In-patient psychiatry management of COVID-19: rates of asymptomatic infection and on-unit transmission

Abstract

Background New York City's first case of SARS-associated coronavirus (SARS-CoV-2) disease 2019 (COVID-19) was identified on 1 March 2020, prompting rapid restructuring of hospital-based services to accommodate the increasing numbers of medical admissions. Non-essential services were eliminated but in-patient treatment of psychiatric illnesses was necessarily maintained. Aims To detail the response of the NYU Langone Health in-patient psychiatric services to the COVID-19 outbreak from 1 March to 1 May 2020. Method Process improvement/quality improvement study. Results Over this time period, our two in-patient psychiatric units (57 total beds) treated 238 patients, including COVID-19-positive and -negative individuals. Testing for COVID-19 was initially limited to symptomatic patients but expanded over the 62-day time frame. In total, 122 SARS-CoV-2 polymerase chain reaction (PCR) tests were performed in 98 patients. We observed an overall rate of COVID-19 infection of 15.6% in the patients who were tested, with an asymptomatic positive rate of 13.7%. Although phased roll-out of testing impaired the ability to fully track on-unit transmission of COVID-19, 3% of cases were clearly identified as results of on-unit transmission. Conclusions Our experience indicates that, with appropriate precautions, patients in need of in-patient psychiatric admission who have COVID-19 can be safely managed. We provide suggested guidelines for COVID-19 management on in-patient psychiatric units which incorporate our own experiences as well as published recommendations.

The Early Impacts of the COVID-19 Pandemic on Mental Health Facilities and Psychiatric Professionals

“…In facilities 38 [9,13,[20][21][22][23][25][26][27][28][29][30][31]33,35,36,38,39,[41][42][43]49,52,54,55,[57][58][59][63][64][65][66][67]70,76,77,79,80] In private medical practices 3 [24,58,69] Within the community 5 [6,27,56,58,75] Related to somatic care 3 [35,59,74] Related to drug prescription 4 [53,56,…”

“…Since they gather many people in a limited space, psychiatric hospitals are particularly at risk of becoming transmission clusters [7,8,41,59,66], especially since community life and shared activities such as eating together, therapy groups, physical activities, and sports are important parts of therapeutic plans [13,21,41,54,66].…”

Hospital-wide SARS-CoV-2 antibody screening of staff in a university psychiatric centre in Belgium

“…Our data corroborate the findings from other authors that although patients with mental disorders are at increased risk of COVID-19 infection, 6 , 7 with appropriate precautions, in-patient psychiatric services do not represent COVID-19 outbreak hotspots, and even patients with COVID-19 who need in-patient psychiatric treatment can be managed safely. 8 , 9 …”

Buffering Effect of in-patient Psychiatric Care on the Link Between Fear of Covid-19 and Mental Health Consequences

“…In the setting of a pandemic, treating psychiatric patients, especially those who necessitate more intensive treatment, poses a challenge due to the risk of spreading the disease and endangering patients' physical health (9,10,23). Based on these dangers, actual therapeutic encounters were generally minimized in the face of the pandemic, and psychiatric inpatient therapy, day therapy, and all forms of intensive therapy were extremely limited (9, 10).…”