Coronavirus: New report reveals high Covid-19 rates in London psychiatric wards during peak of pandemic

Research shows psychiatric wards were also slow to receive tests and personal protective equipment

Samuel Lovett@samueljlovett
Tuesday 06 October 2020 17:16
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At least 38 per cent of older adults in psychiatric wards in London were infected with Covid-19 during the height of the pandemic, according to a new study.

Researchers at University College London reviewed data from five of the capital’s mental health trusts, which, throughout March and April, cared for a total of 344 patients who were either over 65 or had young onset dementia.

From this group, identified as particularly vulnerable to Covid-19, 131 people were diagnosed with the virus. None of the patients were known to have been infected with Covid-19 when they were admitted to hospital.

The study showed that 15 per cent of infected patients (19 people) died from the disease.

According to the research, psychiatric wards were also slow to receive tests and personal protective equipment (PPE), which may have increased the mortality rates.

On average, testing became available in the wards four-and-a-half days after the first clinically suspected case of Covid-19.

In some of the trusts, tests and PPE arrived later to the psychiatric wards than they did for wards dedicated to physical illnesses.

Researchers say the true infection rate within London’s mental health wards may have been even higher, given the low rates of testing early on in the outbreak.

The majority (92 per cent) of the patients had at least one comorbidity, such as high blood pressure or heart disease, which would put them at greater risk of severe Covid-19, researchers said.

More than half (56 per cent) had dementia while most others had either a psychotic illness or depression.

The researchers also suggest that patients may have faced elevated risks of disease transmission as their care often requires socialisation and relatively close contact with a large number of hospital staff, while they may also have difficulty adhering to social distancing.

Of those who fell ill with Covid-19, 35 per cent experienced delirium or acute cognitive decline as a result, according to the study.

Lead author Professor Gill Livingston, of UCL Psychiatry, said: "Most of these people had no choice but to be in psychiatric care, so the state has an ethical imperative to protect them. Our findings show that there are unequal standards of care between mental health and physical health wards.

"People shouldn't be disadvantaged by being in a psychiatric ward.”

A psychiatric nurse based in Bristol, who asked to remain anonymous, said her ward faced similar challenges to the ones reported in London.

“PPE wasn’t supplied quickly enough, especially as before we would wear our own clothes so the risk of contamination and taking it home was higher,” she told The Independent. “There were times that our ward couldn’t even order more PPE.

“Also it’s been almost impossible to social distance with our patients.”

She added that psychiatric care in general had been “forgotten about” during the initial stages of the pandemic.

The UCL research team found positive signs in terms of how quickly the hospital staff adapted, as some staff were quickly trained to support with oxygen treatment, and some fostered closer connections with doctors from other wards who came in to treat respiratory illnesses.

The researchers are calling for increased testing, in particular when each new patient is admitted, and isolating them in suspected cases until the result is known.

When admission is planned in advance, patients should be tested beforehand, the study adds.

Adequate PPE provision, close liaison with respiratory physicians and the provision of oxygen therapy are also vital measures, the report said.

Prof Livingston said: “There remains an urgent need to fully prepare for a possible second wave this winter, while also ensuring that we are well prepared for potential future pandemics.”

Co-author Dr Andrew Sommerlad, of UCL Psychiatry said: “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.”

Alison Evans, head of policy at Alzheimer’s Research UK, said that the “disproportionate impact” of Covid-19 on people with dementia reiterated the “already pressing need” to increase research funding.

“The virus and its economic fallout put the future of dementia research at risk,” she said. “We must hold this government to account on their promise to double dementia research funding. People with dementia, and their loved ones, deserve nothing less.”

An NHS London spokesperson said: “Mental health trusts in England have worked hard to deliver high quality physical and psychological care to patients, including those living with dementia and offer protection to staff during the pandemic.

“This small study was apparently conducted in the early stages of the pandemic and since then mental health providers have had specific guidance on this which will continue to be followed in the case of a second wave of Covid-19.”

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