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Klousnitzer J, Tatar JM, Snyder AH, Snyder GM. A retrospective review of COVID-19 testing and mitigation strategies at a psychiatric hospital and subsequent COVID-19 acquisition. Am J Infect Control 2023; 51:1360-1365. [PMID: 37263420 PMCID: PMC10228166 DOI: 10.1016/j.ajic.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 05/24/2023] [Accepted: 05/25/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND Behavioral health settings present increased challenges in preventing the transmission of infectious agents. Characterizing the relative effectiveness of various strategies, including testing for asymptomatic carriage of Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus, will inform transmission reduction efforts in behavioral health settings. METHODS A single-center retrospective study was conducted in an inpatient behavioral health hospital by reviewing COVID-19 mitigation and testing strategies with information collected from discharges between July 1, 2020 and February 28, 2021. RESULTS During the study period, there were 3,694 total discharges and 3,229 unique admitted patients, including 86 (2.7%) patients who had positive SARS-CoV-2 polymerase chain reaction test results. Preadmission testing from noncongregate care settings (38, 44.1%), and testing after an in-hospital exposure (27, 31.4%) were the most common indications for testing among patients with a positive test. Up to 29 (33.7%) potentially acquired the infection during their hospitalization. Asymptomatic screening tests identified approximately two-thirds (55, 64.0%) of potentially contagious patients. CONCLUSION Asymptomatic screening testing on admission and after exposure and universal masking were strong interventions to prevent SARS-CoV-2 transmission in this investigation Future studies of SARS-CoV-2 and other pathogens in behavioral health settings should endeavor to characterize the effectiveness of infection prevention interventions.
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Affiliation(s)
- Jessie Klousnitzer
- University of Pittsburgh School of Public Health, Department of Epidemiology, Pittsburgh, PA
| | - Janina-Marie Tatar
- UPMC Western Psychiatric Hospital, Infection Prevention and Control, Department of Nursing, Pittsburgh, PA
| | - Amy H Snyder
- UPMC Western Psychiatric Hospital, Infection Prevention and Control, Department of Nursing, Pittsburgh, PA
| | - Graham M Snyder
- Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, PA; Department of Infection Control and Hospital Epidemiology, UPMC Presbyterian, Pittsburgh, PA.
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El Abdellati K, Lucas A, Perron H, Tamouza R, Nkam I, Richard JR, Fried S, Barau C, Djonouma N, Pinot A, Fourati S, Rodriguez C, Coppens V, Meyer U, Morrens M, De Picker L, Leboyer M. High unrecognized SARS-CoV-2 exposure of newly admitted and hospitalized psychiatric patients. Brain Behav Immun 2023; 114:500-510. [PMID: 37741299 DOI: 10.1016/j.bbi.2023.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 08/28/2023] [Accepted: 09/16/2023] [Indexed: 09/25/2023] Open
Abstract
BACKGROUND Patients with pre-existing mental disorders are at higher risk for SARS-CoV-2 infection and adverse outcomes, and severe mental illness, including mood and psychosis spectrum disorders, is associated with increased mortality risk. Despite their increased risk profile, patients with severe mental illness have been understudied during the pandemic, with limited estimates of exposure in inpatient settings. OBJECTIVE The aim of this study was to describe the SARS-CoV-2 seroprevalence and antibody titers, and pro-inflammatory cytokine concentrations of newly admitted or hospitalized psychiatric inpatients without known history of COVID-19 infection, using robust quantitative multi-antigen assessments, and compare patients' exposure to that of hospital staff. METHODS This multi-centric, cross-sectional study compared SARS-CoV-2 seroprevalence and titers of 285 patients (University Psychiatric Centre Duffel [UPCD] N = 194; Assistance-Publique-Hopitaux de Paris [AP-HP] N = 91), and 192 hospital caregivers (UPCD N = 130; AP-HP N = 62) at two large psychiatric care facilities between January 1st and the May 30th 2021. Serum levels of SARS-CoV-2 antibodies against Spike proteins (full length), spike subunit 1 (S1), spike subunit 2 (S2), spike subunit 1 receptor binding domain (S1-RBD) and Nucleocapsid proteins were quantitatively determined using an advanced capillary Western Blot technique. To assess the robustness of the between-group seroprevalence differences, we performed sensitivity analyses with stringent cut-offs for seropositivity. We also assessed peripheral concentrations of IL-6, IL-8 and TNF-a using ELLA assays. Secondary analyses included comparisons of SARS-CoV-2 seroprevalence and titers between patient diagnostic subgroups, and between newly admitted (hospitalization ≤ 7 days) and hospitalized patients (hospitalization > 7 days) and correlations between serological and cytokines. RESULTS Patients had a significantly higher SARS-CoV-2 seroprevalence (67.85 % [95% CI 62.20-73.02]) than hospital caregivers (27.08% [95% CI 21.29-33.77]), and had significantly higher global SARS-CoV-2 titers (F = 29.40, df = 2, p < 0.0001). Moreover, patients had a 2.51-fold (95% CI 1.95-3.20) higher SARS-CoV-2 exposure risk compared to hospital caregivers (Fisher's exact test, P < 0.0001). No difference was found in SARS-CoV-2 seroprevalence and titers between patient subgroups. Patients could be differentiated most accurately from hospital caregivers by their higher Spike protein titers (OR 136.54 [95% CI 43.08-481.98], P < 0.0001), lower S1 (OR 0.06 [95% CI 0.02-0.15], P < 0.0001) titers and higher IL-6 (OR 3.41 [95% CI 1.73-7.24], P < 0.0001) and TNF-α (OR 34.29 [95% CI 5.00-258.87], P < 0.0001) and lower titers of IL-8 (OR 0.13 [95% CI 0.05-0.30], P < 0.0001). Seropositive patients had significantly higher SARS-COV-2 antibody titers compared to seropositive hospital caregivers (F = 19.53, df = 2, P < 0.0001), while titers were not different in seronegative individuals. Pro-inflammatory cytokine concentrations were not associated with serological status. CONCLUSION Our work demonstrated a very high unrecognized exposure to SARS-CoV-2 among newly admitted and hospitalized psychiatric inpatients, which is cause for concern in the context of highly robust evidence of adverse outcomes following COVID-19 in psychiatric patients. Attention should be directed toward monitoring and mitigating exposure to infectious agents within psychiatric hospitals.
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Affiliation(s)
- K El Abdellati
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerp, Belgium; Scientific Initiative of Neuropsychiatric and Psychopharmacological Studies (SINAPS), University Psychiatric Centre Duffel, Duffel, Belgium.
| | - A Lucas
- Institut des Maladies Métaboliques et Cardiovasculaires (I2MC), plateau We-Met, Inserm UMR1297 and Université Paul Sabatier, Toulouse, France
| | - H Perron
- GeNeuro, Plan-les-Ouates, Geneva, Switzerland; Geneuro-Innovation, Lyon, France
| | - R Tamouza
- INSERM U955 IMRB, Translational Neuropsychiatry laboratory, AP-HP, Hôpital Henri Mondor, DMU IMPACT, Fédération Hospitalo-Universitaire de Médecine de Précision en Psychiatrie (FHU ADAPT), Paris Est Créteil University, Fondation FondaMental, 94010 Créteil, France; ECNP Immuno-NeuroPsychiatry Network
| | - I Nkam
- INSERM U955 IMRB, Translational Neuropsychiatry laboratory, AP-HP, Hôpital Henri Mondor, DMU IMPACT, Fédération Hospitalo-Universitaire de Médecine de Précision en Psychiatrie (FHU ADAPT), Paris Est Créteil University, Fondation FondaMental, 94010 Créteil, France
| | - J-R Richard
- INSERM U955 IMRB, Translational Neuropsychiatry laboratory, AP-HP, Hôpital Henri Mondor, DMU IMPACT, Fédération Hospitalo-Universitaire de Médecine de Précision en Psychiatrie (FHU ADAPT), Paris Est Créteil University, Fondation FondaMental, 94010 Créteil, France
| | - S Fried
- Institut des Maladies Métaboliques et Cardiovasculaires (I2MC), plateau We-Met, Inserm UMR1297 and Université Paul Sabatier, Toulouse, France
| | - C Barau
- Plateforme de resources biologiques, Hôpital Universitaire Henri Mondor, Université Paris Est Créteil, Créteil, France
| | - N Djonouma
- Département Hospitalo-Universitaire de psychiatrie et d'addictologie des hopitaux Henri Mondor, Créteil, France
| | - A Pinot
- INSERM U955 IMRB, Translational Neuropsychiatry laboratory, AP-HP, Hôpital Henri Mondor, DMU IMPACT, Fédération Hospitalo-Universitaire de Médecine de Précision en Psychiatrie (FHU ADAPT), Paris Est Créteil University, Fondation FondaMental, 94010 Créteil, France
| | - S Fourati
- Department of Virology, INSERM U955, Team « Viruses, Hepatology, Cancer », Hôpitaux Universitaires Henri Mondor, Assistance Publique - Hôpitaux de Paris, Créteil, France
| | - C Rodriguez
- Department of Virology, INSERM U955, Team « Viruses, Hepatology, Cancer », Hôpitaux Universitaires Henri Mondor, Assistance Publique - Hôpitaux de Paris, Créteil, France
| | - V Coppens
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerp, Belgium; Scientific Initiative of Neuropsychiatric and Psychopharmacological Studies (SINAPS), University Psychiatric Centre Duffel, Duffel, Belgium
| | - U Meyer
- ECNP Immuno-NeuroPsychiatry Network; Institute of Pharmacology and Toxicology, University of Zürich-Vetsuisse, Zürich, Switzerland; Neuroscience Center Zürich, Zürich, Switzerland
| | - M Morrens
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerp, Belgium; Scientific Initiative of Neuropsychiatric and Psychopharmacological Studies (SINAPS), University Psychiatric Centre Duffel, Duffel, Belgium
| | - L De Picker
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerp, Belgium; Scientific Initiative of Neuropsychiatric and Psychopharmacological Studies (SINAPS), University Psychiatric Centre Duffel, Duffel, Belgium; ECNP Immuno-NeuroPsychiatry Network
| | - M Leboyer
- INSERM U955 IMRB, Translational Neuropsychiatry laboratory, AP-HP, Hôpital Henri Mondor, DMU IMPACT, Fédération Hospitalo-Universitaire de Médecine de Précision en Psychiatrie (FHU ADAPT), Paris Est Créteil University, Fondation FondaMental, 94010 Créteil, France; ECNP Immuno-NeuroPsychiatry Network
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3
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Bai W, Cai H, Jin Y, Zhang Q, Cheung T, Su Z, Tang YL, Ng CH, Xiang YT. COVID-19 vaccine hesitancy in community-dwelling and hospitalized patients with severe mental illness. Psychol Med 2023; 53:4288-4290. [PMID: 34915962 PMCID: PMC9433704 DOI: 10.1017/s0033291721004918] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 11/04/2021] [Accepted: 11/08/2021] [Indexed: 11/09/2022]
Affiliation(s)
- Wei Bai
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China
- Centre for Cognitive and Brain Sciences, University of Macau, Macao SAR, China
- Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Macao SAR, China
| | - Hong Cai
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China
- Centre for Cognitive and Brain Sciences, University of Macau, Macao SAR, China
- Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Macao SAR, China
| | - Yu Jin
- College of Education for the Future, Beijing Normal University, Beijing, China
| | - Qinge Zhang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Teris Cheung
- School of Nursing, Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
| | - Zhaohui Su
- Center on Smart and Connected Health Technologies, Mays Cancer Center, School of Nursing, UT Health San Antonio, San Antonio, TX, USA
| | - Yi-Lang Tang
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, USA
- Atlanta VA Medical Center, Atlanta, GA, USA
| | - Chee H. Ng
- Department of Psychiatry, The Melbourne Clinic and St Vincent's Hospital, University of Melbourne, Richmond, Victoria, Australia
| | - Yu-Tao Xiang
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China
- Centre for Cognitive and Brain Sciences, University of Macau, Macao SAR, China
- Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Macao SAR, China
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Shaffer CW, Wyka K, Ewing J, Russ MJ, Kanellopoulos D, Brody BD. Low COVID-19 Vaccination Rates Among Psychiatric Inpatients: Implications for Institutional Settings and Outreach Efforts. Psychiatr Serv 2023; 74:320-323. [PMID: 36065578 DOI: 10.1176/appi.ps.20220222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study sought to determine COVID-19 vaccination rates for individuals with serious mental illness admitted to a large health system in New York State. METHODS Vaccination rates among 12,714 patients admitted to psychiatric units and to medical and surgical units were compared between April 6, 2021, and September 30, 2021. RESULTS Only 40% (N=416 of 1,029) of patients admitted to psychiatric services had at least one COVID-19 vaccination, whereas 64.4% (7,523 of 11,685) of patients admitted to medical and surgical services had at least one vaccination. After adjustment for differences in key demographic and clinical characteristics, patients admitted to psychiatric services had a significantly lower likelihood of vaccination during the study period (risk ratio=0.78, 95% confidence interval=0.73-0.85, p<0.001). Black psychiatric patients had the lowest vaccination rate (28%). CONCLUSIONS Psychiatric patients with acute illness had low COVID-19 vaccination rates. Targeted outreach for COVID-19 vaccination is necessary to reach this population.
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Affiliation(s)
- Charles W Shaffer
- Department of Psychiatry, Weill Cornell Medicine, New York City (Shaffer, Wyka, Russ, Kanellopoulos, Brody); Graduate School of Public Health and Health Policy, City University of New York, New York City (Wyka); New York-Presbyterian Hospital, New York City (Ewing)
| | - Katarzyna Wyka
- Department of Psychiatry, Weill Cornell Medicine, New York City (Shaffer, Wyka, Russ, Kanellopoulos, Brody); Graduate School of Public Health and Health Policy, City University of New York, New York City (Wyka); New York-Presbyterian Hospital, New York City (Ewing)
| | - Julie Ewing
- Department of Psychiatry, Weill Cornell Medicine, New York City (Shaffer, Wyka, Russ, Kanellopoulos, Brody); Graduate School of Public Health and Health Policy, City University of New York, New York City (Wyka); New York-Presbyterian Hospital, New York City (Ewing)
| | - Mark J Russ
- Department of Psychiatry, Weill Cornell Medicine, New York City (Shaffer, Wyka, Russ, Kanellopoulos, Brody); Graduate School of Public Health and Health Policy, City University of New York, New York City (Wyka); New York-Presbyterian Hospital, New York City (Ewing)
| | - Dora Kanellopoulos
- Department of Psychiatry, Weill Cornell Medicine, New York City (Shaffer, Wyka, Russ, Kanellopoulos, Brody); Graduate School of Public Health and Health Policy, City University of New York, New York City (Wyka); New York-Presbyterian Hospital, New York City (Ewing)
| | - Benjamin D Brody
- Department of Psychiatry, Weill Cornell Medicine, New York City (Shaffer, Wyka, Russ, Kanellopoulos, Brody); Graduate School of Public Health and Health Policy, City University of New York, New York City (Wyka); New York-Presbyterian Hospital, New York City (Ewing)
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5
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Universal admission laboratory screening for severe acute respiratory coronavirus virus 2 (SARS-CoV-2) asymptomatic infection across a large health system. Infect Control Hosp Epidemiol 2023; 44:68-74. [PMID: 36533305 DOI: 10.1017/ice.2022.301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Admission laboratory screening for asymptomatic coronavirus disease 2019 (COVID-19) has been utilized to mitigate healthcare-associated severe acute respiratory coronavirus virus 2 (SARS-CoV-2) transmission. An understanding of the impact of such testing across a variety of patient populations is needed. METHODS SARS-CoV-2 nucleic acid amplification admission testing results for all asymptomatic patients across 4 distinct inpatient facilities between April 20, 2020, and June 14, 2021, were analyzed. Positivity rates and the number needed to test (NNT) to identify 1 asymptomatic infected patient were calculated. Admission results were compared to COVID-19 community incidence rates for the system's surrounding metropolitan service area. Using a national survey of hospital epidemiologists, a clinically meaningful NNT of 1:100 was identified. RESULTS In total, 51,187 tests were collected (positivity rate, 1.8%). During periods of high transmission, the NNT met the clinically relevant threshold in all populations. The NNT approached or met the threshold for most locations during periods of lower transmission. For all transmission levels, the NNT for fully vaccinated patients did not meet the threshold. CONCLUSIONS Implementing an asymptomatic patient admission testing program can provide clinically relevant data based on the NNT, even during periods of lower transmission and among different patient populations. Limiting admission testing to non-fully vaccinated patients during periods of lower transmission may be a strategy to address resource concerns around this practice. Although the impact of such testing on healthcare-associated COVID-19 among patients and healthcare workers could not be clearly determined, these data provide important information as facilities weigh the costs and benefits of such testing.
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Asymptomatic screening for severe acute respiratory coronavirus virus 2 (SARS-CoV-2) as an infection prevention measure in healthcare facilities: Challenges and considerations. Infect Control Hosp Epidemiol 2023; 44:2-7. [PMID: 36539917 DOI: 10.1017/ice.2022.295] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Testing of asymptomatic patients for severe acute respiratory coronavirus virus 2 (SARS-CoV-2) (ie, "asymptomatic screening) to attempt to reduce the risk of nosocomial transmission has been extensive and resource intensive, and such testing is of unclear benefit when added to other layers of infection prevention mitigation controls. In addition, the logistic challenges and costs related to screening program implementation, data noting the lack of substantial aerosol generation with elective controlled intubation, extubation, and other procedures, and the adverse patient and facility consequences of asymptomatic screening call into question the utility of this infection prevention intervention. Consequently, the Society for Healthcare Epidemiology of America (SHEA) recommends against routine universal use of asymptomatic screening for SARS-CoV-2 in healthcare facilities. Specifically, preprocedure asymptomatic screening is unlikely to provide incremental benefit in preventing SARS-CoV-2 transmission in the procedural and perioperative environment when other infection prevention strategies are in place, and it should not be considered a requirement for all patients. Admission screening may be beneficial during times of increased virus transmission in some settings where other layers of controls are limited (eg, behavioral health, congregate care, or shared patient rooms), but widespread routine use of admission asymptomatic screening is not recommended over strengthening other infection prevention controls. In this commentary, we outline the challenges surrounding the use of asymptomatic screening, including logistics and costs of implementing a screening program, and adverse patient and facility consequences. We review data pertaining to the lack of substantial aerosol generation during elective controlled intubation, extubation, and other procedures, and we provide guidance for when asymptomatic screening for SARS-CoV-2 may be considered in a limited scope.
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Paruk S, Ngcobo NN, Karim E, Tomita A, Ramlall S. COVID-19 infection at a psychiatric hospital in KwaZulu-Natal, South Africa: Clinical service planning and challenges. S Afr J Psychiatr 2022; 28:1933. [PMID: 36569809 PMCID: PMC9772653 DOI: 10.4102/sajpsychiatry.v28i0.1933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 08/05/2022] [Indexed: 12/23/2022] Open
Abstract
Background South Africa had over 4 million cases of coronavirus disease 2019 (COVID-19) infections and more than 1 million COVID-19-related deaths. Despite the devastating psychological impact of the COVID-19 pandemic, there is little qualitative, critical evaluation of government mental health services in this resource-limited setting. Aim The authors describe the clinical service plan and response to the COVID-19 pandemic at a government psychiatric hospital. Setting KwaZulu-Natal, South Africa. Methods A descriptive narrative overview of the specialised psychiatric hospital's clinical response (April 2020 - March 2021) to the COVID-19 pandemic was undertaken in the following domains: screening policy; testing and swabbing policy; staff training and monitoring; and restructuring the wards to accommodate mental health care users (MHCUs) with suspected cases of COVID-19. Results The in-depth narrative reviews led to the introduction of staff training, routine COVID-19 reverse transcription polymerase chain reaction (RT-PCR) testing of all MHCUs, the creation of designated quarantine and isolation facilities and screening of physical health status of patients with COVID-19 prior to transfer being implemented to prevent an outbreak or increased morbidity or mortality. Conclusion Implementing a service plan early which included staff training, screening and routine COVID-19 testing services for psychiatric admissions in a rapidly evolving environment with few additional resources was challenging. The absence of guidelines early in the pandemic that addressed the unique needs of a clinical psychiatric inpatient population is a noteworthy learning point. Contribution The article highlights that the inpatient infrastructural requirements and clinical management protocols of acutely psychiatrically ill inpatients, in the context of infectious outbreaks, require dedicated task teams and bespoke policies.
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Affiliation(s)
- Saeeda Paruk
- Department of Psychiatry, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Ntokozo N. Ngcobo
- Department of Psychiatry, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Enver Karim
- Department of Psychiatry, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Andrew Tomita
- KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa,Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Suvira Ramlall
- Department of Psychiatry, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
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Simpson SA, Loh R, Goans CRR, Ryall K, Middleton M, Dalton A. Reply to Letter to the Editor. J Emerg Med 2022; 62:570-571. [PMID: 35065864 DOI: 10.1016/j.jemermed.2021.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 11/27/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Scott A Simpson
- Department of Behavioral Health Services, Denver Health and Hospital Authority, Denver, Colorado
| | - Ryan Loh
- Department of Behavioral Health Services, Denver Health and Hospital Authority, Denver, Colorado
| | | | | | - Molly Middleton
- Colorado Department of Public Health and Environment, Denver, Colorado
| | - Alicia Dalton
- Rocky Mountain Poison and Drug Safety, Denver, Colorado
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Berezin J, Casoy F, Erlich MD, Hernandez Y, Smith TE. Inpatient Psychiatry During COVID-19: A Systems Perspective. Psychiatr Clin North Am 2022; 45:45-55. [PMID: 35219441 PMCID: PMC8580853 DOI: 10.1016/j.psc.2021.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Numerous reports describe how individual hospitals responded to the COVID-19 pandemic, but few describe how these changes occurred across a large public health system of care. As the early epicenter of the pandemic, New York State's response, particularly the New York City metropolitan area, included a range of coordinated planning and regulatory efforts to preserve and create medical and intensive care unit capacity where needed; maintain access to acute psychiatric services; and redefine inpatient psychiatric care through strict infection control, easing of regulatory requirements, and use of telehealth. These strategies reflected similar efforts across the United States.
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Affiliation(s)
- Joshua Berezin
- New York State Office of Mental Health, 330 Fifth Avenue – 9th Floor, New York, NY 10001, USA
| | | | - Matthew D. Erlich
- New York State Office of Mental Health, 330 Fifth Avenue – 9th Floor, New York, NY 10001, USA
| | | | - Thomas E. Smith
- New York State Office of Mental Health,Corresponding author. 1051 Riverside Drive, Unit 100, New York, NY 10032
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Carrara E, Ong DSY, Hussein K, Keske S, Johansson AF, Presterl E, Tsioutis C, Tschudin-Sutter S, Tacconelli E. ESCMID guidelines on testing for SARS-CoV-2 in asymptomatic individuals to prevent transmission in the healthcare setting. Clin Microbiol Infect 2022; 28:672-680. [PMID: 35124258 PMCID: PMC8812094 DOI: 10.1016/j.cmi.2022.01.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 01/14/2022] [Accepted: 01/16/2022] [Indexed: 12/20/2022]
Abstract
Scope This guideline addresses the indications for direct testing of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in asymptomatic individuals in health care facilities, with the aim to prevent SARS-CoV-2 transmissions in these settings. The benefit of testing asymptomatic individuals to create a safe environment for patients and health care workers must be weighed against potential unintended consequences, including delaying necessary treatments owing to false positive results and lower quality of care owing to strict isolation measures. Methods A total of nine PICOs (population, intervention, comparison, outcome) on the topic of testing asymptomatic individuals was selected by the panel members. Subsequently, a literature search for existing guidelines and systematic reviews was performed on PubMed, Epistemonikos, and RecMap using relevant filters available in each database. Data on article/recommendation type, setting, target population, intervention, and quality of the evidence were extracted. Credibility of the systematic reviews was evaluated using the AMSTAR tool, and level of agreement with available recommendation was evaluated with the AGREE II score. Because the evidence available from systematic reviews was deemed insufficiently updated to formulate relevant recommendations, an additional search targeting relevant guidance documents from major public health institutions and original studies was performed. Provisional recommendations were discussed via web conferences until agreement was reached, and final recommendations were formulated according to the GRADE approach. Recommendations Recommendations were formulated regarding systematic testing in asymptomatic individuals upon admission to a health care setting, during hospital stay, before elective procedures, and before scheduled nonsurgical procedures. Moreover, recommendations regarding testing of asymptomatic visitors, personal caregivers, and health care workers in health care facilities were presented. Recommendations also were given on contact tracing in asymptomatic patients or health care workers and the possibility of a negative screening test to shorten the quarantine period. Furthermore, if applicable, recommendations were specified to transmission rate and vaccination coverage.
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Affiliation(s)
- Elena Carrara
- Division of Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, Italy; European Committee on Infection Control (EUCIC), Basel, Switzerland.
| | - David S Y Ong
- Department of Medical Microbiology and Infection Control, Franciscus Gasthuis & Vlietland, Rotterdam, Netherlands; Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands; ESCMID Study Group for Respiratory Viruses (ESGREV), Basel, Switzerland
| | - Khetam Hussein
- European Committee on Infection Control (EUCIC), Basel, Switzerland; The Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel; Infection Control Unit, Rambam Health Care Campus, Haifa, Israel
| | - Siran Keske
- European Committee on Infection Control (EUCIC), Basel, Switzerland; Department of Infectious Diseases and Clinical Microbiology, Koç University School of Medicine, Istanbul, Turkey
| | - Anders F Johansson
- European Committee on Infection Control (EUCIC), Basel, Switzerland; Department of Clinical Microbiology and the Laboratory for Molecular Infection Medicine Sweden, Umeå University, Umeå, Sweden
| | - Elisabeth Presterl
- European Committee on Infection Control (EUCIC), Basel, Switzerland; Department of Infection Control and Hospital Epidemiology, Medical University of Vienna, Vienna, Austria
| | - Constantinos Tsioutis
- European Committee on Infection Control (EUCIC), Basel, Switzerland; School of Medicine, European University Cyprus, Nicosia, Cyprus
| | - Sarah Tschudin-Sutter
- Division of Infectious Diseases & Hospital Epidemiology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Evelina Tacconelli
- Division of Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, Italy; European Committee on Infection Control (EUCIC), Basel, Switzerland
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Czeisler MÉ, Wiley JF, Facer-Childs ER, Robbins R, Weaver MD, Barger LK, Czeisler CA, Howard ME, Rajaratnam SMW. Mental health, substance use, and suicidal ideation during a prolonged COVID-19-related lockdown in a region with low SARS-CoV-2 prevalence. J Psychiatr Res 2021; 140:533-544. [PMID: 34174556 PMCID: PMC8177437 DOI: 10.1016/j.jpsychires.2021.05.080] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 05/11/2021] [Accepted: 05/29/2021] [Indexed: 02/07/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has been associated with mental health consequences due to direct (i.e., SARS-CoV-2 infection, potentially due to neuronal or astrocytic infection, microvascular, or inflammatory mechanisms) and indirect (i.e., social and economic impacts of COVID-19 prevention measures) effects. Investigation of mental health in a region with one of the longest lockdowns and lowest COVID-19 prevalence globally (Victoria, Australia) allowed for evaluation of mental health in the absence of substantial direct pandemic mental health consequences. Surveys were administered during 15-24 September 2020 to Victorian residents aged ≥18 years for The COVID-19 Outbreak Public Evaluation (COPE) Initiative. Responses were compared cross-sectionally with April-2020 data, and longitudinally among respondents who completed both surveys. Multivariable Poisson regressions were used to estimate prevalence ratios for adverse mental health symptoms, substance use, and suicidal ideation adjusted for demographics, sleep, and behaviours (e.g., screen-time, outdoor-time). In September-2020, among 1157 Victorians, one-third reported anxiety or depressive disorder symptoms, one-fifth reported suicidal ideation, and one-tenth reported having seriously considered suicide in the prior 30 days. Young adults, unpaid caregivers, people with disabilities, and people with diagnosed psychiatric or sleep conditions showed increased prevalence of adverse mental health symptoms. Prevalence estimates of symptoms of burnout, anxiety, and depressive disorder were unchanged between April-2020 and September-2020. Persistently common experiences of adverse mental health symptoms despite low SARS-CoV-2 prevalence during prolonged lockdown highlight the urgent need for mental health support services.
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Affiliation(s)
- Mark É Czeisler
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia; Institute for Breathing and Sleep, Austin Health, Melbourne, Victoria, Australia; Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, United States.
| | - Joshua F Wiley
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Elise R Facer-Childs
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Rebecca Robbins
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA, United States; Division of Sleep Medicine, Harvard Medical School, Boston, MA, United States
| | - Matthew D Weaver
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia; Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA, United States; Division of Sleep Medicine, Harvard Medical School, Boston, MA, United States
| | - Laura K Barger
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia; Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA, United States; Division of Sleep Medicine, Harvard Medical School, Boston, MA, United States
| | - Charles A Czeisler
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia; Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA, United States; Division of Sleep Medicine, Harvard Medical School, Boston, MA, United States
| | - Mark E Howard
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia; Institute for Breathing and Sleep, Austin Health, Melbourne, Victoria, Australia; Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Shantha M W Rajaratnam
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia; Institute for Breathing and Sleep, Austin Health, Melbourne, Victoria, Australia; Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA, United States; Division of Sleep Medicine, Harvard Medical School, Boston, MA, United States
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Brody BD, Shi Z, Shaffer C, Eden D, Wyka K, Parish SJ, Alexopoulos GS, Nazario H, Russ MJ, Kanellopoulos D. Universal COVID-19 testing and a three-space triage protocol is associated with a nine-fold decrease in possible nosocomial infections in an inpatient psychiatric facility. Psychiatry Res 2021; 302:114036. [PMID: 34098157 PMCID: PMC8161793 DOI: 10.1016/j.psychres.2021.114036] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 05/22/2021] [Indexed: 11/17/2022]
Abstract
In May of 2020, the Substance Abuse and Mental Health Service Administration (SAMSA) issued guidelines for state psychiatric hospitals, recommending that these facilities adopt universal testing for COVID-19 and "three-space" triage protocols for dedicated COVID-19 positive, negative, and quarantine spaces to mitigate the risk of nosocomial infection. The Westchester Behavioral Health Center of New York Presbyterian Hospital (WBHC-NYP) adopted a comprehensive infection control protocol consistent with these recommendations in April, 2020. We reviewed the records of 1,139 patients treated on the inpatient service at WBHC-NYP between March 14th and June 10th, 2020, dates corresponding to the first COVID-19 surge in the New York City metropolitan region. The incidence of detected nosocomial or possible nosocomial infections before and during the implementation of the protocol was 0.096 (16/167), or 0.96 infections per 10 at-risk patients. The incidence of nosocomial or possible nosocomial infections after complete implementation was 0.0110 (2/182), or 1.1 infections per 100 at-risk patients. The difference in incidence between the two time points was statistically significant (p<.0003) and represents a 9-fold decrease. Our findings support the institutional use of a combined testing and space allocation protocol to mitigate risk of outbreaks in confined settings.
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Affiliation(s)
| | | | | | | | - Katarzyna Wyka
- City University of New York Graduate School of Public Health and Weill Cornell Medicine / Psychiatry
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Abbas J, Wang D, Su Z, Ziapour A. The Role of Social Media in the Advent of COVID-19 Pandemic: Crisis Management, Mental Health Challenges and Implications. Risk Manag Healthc Policy 2021; 14:1917-1932. [PMID: 34012304 PMCID: PMC8126999 DOI: 10.2147/rmhp.s284313] [Citation(s) in RCA: 118] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 03/11/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND This study focuses on how educating people through social media platforms can help reduce the mental health consequences of the COVID-19 to manage the global health crisis. The pandemic has posed a global mental health crisis, and correct information is indispensable to dispel uncertainty, fear, and mental stress to unify global communities in collective combat against COVID-19 disease worldwide. Mounting studies specified that manifestly endless coronavirus-related newsfeeds and death numbers considerably increased the risk of global mental health issues. Social media provided positive and negative data, and the COVID-19 has resulted in a worldwide infodemic. It has eroded public trust and impeded virus restraint, which outlived the coronavirus pandemic itself. METHODS The study incorporated the narrative review analysis based on the existing literature related to mental health problems using the non-pharmaceutical interventions (NPIs) approach to minimize the COVID-19 adverse consequences on global mental health. The study performed a search of the electronic databases available at PsycINFO, PubMed, and LISTA. This research incorporates the statistical data related to the COVID-19 provided by the WHO, John Hopkins University, and Pakistani Ministry of Health. RESULTS Pakistan reported the second-highest COVID-19 cases within South Asia, the fifth-highest number of cases in Asia after Iran, India, Russia, Saudi Arabia, and the 14th highest recorded cases, as of October 14, 2020. Pakistan effectively managed the COVID-19 pandemic in the second wave. It stands at the eighth-highest number of confirmed cases in Asia, the 3rd-highest in South Asia, and the 28th-highest number of established patients globally, as of February20, 2021. CONCLUSION The COVID-19 has resulted in over 108.16 million confirmed cases, deaths over 2.374 million, and a recovery of 80.16 million people worldwide, as of February 12, 2021. This study focused on exploring the COVID-19 pandemic's adverse effects on global public health and the indispensable role of social media to provide the correct information in the COVID-19 health crisis. The findings' generalizability offers helpful insight for crisis management and contributes to the scientific literature. The results might provide a stepping-stone for conduct future empirical studies by including other factors to conclude exciting developments.
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Affiliation(s)
- Jaffar Abbas
- Antai College of Economics and Management (ACEM), Shanghai Jiao Tong University (SJTU), Shanghai, 200240, People’s Republic of China
- School of Media and Communication (SMC), Shanghai, Shanghai Jiao Tong University (SJTU), 200240, People's Republic of China
| | - Dake Wang
- School of Media and Communication (SMC), Shanghai, Shanghai Jiao Tong University (SJTU), 200240, People's Republic of China
| | - Zhaohui Su
- School of Nursing, University of Texas, Center on Smart and Connected Health Technologies, Mays Cancer Center, UT Health San Antonio, San Antonio, TX, 78229, USA
| | - Arash Ziapour
- Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, 6715847141, Iran
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