Position Statement on ECT as an Essential Procedure during COVID-19

December 8, 2020
The COVID-19 pandemic has had a major impact on the delivery of ECT around the world since early 2020. This winter of 2020-2021, another COVID-19 surge is upon us. Thus, making a position statement about ECT for our members, patients, and health care administrators is extremely important. During peak COVID-19 prevalence, ECT programs face the challenges of potentially suspending ECT care or dramatically reducing the number of patients treated. In battling this disease, care teams have encountered many problems including the need to preserve Personal Protective Equipment (PPE), reduce spread of the virus, and protect patients and medical personnel.
To address the pandemic in the United States, the Center for Medicare and Medicaid Services (CMS) previously recommended a tiered system which suggested suspending elective procedures during the COVID-19 crisis and times of reduced resources (1). For patients receiving acute/index ECT courses, ECT is commonly urgent or emergent. For patients receiving maintenance courses of ECT, ECT may be required to avoid severe relapses and rehospitalization. Therefore, the ISEN considers ECT an essential medical procedure for many individuals who are suffering from the most severe forms of mental illness including life-threatening depression, mania, psychosis, and catatonia.
In early April 2020, the ISEN executive committee disseminated a letter of recommendations to its members regarding many issues in conducting ECT during the COVID-19 pandemic and addressed patient selection/triaging, screening, and infection control (2). These recommendations can be revisited by ISEN members if health care resources become limited or ECT services need to be reduced. This position statement, however, is more direct and intended to communicate more broadly that ECT should be considered an essential medical procedure for those requiring urgent or emergent care during COVID-19 or any other pandemic.