Coronavirus: Are People with Schizophrenia at Higher Risk?
Posted: Friday, May 1st, 2020
In this series of blogs we will be looking at the possible impacts of the Covid 19 (Coronavirus) epidemic on people with schizophrenia and asking the question: are people with schizophrenia at particular risk from Covid 19?
The early studies coming out of China following the Wuhan epidemic do not show that people with schizophrenia are at any higher risk of contracting a Covid 19 infection than the general population. Instead, the risk factors are pre-existing physical conditions such as high blood pressure and diabetes. However looking beyond the research data there may be more obvious factors that put people with schizophrenia as a group at higher risk.
First of all we know that people with schizophrenia are disproportionately represented amongst the prison population (in the UK over 10% of prisoners have a psychotic illness) and the rough sleeper population. Both of these groups are at higher risk of infection by Covid 19 as social distancing measures and isolation are very difficult to achieve in practice in these settings. Rough sleepers in particular, suffering from under-nourishment, lack of basic amenities for hygiene and poor access to health care and for whom social distancing would not be practically possible, are at especial risk.
Then there is the higher risk of infection to people in inpatient mental health care. In China, where Covid 19 started, people in inpatient care along with the medical staff working in those establishments suffered disproportionately during the Wuhan outbreak. In the Wuhan Mental Health Centre for instance around 80 patients and staff were infected by Covid 19. Although steps have been taken in the UK to reduce the risks of infection on mental health wards there is clearly a higher risk here.
Lastly there is the issue of clozapine. Clozapine is a second-generation antipsychotic medicine which is considered by many to be the gold standard as it is often successful in treating cases of schizophrenia in which other medicines have failed. Sadly, clozapine does suffer from a number of serious adverse side effects and a number of studies have found that people taking clozapine have a higher risk of respiratory infections like pneumonia. This does suggest that people taking clozapine may be at higher risk. It is vital therefore that people with schizophrenia who are currently taking clozapine should discuss with their health care professionals the implications around this medicine (we will be covering this in more detail in a later blog) but they should not make any decisions about continuing on this medicine until they have taken professional advice.
So although we can say with some confidence that people with schizophrenia in general are not at higher risk of contracting Covid 19 infections, we must be aware that amongst the specific groups highlighted here: prisoners, rough sleepers, those in inpatient wards and those on clozapine the risk may be higher than for the general population.
- Fei Zhou et al, 9 March 2020, Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study, , Published in the Lancet on line.
- Prison Reform Trust, 2015, Prison the Facts, Bromley Briefings, Published, Prison Reform Trust.
- Yuncheng Zhu et al, March 2020, The Risk and Prevention of Novel Coronavirus Pneumonia Infections Among Inpatients in Psychiatric Hospitals, Published, Neuroscience Bulletin.
- Chian-Jue Ku et al, 2013, Second-Generation Antipsychotic Medications and Risk of Pneumonia in Schizophrenia, Published in Schizophrenia Bulletin.