The COVID-19 global pandemic is expected to have an outsized impact on people with schizophrenia, further exacerbating health and economic disparities they experience. Public health interventions designed to slow and curb the spread of the virus (flatten the curve) will likely disproportionately affect people with schizophrenia. We propose the following recommendations for consideration to temper the effect of COVID-19 on people with schizophrenia:
Addressing the social determinants of health, including ensuring safe and comfortable housing and implementing strategies to reduce health disparities, should be a foremost priority.
Guidelines for resource allocation in the context of the outbreak may help protect vulnerable populations by ensuring fair and consistent decision-making, acknowledging this may be challenging in the short-term, but remains a long-term goal.
Families, neighbors, and community-based programs that may comprise the social network for people with schizophrenia should find ways to maintain social connection that adhere to physical distancing, including through the use of video conferencing.
Programs and government agencies that provide essential services that address people's basic needs (eg, income support, food banks) should find ways to continue to safely deliver them.
Inpatient mental health settings should develop capacity to rapidly isolate people with suspected and confirmed COVID-19 from each other and nonaffected patients; limit and screen people coming into the facilities; perform infection control training and audits, including proper use of personal protective equipment; and make contingency plans to introduce alternate trained personnel in case frontline staff become ill.
Outpatient mental health settings and their funders should embrace the use of telepsychiatry and other digital health interventions to support continuity of care. Prescribers, patients, and caregivers should weigh the risks and benefits of treatments that must be delivered or monitored in person. Long-acting injectable antipsychotics may be safer to continue than to stop, so long as appropriate infection control procedures are followed. Clozapine bloodwork may be completed less frequently to reduce the risk of COVID-19 transmission according with current FDA standards and with ample education provided to the treatment decision-maker.
Researchers and institutional review boards should work together to substitute remote assessments and delivery methods to allow studies to safely continue when possible.
We suggest that thoughtful consideration of the implications of COVID-19 for people with schizophrenia may not only reduce the burden of the global pandemic on people with schizophrenia, but also on the population as a whole.
NK is supported by the Canadian Institutes of Health Research (CIHR), the Centre for Addiction and Mental Health (CAMH) Alternative Funding Plan Innovation Fund, and the CAMH Foundation. BHM receives research support from Brain Canada, CIHR, the CAMH Foundation, the Patient-Centered Outcomes Research Institute (PCORI), and the National Institutes of Health (NIH). VS is supported by CIHR. ANV is supported by CIHR, the National Institute of Mental Health (NIMH), the Natural Sciences and Engineering Research Council (NSERC), the CAMH Foundation, and the University of Toronto.
During the past 3 years, BHM has received nonfinancial support from Eli Lilly (medications and matching placebo for a NIH-funded clinical trial) and Pfizer (medications for a NIH-funded clinical trial), Capital Solution Design LLC (software used in a study funded by the CAMH Foundation), and HAPPYneuron (software used in a study founded by Brain Canada).
Schizophr Bull. 2020;46(4):752-757. © 2020 Oxford University Press