-19 in the future, the government will advise fewer families with seriously ill children to shield than they did last time. This is because the Scientific Advisory Group for Emergencies (SAGE) has advised the Government that many of the children who were initially asked to shield are at lower risk from the virus than previously thought.
If shielding resumes in your area, the children/adults who remain on the shielding list (category A) will be advised to stay home from school again (see the RCPCH website for an updated list of shielded conditions).
Those who were on the original shielding list, but are now longer included, will not be advised to shield again by the Government. This is likely to be the case for the majority of children/adults with Dravet Syndrome. They are expected to continue to attend school unless the schools are asked to close to a majority of pupils once again.
The exceptions to this are children/adults who are no longer on the government’s shielding list, but who have been specifically advised to shield by their healthcare specialist, which then overrides the government advice on shielding.
If you think shielding may need to be continued for your child/adult with Dravet Syndrome, please raise this with your lead clinician/neurologist to request a risk assessment (see Q1, above). For more information about shielding, please see this helpful resource from Wellchild UK. Although this is aimed at children, many points are relevant for adults returning to residential homes or day centres.
Q3: Are people with Dravet Syndrome at high risk from COVID-19?
Dravet Syndrome is a spectrum condition, meaning the risks from COVID-19 will vary depending on a person’s overall health. Whilst fever sensitive epilepsies have been assessed as being low risk by the Association of British Neurologists (26.03.20), people with Dravet Syndrome have other health problems known as comorbidities. People with Dravet Syndrome may be at higher risk if their comorbidities mean they have compromise of the respiratory function such as recurrent chest infections, scoliosis or swallowing difficulties in the absence of a feeding tubes. A determination of low, medium or high risk should be clinician led. Guidance from the Association of British Neurologists on the risk from COVID-19 for people with neurological conditions can be found here. Guidance from the Government on people who are at very high risk of severe illness from COVID-19 and classified as extremely vulnerable can be found here.
Watch our 'Dravet Syndrome in the COVID-19 pandemic' webinar with Professor Helen Cross
On Monday 30th March, Professor Cross, a globally-recognised authority on Dravet Syndrome and Chair of our Medical Advisory, presented a webinar on the implications of COVID-19 for Dravet individuals.Watch the video
Q4: What measures should be taken to protect people with Dravet Syndrome from COVID-19?
Advice on the measures needed to protect against infection from COVID-19 is being regularly updated. The two main sources of information are the NHS website and the Government’s website. Currently (26.08.20) everyone is being advised that to protect yourself and others, when you leave home you must:
- wash hands - keep washing your hands regularly
- cover face - wear a face covering over your nose and mouth in enclosed spaces
- make space - stay at least a metre away from people not in your household
- If you are feeling unwell, get a test and do not leave home for at least 10 days
On Saturday 1 August, the official guidance on shielding was relaxed, with clinically extremely vulnerable people no longer advised to shield. A summary of the up-to-date guidance for people who have been shielding setting out the recent changes can be found here.
As Dravet Syndrome is a spectrum condition, the risks from COVID-19 infection will vary according to each individual. If you have any worries or concerns about the end of shielding you should raise these with your medical team.
Q5: Is it safe for carers to come into the home and/or for my Dravet child/adult to return to respite care?
If your child/adult is NOT on the clinically vulnerable list (confirmed by a text and letter from your GP) and provided carers/respite follow the latest government guidance (see below), the risks of COVID-19 infection remain low, so if families feel their child and the family as whole would benefit from a return to care or respite, they should feel comfortable in doing so.
Information for carers:
Carers should make sure they know which of their clients are on this list before your duties. The government has issued guidance for residential care, supported living and home-care, which can be found here. If you're a carer, your organisation should have a list of all clients who are shielded and in the clinically extremely vulnerable group, so you do not need to make an assessment yourself. Helpful information can also be found on the Carers UK website.
Watch our 'Family Wellness During COVID-19' webinar with Neil Williamson
On 25th April 2020, Neil Williamson, who is an Epilepsy Nurse Specialist and member of the DSUK Medical Advisory Board, hosted a webinar for Dravet families, which focused on family wellness through COVID-19, with practical tips and Dravet-specific advice for coping with the virus outbreak.Watch the video
Q6: Are there any issues children/adults with Dravet Syndrome needing to wear a mask?
Up until now (26.08.20), the use of face coverings in schools has been voluntary. However, some schools have started asking staff and pupils to wear them, to help stop the spread of COVID-19.
From 1st September, pupils at secondary schools in Scotland, England and Northern Ireland are expected to wear face masks in corridors and communal areas (but not in classrooms). On school buses, everyone over the age of five will have to wear face coverings.
There should be no contraindication for individual with Dravet Syndrome to wearing a mask. Cloth face coverings should not be placed on young children younger than 2 years of age, anyone who has trouble breathing, or is unconscious, incapacitated or otherwise unable to remove the cover without assistance.
Should a convulsive seizure occur it is advised that someone removes the mask with caution to ensure optimal airway function.
In some cases, mask wearing may not be tolerated even in older children with Dravet Syndrome due to sensory and other issues. Parents/carers may need to be prepared to explain this in situations where mask-wearing is requested. For public transport, exemptions for the use of face coverings apply to those with certain health conditions, disabled people and children under the age of 11 (find out more here).
PHE has produced a face coverings exemption toolkit which might be of use to parents/carers and can be found here.
Q7: My child/adult needs emergency care that I would normally go to A&E for. Should I still go to A&E if it is not COVID-19 related?
If a child/adult with Dravet Syndrome needs A&E then they should go to A&E and not avoid or delay due to COVID-19. Hospitals are still fully open and responding to all emergency situations, despite the COVID-19 situation, so it is important to follow your normal escalation procedure.
Children or adults with complex health needs and disabilities, such as Dravet Syndrome, may have their ‘own normals’. If as a parent or carer you feel your child is sicker than they normally are, are getting worse, or they have any new symptoms, trust your instincts and seek medical advice urgently. The Royal College of Paediatrics and Child Health (RCPCH) has some helpful guidance on seeking help - click here to view.
Q8: I’ve heard that the Coronavirus Act 2020 could lead to my local council suspending its social care duties for adults with disabilities. Should I be concerned about the impact this will have regarding social care provision for my son/daughter with Dravet Syndrome?
So far, there are very few examples of local authorities taking the decision to ease social care duties for adults with disabilities, as a result of the new Coronavirus Act.
Government guidance states that a local authority should only take a decision to begin easing Care Act duties if there is no alternative. In other words, a 'tipping point’ needs to be reached, where the workforce is significantly depleted, or demand on social care increased, to an extent that it is no longer reasonably practicable for the local authority to comply with its duties or to do so would lead to urgent or acute needs going unmet, risking life.
If you are concerned about any changes, do speak to your social care team. Any decision to reduce or suspend care cannot be made without approval by the Director of Social Services and Department of Health, and it must be reviewed every two weeks.
For more insights from Fiona Scolding, a leading family lawyer, please do check out our ‘Focus on Adults’ webinar; the relevant section starts at around 44 minutes into the webinar: https://bit.ly/DSadults. A more detailed presentation on the Coronavirus Act and its impact on adult social care is also available. Click here to view: https://bit.ly/DSCareAct.
Watch our webinar - 'COVID-19: Focus on Adults with Dravet Syndrome'
On Saturday 25th April, Professor Sanjay Sisodiya, an adult neurologist, and Fiona QC, a leading family lawyer, jointly presented a webinar focused on meeting the medical needs and safeguarding the rights of Dravet adults.Watch the video
Q9: What treatment plans will people with Dravet Syndrome need for COVID-19?
Any treatment plans for people with Dravet Syndrome and COVID-19 should be decided in consultation with clinicians, taking into account the latest information from reputable bodies. As people with Dravet Syndrome have fever sensitive seizures, the main issue is the likelihood of fever reported to be present for 65% to 80% of all people infected with COVID-19. We would expect treatment plans to be as follows:
- Administer paracetamol to control fevers
- Consider extra clobazam during the course of the illness (if already prescribed)
- Consider early application of rescue medication if seizures occur
Q10: Is it safe to give ibuprofen or other NSAIDs to people with Dravet Syndrome and COVID-19?
Ibuprofen, naproxen sodium and other non-steroidal anti-inflammatory drugs (NSAIDs) can relieve pain and fever; they also reduce inflammation. Another drug, paracetamol (also known as acetaminophen), controls pain and fever but does not affect inflammation. Although there have been concerns circulating about a risk of more severe infection with nonsteroidal anti-inflammatory drugs there is no definitive evidence to support this.
If your chid/adult has a fever or body aches, you can take one of these drugs for relief, as long as you follow the dose instructions.
Q11: Will the situation with COVID-19 lead to shortages of anti-seizure medicines?
Epilepsy Action and the Epilepsy Society both have helpful guidance on the availability of anti-seizure medicines. According to Epilepsy Action (27.03.20): “The Department of Health and Social Care is working with drug companies to minimise any impact of coronavirus on drug supplies. Drug companies have already built up stockpiles of medicines in preparation for Brexit and have now been asked to maintain this level of stockpiling. This should mean medicines will continue to be available, even if there are temporary disruptions to the supply chain. We don’t currently know of any coronavirus-related drug shortages. If we find out about any shortages of epilepsy medicines, we will post these on our Drugwatch webpage.”
For more information about the impact of coronavirus on people with epilepsy and their families, visit the ILAE (International League Against Epilepsy) COVID-19 resources.
Please check https://bit.ly/2UtnJei for the latest government guidance on social distancing. More information is available on coronavirus here https://www.nhs.uk/conditions/coronavirus-covid-19/.
For more information about our Medical Advisory Board, click here.
We will continue to monitor developments closely with the support of our Medical Advisory Board and through information provided by Public Health England and bring you further updates on a regular basis. In the meantime, please keep safe, keep well and stay at home.
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Visit our healthcare professional section for more resources, including information on common drug-drug interactions for Dravet Syndrome and COVID-19.Read More