Electroconvulsive therapy during severe acute respiratory syndrome coronavirus 2 pandemic

To the Editor

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) first emerged during the late-2019, in Wuhan, China, and is the cause of the pandemic – COVID-19. SARS-CoV-2 is transmitted through respiratory droplets and is associated with substantial morbidity and mortality. Although Australia has been fortunate to not see large case numbers at this stage, there may be significant implications for how electroconvulsive therapy (ECT) is delivered in future possible resurgences.

There are concerns that certain anaesthetic procedures such as manual ventilation and laryngeal mask intubation, more commonly used in ECT, increases aerosolisation of the virus from airways (Caputo et al., 2006). It is thought that the virus may remain viable in aerosol form for at least 3 hours and up to 72 hours on surfaces such as stainless steel (Van Doremalen et al., 2020). Screening for viral symptoms and travel/contact history should occur routinely. Personal protective equipment should be appropriately used during ECT to reduce the risk for health care workers, and sanitisation of the ECT area conducted to reduce risks to other patients.

If the number of SARS-CoV-2 cases increased, hospital resources, including anaesthetic staff and operating theatre capacity, would likely be limited. The focus should be on how to make each ECT treatment as effective as possible and resilient to workforce shortages and procedure cancellations. Frequent review of cases, considering indication and alternative treatment options prior to each ECT session, as well as consideration of bi-weekly (vs thrice weekly) sessions and bi-temporal electrode placements should occur. The use of formulas to derive initial ECT dosing, as compared to titration, may reduce the time under anaesthesia and allow staff without titration experience to deliver treatment (Petrides et al., 2009). Workforce constraints may result in use of single operator delivery options, such as Thymapads and Therabands, and additional training and resources should be sourced.

ECT remains one of most effective and fast-acting treatments for acute severe psychiatric conditions, and appropriate use leads to reduced hospital admissions and earlier discharges. It is important for psychiatrists to advocate for ongoing access to ECT while acknowledging this will need to be balanced with other health service requirements.