Damian Sendler: COVID-19 has had a major impact on the mental health care system. In terms of preventing the spread of the virus, treating patients with COVID-19 in an inpatient psychiatric setting presents numerous difficulties. At the New York City-based Gracie Square Hospital, a freestanding mental health facility, patients with COVID-19 who require inpatient psychiatric care have their own specialized wing. Treatment refusal, difficulty complying with safety precautions due to psychosis, agitated behavior, and staff psychological well-being were some of the difficulties we encountered. Reforming protocols, expanding the use of technology, creating a supportive platform, and standardizing clinical practice were all things we discussed. While treating COVID-19 patients, we face many challenges. This paper outlines our strategies for dealing with these issues.
Damian Jacob Sendler: Public health officials around the world have expressed concern about the new coronavirus, known as COVID-19, which can cause a wide range of symptoms, from mild illness to death. The WHO declared COVID-19 a pandemic in March 2020, and the United States declared a national emergency due to the outbreak [1].
Dr. Sendler: The COVID-19 crisis in the United States was centered in New York City, which was the worst-hit city in the country. One thousand people were killed by the pandemic’s first month in New York City, the city’s Health and Mental Hygiene Department reported [2].
Damian Sendler
NYC hospitals were severely impacted by the CoViD-19 pandemic. Hospital bed capacity was reduced as a result of the rapid spread of the COVID-19 virus and the rising number of patients who needed to be treated. Some hospitals have converted their psychiatric beds to critical care in order to meet rising demand [3]. Psychiatric disorders were more likely to be diagnosed in the wake of the COVID-19 pandemic, but it also increased the number of patients who needed hospitalization because of their pre-existing mental illness [4, 5].
Inpatient units at Gracie Square Hospital are part of the New York Presbyterian (NYP) Regional Hospital Network, a freestanding psychiatric hospital in New York City. During the pandemic, the hospital continued to accept and treat patients in need of inpatient psychiatric treatment. On the inpatient wards, concerns were expressed about the spread of COVID-19 and how to control it. As a result of this unprecedented occurrence, the hospital established the city’s first unit dedicated solely to the care of COVID-19 patients experiencing an acute mental health crisis. Together with the leadership of NYP, Gracie Square Hospital worked to improve patient care and lessen the effects of the pandemic on individuals and the hospital.
It was imperative that the CDC’s recommendations and safety measures be implemented across the board at Gracie Square Hospital. Patients and staff members were encouraged to use social distancing techniques to avoid close contact, and the CDC’s website was monitored for any changes. The CDC website was also monitored, and a multidisciplinary team of doctors and psychiatrists was assembled. Infection control guidelines were followed, hand hygiene and disinfection were improved, and the CDC website was monitored for any changes.
Patients with mental health conditions had difficulty giving consent to treatment, impaired judgment, treatment refusals, uncooperativeness, difficulties complying or understanding social distancing, aggression and psychosis as a result of the COVID-19 outbreak while implementing the recommendations of the CDC. Some patients were unable to adhere to isolation protocols because of behavioral dysregulation. When agitated, some patients spit or drank alcohol-based hand sanitizer, which was a violation of safety protocols.
Accordingly, the mental health COVID unit at Gracie Square Hospital was converted from one of the hospital’s general mental health units. In order to minimize the risk of exposure to patients and staff, the unit was dedicated solely to the treatment of COVID-19 patients who require psychiatric care. In light of the outbreak’s rapid evolution, this conversion was completed on time. For this patient population, the hospital established a multidisciplinary team. IPC at New York Presbyterian Hospital (NYP) was also providing ongoing clinical advice, including protocols and individual patient consultations on a daily basis.
Damian Jacob Markiewicz Sendler: During the COVID-19 pandemic, researchers discovered how little is known about the pathogenesis of this virus and how little is known about its clinical manifestations in the medical literature. The CDC and WHO, for example, were constantly revising their estimates of how COVID-19 spread. Close contact and droplets in the lungs were the only known transmission routes [6]. Airborne transmission may be possible, according to some evidence [7]. Additionally, the virus has been discovered in samples of the digestive system, saliva, feces, and urine [8].. A molecular test, a rapid antigen test, and a serology antibody test developed by the CDC were all given the green light by the FDA [9]. The gold standard for diagnosing COVID-19 is the detection of viral nucleic acid. As a result, false-negative results are possible when trying to detect COVID-19 nucleic acid [10].
Damian Jacob Sendler
Many studies have shown that COVID-19 has a wide range of clinical manifestations, but little is known about them [11]. To treat COVID-19 symptoms and prevent complications, there was no FDA-approved antiviral medication until recently. In October 2020, the FDA approved the antiviral drug, remdesivir, for the treatment of COVID-19 patients, but only in a hospital setting capable of providing acute clinical care.
Many public health measures were implemented as a result of the wide range of clinical presentations. Among other things, the Centers for Medicare & Medicaid Services (CMS) ensured that hospitals could handle a surge in patients with COVID-19. [13] The CDC used a variety of public strategies to control the outbreak, including isolation, quarantine, social distancing, and community containment. An emergency use authorization for the first dose of the COVID vaccine in people 16 and older was granted by the FDA in December 2020 [15].
There were some patients who needed inpatient care during the outbreak, despite CDC and WHO recommendations for out-of-hospital treatment. Special consideration had to be given to psychiatric inpatients because of the unique clinical challenges they face. COVID-19 quickly spread through a psychiatric unit in a South Korean hospital, infecting 101 out of 103 patients. In an effort to keep the virus contained within the hospital, psychiatric COVID-19 units were created [16]. Covid-19 patients who require inpatient psychiatric treatment can be treated in a unit created by the University of Rochester Medical Center and an Israeli psychiatric hospital [17, 18].
Gracie Square Hospital, on the other hand, has a special unit for COVID-19 patients. Rapidly changing conditions necessitated constant revision of protocols and safety measures. During the months of April and May of 2020, our psychiatric unit received a total of 48 patients with COVID-19. COVID-19 was detected in 33 patients referred from the ER and medical floors, and they all tested positive prior to their admission. At our hospital, fifteen patients tested positive during their stay on non-COVID-19 units and were transferred to the psychiatric COVID-19 unit. The maximum number of patients was 26. At the time of admission, all patients had typical symptoms such as fever, cough, and sore throat, but they were not ill enough to be admitted to the medical ward. As a result, ten patients were discharged and eight patients were taken to the emergency room because of respiratory complications during their stay. At the end of the day, 40 patients were discharged. Once the psychiatric COVID-19 unit was up and running, all of the staff remained unfazed.
There has been a rapid shift in mental health practice as the level of clinical uncertainty and unique circumstances surrounding the COVID-19 pandemic have emerged. Contingency plans must be devised to deal with the unique challenges faced by patients in the inpatient psychiatric setting when dealing with COVID-19 transmission [19].
Damien Sendler: COVID-19 acute psychiatric patients are clinically complex and require multidimensional treatment approaches, as demonstrated by our experience on the psychiatric COVID-19 unit at Gracie Square Hospital in New York. Patients’ vulnerability can be assessed; infectious disease consultations are available; clinical activities can be reorganized to maintain safety; technology can be expanded; staff mental health can be maintained; safety measures can be optimized; and patient education and standardization can all be considered as part of these approaches.
Psychiatric facilities need to share their knowledge and strategies in order to prevent the spread of this pandemic among patients. Longitudinal studies can be conducted to examine the effectiveness of dedicating a psychiatric unit for COVID-19 patients in reducing morbidity and mortality associated with the virus while providing acute mental health care, despite the difficulties of conducting research during a public health crisis [4].