COVID-19 outbreak in a psychiatric hospital: what makes it worse?

Background: Psychiatric patients could be at risk of worse outcomes from COVID-19 than the general population. The primary objective of the present study was to describe the symptoms and clinical characteristics of COVID-19 patients living in long-term hospital for mental illness in Lebanon. The secondary objective was to evaluate the factors related to COVID-19 disease severity among these patients.

Methods: A retrospective observational study was conducted from September 2020 to January 2021 at the Psychiatric Hospital of the Cross. The total number of COVID-19 patients in the infected floors is 410 out of 548. The outcome variable was the severity of COVID-19 illness classified into five categories: asymptomatic, mild, moderate, severe and critically ill.

Results: The rate of infection in the affected floors was 74.81%. Almost half of the patients were asymptomatic (49.3%), 43.4% had hyperthermia and only 28.0% had tachycardia and 25.1% developed hypoxia. The multivariate regression analysis showed that higher temperature (ORa = 6.52), lower saturation (ORa = 0.88), higher BMI (ORa = 1.12), higher CRP (ORa = 1.01), being a female (ORa = 4.59), having diabetes (ORa = 8.11) or COPD (ORa = 10.03) were significantly associated with the increase of the COVID-19 severity.

Conclusions: The current study showed that a high rate of infection from COVID-19 was detected in a psychiatric hospital with the majority having asymptomatic to mild symptoms. Female psychiatric patients, desaturation, increase inflammation and comorbidities such as diabetes and COPD were associated with the severity of COVID-19 among psychiatric patients. Future studies are needed to better understand the causal relation of the factors with severity and long term effects or sequelae of the disease.