Published online Jan 19, 2022. doi: 10.5498/wjp.v12.i1.140
Peer-review started: February 13, 2021
First decision: March 16, 2021
Revised: March 29, 2021
Accepted: November 24, 2021
Article in press: November 24, 2021
Published online: January 19, 2022
Processing time: 338 Days and 9.3 Hours
In contrast to many Western countries, China has maintained its large psychiatric hospitals. The prevalence and clinical characteristics of coronavirus disease 2019 (COVID-19) in inpatients with schizophrenia (SCZ) are unclear.
In the large mental health hospitals in China, the resources for managing this COVID-19 epidemic are very limited, and these SCZ inpatients are expected to be highly contagious.
To assess the prevalence of COVID-19 among inpatients with SCZ and compare the infected to uninfected SCZ patients in a Wuhan psychiatric hospital.
We retrospectively collected demographic characteristics and clinical profiles of all SCZ patients with COVID-19 at Wuhan’s Youfu Hospital.
Among the 504 SCZ patients, 84 had COVID-19, and we randomly sampled 174 who were uninfected as a comparison group. The overall prevalence of COVID-19 in SCZ inpatients was 16.7%. Among these 84 SCZ patients with confirmed COVID-19, the median age was 54 years and 76.2% were male. The most common symptom was fever (82%), and less common symptoms were cough (31%), poor appetite (20%), and fatigue (16%). Compared with SCZ patients without COVID-19, patients with COVID-19 were older (P = 0.006), significantly lighter (P = 0.002), and had more comorbid physical diseases (P = 0.001). Surprisingly, those infected were less likely to be smokers (< 0.001) or to be treated with clozapine (P = 0.03). Further logistic regression showed that smoking [odds ratio (OR) = 5.61], clozapine treated (OR = 2.95), and male (OR = 3.48) patients with relatively fewer comorbid physical diseases (OR = 0.098) were at lower risk of COVID-19. The SCZ patients with COVID-19 presented primarily with fever, but only one-third had a cough, which might otherwise be the most common mode of transmission between individuals.
Two unexpected protective factors for COVID-19 among these SCZ inpatients are smoking and clozapine treatment.
Clozapine treatment and smoking may be protective for COVID-19 among SCZ inpatients, perhaps related to nicotine and clozapine immunosuppression, which deserves further exploration.