Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

COVID-19 and psychiatric units: Keeping clinicians and patients safe throughout the pandemic

Anoush Calikyan, Hank Weinstock, and Ania Poteraj
Conditions
September 27, 2022
13 Shares
Share
Tweet
Share

Patients running rampant- unmasked, hand unwashed, undistanced. You stand in the nurse’s workstation, watching the chaos ensue while holding the positive COVID test results in your hands. The world slows as you think, “How am I ever going to control this one?”

This scene is unfortunately ever present in our current health system. Since March 2020, the COVID-19 pandemic has put constant pressure on the medical system, uniquely affecting health care facilities with limited resources. Inpatient psychiatric hospitals present unique challenges as patients may struggle to maintain personal hygiene, consistently wear masks, or maintain social distancing in group settings. Additionally, psychiatric patients often have multiple unmanaged medical conditions and are less likely to have received a COVID-19 vaccination. These individuals have a significant risk of death due to their psychiatric and medical conditions, with a two to three times higher mortality rate than the general life expectancy. At the Mount Sinai Campus of St. Francis Hospital in Hartford, CT, the inpatient psychiatry unit has had considerable difficulties during the pandemic. The hospital was built in 1923 and does not have air-tight doors, negative pressure rooms, HEPA filtration symptoms, or other environmental necessities to promote infection control.

General hospital policy calls for the isolation of suspected or confirmed patients with COVID-19. This entails a private room, often in a dedicated wing, COVID-19 rapid antigen testing, and signage denoting the patient’s infectious status with PPE requirements. This strategy has shown varying levels of success, especially during COVID-19 surges. During the Omicron surge in January 2022, we noticed several challenges in maintaining infection control within our institution. The facility has demonstrated unprecedented demand for psychiatric beds since the beginning of the pandemic, causing there to rarely be an unfilled bed. Patients are allowed to freely move throughout the halls, eat meals, and attend group therapy sessions together in the same room. Coupled with inconsistent mask-wearing, this may facilitate increased infection transmission. Moreover, many of these patients have not received the full course of COVID-19 vaccinations, leaving them and others exposed to infection. Finally, given the increased demand for beds at inpatient and extended care psychiatric facilities, patients in psychiatric units may experience delays to discharge, leading to extended stays and potentially increased exposure to infection.

COVID-19 safety guidelines must be considered and implemented in inpatient units, including psychiatric floors. Many patients are unable to follow established COVID-19 protocol, including mask-wearing, social distancing, maintaining personal hygiene, and vaccinating pose a risk to themselves and patients and providers who come into contact with them. While it is important to consider the safety of others around the patients, it is essential also to consider patient autonomy. Just as providers cannot force treatment on a patient, patients cannot be forced to follow these safety guidelines. Ultimately, we can only make strong recommendations and reminders. In psychiatric units especially, this line blurs as providers rarely enforce these rules in an attempt to preserve the fragile relationship between patients and providers, as well as the risk of causing significant patient agitation.

As mentioned above, providers in our hospital had unique challenges during the pandemic. The Omicron variant “wave” overwhelmed testing capabilities and call centers everywhere, including the Trinity Health call center. As of January 3rd, Connecticut was having 1,457 cases of confirmed COVID daily, sustaining over 20 percent test positivity rate for much of January. This resulted in employees who were exposed to COVID or had symptoms being unable to receive timely work instructions or testing. In addition, staffing was stretched to its limit as many individuals were unable to safely report to work, often increasing the threshold that testing had to fall back to.

We present our recommendations now as COVID-19 moves toward endemicity. We emphasize the importance of having collaborative medical professionals who can be instrumental in managing comorbidities, acute illness, and vaccination. When individuals enter the facility, they should be offered the opportunity to have any missing COVID vaccination that they may qualify for, though we recognize that patients may not always be able to consent to this immediately upon entry, depending on their mental status at the time. Testing and vaccination should again be offered to patients upon discharge and ensure appropriate psychiatric and medical follow-up.

We note that vaccinations are not an instantaneous solution as significant efficacy takes up to two weeks, but given the large rate of return to both our as well as other outpatient/inpatient facilities signifies the important opportunity for public health that will help these individuals as well as those who care for them. Moreover, providers also require adequate testing, and health care workplaces either need to be provided an adequate number of COVID-19 tests to keep their workers safe during surges, or there must be a consideration of the types of tests that are adequate for confirming COVID-19 infection and safely returning to work. Reliable telehealth services should be available to mitigate the mental health burden and social isolation of exposed/infected patients and to lessen the burden on the health care system in cases where health care providers have been infected or exposed and are temporarily unable to see patients in person.

The authors thank Dr. Mahreen Raza, the psychiatrist in the Mount Sinai Campus of St. Francis Hospital in Hartford, for valuable discussion and comments on this case.

Anoush Calikyan. Hank Weinstock, and Ania Poteraj are medical students.

Image credit: Shutterstock.com

Prev

The heartbreak and joy of missions-based pain medicine: a pain physician’s perspective

September 27, 2022 Kevin 1
…
Next

We are all responsible for women physicians’ pay discrepancy [PODCAST]

September 27, 2022 Kevin 0
…

Tagged as: COVID, Psychiatry

Post navigation

< Previous Post
The heartbreak and joy of missions-based pain medicine: a pain physician’s perspective
Next Post >
We are all responsible for women physicians’ pay discrepancy [PODCAST]

Related Posts

  • How to get patients vaccinated against COVID-19 [PODCAST]

    The Podcast by KevinMD
  • The social determinants of health during the COVID-19 pandemic

    Heather Thompson Buum, MD
  • Why health care will never be the same after the COVID-19 pandemic

    Naheed Ali, MD, PhD
  • Malpractice claims from the COVID-19 pandemic: more questions than answers

    Robert E. White, Jr.
  • Medical education in the COVID-19 pandemic can’t be ignored

    Casey Hribar and Carolyn S. Quinsey, MD
  • The uncertainty of an international medical graduate during the COVID-19 pandemic

    Juan J. Delgado-Hurtado, MD, MPH

More in Conditions

  • The endless waves of chronic illness

    Michele Luckenbaugh
  • Surviving and thriving after life’s most difficult moments

    Rebecca Fogg, MBA
  • The surprising power of Play-Doh in pediatric care: How it’s bringing families together

    Alexander Rakowsky, MD
  • Lazarus: the dead man brought back to life

    William Lynes, MD
  • The psychoanalytic hammer: lessons in listening and patient-centered care

    Greg Smith, MD
  • 5 essential tips to help men prevent prostate cancer

    Kevin Jones, MD
  • Most Popular

  • Past Week

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • It’s time for C-suite to contract directly with physicians for part-time work

      Aaron Morgenstein, MD & Corinne Sundar Rao, MD | Physician
    • The struggle to fill emergency medicine residency spots: Exploring the factors behind the unfilled match

      Katrina Gipson, MD, MPH | Physician
    • What is driving physicians to the edge of despair?

      Edward T. Creagan, MD | Physician
    • Beyond the disease: the power of empathy in health care

      Nana Dadzie Ghansah, MD | Physician
    • The psychoanalytic hammer: lessons in listening and patient-centered care

      Greg Smith, MD | Conditions
  • Past 6 Months

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
    • The Titanic sinking: a metaphor for the impending collapse of medicine

      Aaron Morgenstein, MD & Corinne Sundar Rao, MD & Shreekant Vasudhev, MD | Physician
  • Recent Posts

    • Surviving clinical rounds: tips and tales from a pediatric hematologist-oncologist [PODCAST]

      The Podcast by KevinMD | Podcast
    • The harmful effects of shaming patients for self-education

      Maryanna Barrett, MD | Physician
    • The power of self-appreciation: Why physicians need to start acknowledging their own contributions

      Wendy Schofer, MD | Physician
    • The endless waves of chronic illness

      Michele Luckenbaugh | Conditions
    • Skydiving and surgery: How one doctor translates high-stress training to saving lives

      Alexandra Kharazi, MD | Physician
    • Telemedicine in the opioid crisis: a game-changer threatened by DEA regulations

      Julie Craig, MD | Meds

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

Leave a Comment

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • Abortion Is Not Murder in the Eyes of the Law
  • Introducing Allergenic Foods Early Tied to a Reduction in Later Allergies
  • Isotretinoin REMS Still Needed, But Its Burden Could Be Reduced, FDA Staff Says
  • Children Do Well With Fewer Opiates After Surgery
  • High Out-of-Pocket Costs Tied to Less Follow-Up After Initial Mammography

Meeting Coverage

  • Children Do Well With Fewer Opiates After Surgery
  • Advances in Diagnosis and Management of Severe Cutaneous Adverse Reactions
  • Orismilast Clears Skin in Moderate-to-Severe Psoriasis
  • New Combinations Promising in Advanced Urothelial Carcinoma
  • No Survival Benefit With CRT Versus Chemo for Locally Advanced Endometrial Cancer
  • Most Popular

  • Past Week

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • It’s time for C-suite to contract directly with physicians for part-time work

      Aaron Morgenstein, MD & Corinne Sundar Rao, MD | Physician
    • The struggle to fill emergency medicine residency spots: Exploring the factors behind the unfilled match

      Katrina Gipson, MD, MPH | Physician
    • What is driving physicians to the edge of despair?

      Edward T. Creagan, MD | Physician
    • Beyond the disease: the power of empathy in health care

      Nana Dadzie Ghansah, MD | Physician
    • The psychoanalytic hammer: lessons in listening and patient-centered care

      Greg Smith, MD | Conditions
  • Past 6 Months

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
    • The Titanic sinking: a metaphor for the impending collapse of medicine

      Aaron Morgenstein, MD & Corinne Sundar Rao, MD & Shreekant Vasudhev, MD | Physician
  • Recent Posts

    • Surviving clinical rounds: tips and tales from a pediatric hematologist-oncologist [PODCAST]

      The Podcast by KevinMD | Podcast
    • The harmful effects of shaming patients for self-education

      Maryanna Barrett, MD | Physician
    • The power of self-appreciation: Why physicians need to start acknowledging their own contributions

      Wendy Schofer, MD | Physician
    • The endless waves of chronic illness

      Michele Luckenbaugh | Conditions
    • Skydiving and surgery: How one doctor translates high-stress training to saving lives

      Alexandra Kharazi, MD | Physician
    • Telemedicine in the opioid crisis: a game-changer threatened by DEA regulations

      Julie Craig, MD | Meds

MedPage Today Professional

An Everyday Health Property Medpage Today iMedicalApps
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Leave a Comment

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...