Across the globe, the COVID-19 pandemic has caused significant disruptions to all aspects of life. At the Alzheimer’s Association International Conference (21–31 July 2020), the organizers put together a panel discussion for journalists to discuss the impact of the global pandemic on Alzheimer’s research trials, long-term care and the brain.
During the panel, we heard from Gregory Jicha (University of Kentucky, KY, USA), Neelum Aggarwal (Rush University Medical Center, IL, USA), Beth Kallmyer (Alzheimer’s Association, IL, USA), Gabriel de Erausquin (UT Health San Antonio, TX, USA) and Maria Carrillo (Alzheimer’s Association). In this conference report, we aim to highlight some of the key outcomes mentioned during the discussion.
The impact of COVID-19 on Alzheimer’s disease and related dementia research
In the first presentation, we heard from Gregory Jicha on the impact that COVID-19 is having on Alzheimer’s disease and related dementia research. Two main aspects were covered in his talk including the essential features of research conduct and the impact of COVID-19 on research conduct. For example, how can we conduct research while ensuring safety? According to Jicha, the following aspects are effective:
- Screening for symptoms (50% effective)
- Social distancing (93% effective)
- Minimizing exposure time (50% effective)
- Limiting staff to 50% (50% effective)
- Cloth/paper masks (80% effective)
- Testing (99.25% effective)
Overall, he noted that ensuring safety while conducting research is indeed possible. The number of promising targets for Alzheimer’s disease and related dementias has never been higher or more comprehensive, and although COVID-19 risks for our populations are high, research needs to be safer than clinical care, he concluded.
COVID-19 and its impact on long-term care facilities
We also heard from Beth Kallmyer about the worrying headlines that have been appearing around the impact of COVID-19 in long-term care facilities. In the USA, some estimates have indicated that over 59,000 residents and workers have died from the coronavirus at nursing homes and other long-term care facilities. This number has accounted for 42% of deaths in the USA (as of 29 July 2020). According to the 2020 Alzheimer’s disease Facts and Figures report, 48% of residents in nursing homes are reported to be living with Alzheimer’s disease or other forms of dementia.
These individuals are being impacted at significantly greater rates than the rest of society and yet, there is nothing in place to protect them. Prior to COVID-19, pre-existing issues in nursing homes and assisted living communities were already striking (e.g., staff shortages/training, infection control, emergency preparedness, reimbursement, and quality improvement). Consequently, all these issues have been exacerbated by the current climate of the pandemic.
In addition to this, if we consider the toll of social isolation, people living with dementia in these communities are even more affected. Regular programming within long-term care facilities relies on a congregate setting and this has been limited due to current safety procedures put in place. This lack of social engagement is devastating for everyone across the globe but even more so for people living with dementia.
In response to this, the Alzheimer’s Association has implemented 16 policy recommendations that span across four areas:
This includes testing every resident and employee each time they leave and come back. This would mean that residents would not need to be confined in their own rooms – they could sit together in the dining hall and in some sense, live normally. If this testing could be put in place, protocols could be set up for visits from family members.
The challenges of reporting and the different ways it must happen across different states in the USA has been overwhelming for long-term care providers. There is a need for a single portal that is easy and efficient for reporting. If people do not know what is going on, then they cannot address it.
This revolves around being able to respond to hot spots. For example, if there was an incidence or outbreak in a long-term care facility, then what could be done? Can strike teams go in and help provide care?
Long-term care providers still do not have adequate personal protective equipment, which is highly concerning and unacceptable. Support is also required in other areas (e.g., how to do testing, how to manage staff shortages, etc.).
COVID-19, Alzheimer’s disease and health disparities
We also heard from Maria Carrillo about how COVID-19 has exposed health differences that exist between racial and ethnic groups. This includes lack of access to stable housing, transportation and health-enhancing resources; work circumstances; lack of access to insurance and affordable healthcare; underlying health conditions; stigma; and genetics, particularly of under-represented populations.
Carrillo also announced a new research study from the Alzheimer’s Association to globally track and understand the long-term impact of exposure to the novel coronavirus on the brain, including cognition, behavior and function. Researchers from across 30 countries will be joining, with the World Health Organization providing technical assistance. In addition to this, the research will align with existing studies, such as the Framingham Heart Study, and clinicians across the globe on how the data is measured and collected. Cross-study collaborations will also be considered in order to better understand the impact of the virus on the brain.
“Most likely, dementia does not increase risk for COVID-19, just like dementia does not increase risk for the flu. However, dementia-related behaviors, difficulty following safety protocols, increased age and common health conditions that often accompany dementia may increase risk,” explained Carrillo.
Speaking more about the study, Gabriel de Erausquin stated that the investigation would have a target sample size of 1000 persons per cohort (approximately 20,000–40,000 total participants). Initial results from the study are expected within 6 months of recovery time from the first assessment, and within 1 year of initial assessment of the follow-up. Adding to this, Carrillo stated that they will have very good data to present from this at the next Alzheimer’s Association International Conference.
To conclude, the COVID-19 pandemic presents additional challenges for people living with dementia, including their families and caregivers. The impact of the pandemic is especially concerning when taking long-term care settings into account. To echo the statements made from Carrillo, it is crucial that policymakers implement solutions that will address the immediate and long-term issues impacting care facilities during the COVID-19 pandemic. The new study announced by the Alzheimer’s Association is also great news and we look forward to hearing more about this in the future, from both study publications and the next Alzheimer’s Association International Conference.
Sources: personal notes; www.alz.org/aaic/releases_2020/covid-19-cognition-media-panel.asp