Study finds 38% of older adults in London psychiatric wards had Covid-19 at pandemic peak

At least 38% of older adults in psychiatric wards in London were infected with Covid-19 at the height of the pandemic, a new study has suggested.

University College London (UCL) researchers found that 15% of infected patients (19 people) in the mental health wards died from the disease.

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

The research looked at data from all 344 hospital patients of five mental health trusts in London who were either over 65 or had young onset dementia in March and April 2020.

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

None of the patients had known Covid-19 when they were admitted to hospital but 131 ended up diagnosed with coronavirus by the end of the two-month period, the research published in The Lancet Psychiatry reports.

Researchers say the true infection rate may have been even higher, given the low rates of testing early on in the outbreak.

Lead author Professor Gill Livingston, UCL Psychiatry and Camden and Islington NHS Foundation Trust, 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.”

The majority (92%) 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 found.

They 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% experienced delirium or acute cognitive decline as a result, according to the study.

The review found that testing became available in the wards on average 4.5 days after the first clinically suspected case and PPE often arrived after the first case as well.

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

Most (82%) of the patients on the wards were compulsorily detained under the Mental Health Act or Mental Capacity Act.

The 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 before admission, they say.

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

Fiona Carragher, director of research and influencing at Alzheimer’s Society, said: “Our report this week revealed across the country a quarter of people who died of Covid-19 had dementia, but on these wards we can see that it was more than a half.

“Government must put people with dementia at the heart of its winter plans to tackle the virus, including regular testing across health and social care.”

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