Two in five psychiatric ward patients had coronavirus at height of outbreak, study suggests

Up to two in five patients treated on psychiatric wards during the height of the UK’s coronavirus outbreak tested positive for the infection, research suggests.

Scientists from University College London (UCL) analysed more than 300 patients across five London mental health trusts.

The patients – who were over 65 or had young onset dementia – were generally admitted with a severe loss of cognitive function, a psychotic illness or depression.

Results revealed around two in five (38%) tested positive for the coronavirus between March and April, of whom 15% died with the infection.

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This is substantially higher than the World Health Organization’s (WHO) estimated 3.2% death rate in communities at the time, noted the scientists.

The results also revealed some of the psychiatric wards received coronavirus tests and staff personal protective equipment (PPE) after areas of the hospital treating physical illnesses, possibly contributing to patient deaths.

“Most of these people had no choice but to be in psychiatric care, so the state has an ethical imperative to protect them,” said lead author Professor Gill Livingston.

“Our findings show there are unequal standards of care between mental health and physical health wards.

“People shouldn’t be disadvantaged by being in a psychiatric ward.”

Coronavirus outbreaks were flagged in hospitals early in the pandemic, prompting strict rules on visitor numbers.

Experts have warned the outbreak could have a “pervasive” and “profound” impact on people’s mental health for some time, however, the risk among those who already have brain disorders was less clear.

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To learn more, the UCL scientists looked at 344 patients on psychiatric wards between 1 March and 30 April. Most of the participants were over 65, with the risk of coronavirus complications increasing with age.

Just over half of the patients had dementia, another risk factor for COVID-19, the disease caused by the infection. Most of the remaining participants had either a psychotic illness or depression.

None of the patients were known to have the coronavirus when they were admitted to hospital, however, 131 were diagnosed within the next two months, either via a test or because they showed symptoms.

The scientists noted the true infection rate may have been higher, given the insufficient testing.

The vast majority of the patients (92%) had at least one comorbidity (an additional health complication), like high blood pressure or heart disease.

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Psychiatric patients often face a higher risk of infection due to their care typically encouraging they socialise and maintain relatively close contact with staff, according to the UCL scientists.

Of those who tested positive for the coronavirus, more than a third (35%) experienced delirium or “acute cognitive decline”.

Testing became available on average 4.5 days after the first clinically suspected coronavirus case arose on a ward.

PPE also often arrived after the first case had materialised, rather than beforehand to prevent an outbreak.

In some of the trusts, tests and PPE arrived later at psychiatric wards than in areas of the hospital treating physical illnesses.

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The scientists noted 15% of the positive cases died with the infection. “This mortality rate is much higher than in the community, which was 3.2% according to WHO [World Health Organization] global figures,” they wrote.

More than four in five (82%) of the psychiatric patients were compulsorily detained under the Mental Health Act or Mental Capacity Act.

UK policy mandates “parity of esteem” between mental and physical health, which is sometimes interpreted as treating patients with equal respect and hope.

The scientists claim their results reveal widespread parity was not reached.

Fiona Carragher from the Alzheimer’s Society said: “Our report this week revealed across the country a quarter of people who died of COVID-19 had dementia, but on these wards we can see it was more than a half.

“Government must put people with dementia at the heart of its winter plans to tackle the virus, including regular testing across health and social care.”

Officials and medics alike have repeatedly stressed the potential dangers that await as the UK moves into winter, when seasonal flu also circulates.

Ahead of this challenging period, the scientists are calling for increased testing in psychiatric wards, in particular when a new patient is admitted.

They also want to see suspected cases isolated until the result comes back.

Adequate PPE, “close liaison with respiratory physicians” and the provision of oxygen therapy are also “vital measures”, added the team.

“A lot of mental health hospitals are much better prepared now for potential outbreaks this winter, but more work needs to be done to ensure that patients are not facing avoidable risks and that they receive the same standards of care as those in other hospitals,” said co-author Dr Andrew Sommerlad.

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