To the Editor:
The severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) pandemic introduced a new way of caring for inpatients. Patients hospitalized because of infection with the virus are struggling with both the physical disease and the mental burden associated with isolation.
Abad et al.1 have demonstrated the adverse effects of isolation on patients. The standards of precaution for prevention of disease transmission in their meta-analysis were significantly less “strict” than the standards currently practiced in isolation departments for patients with SARS-Cov-2.1
SARS-Cov-2 inpatients suffer from the physical impact of their disease and the forced quarantine, both of which contribute to their mental distress.2 Prior mental health disorders worsen emotional responses brought on by the SARS-Cov-2. Relapses of an already existing mental health condition are observed as well.3
The isolation in departments caring for SARS-Cov-2 patients is multidimensional. Patients cannot leave the hospital, even if they are willing to bear the medical responsibility and consequences. They barely receive visits, and they are able to connect with the outer world mostly via electronic devices.
SARS-Cov-2 departments often have limited open spaces where patients can practice physical activity or roam about. Also, windows are partially shut, so daylight enters only to some extent, with no freedom to control this simple need.
Caring staff are fully covered by protective gear; therefore, their facial expressions are unseen. As a result of the multidimensional isolation, patients lose fundamental anchors of basic existence.
Internists are not well trained in diagnosing and treating mental aspects of medical illness, and it is routine to consult psychiatrists when emotional decompensation occurs. On the other hand, psychiatrists are not part of the internal medicine staff. It is thus conceived that the hospital system caring for SARS-Cov-2 patients have the “two arms” of skills crucially required for holistic treatment of SARS-Cov-2 patients, but a coordinating body integrating these arms is missing.
Over the last 25 years, a new medical discipline has emerged, Med-Psych, an interface between medicine and psychiatry. Med-Psych units are those that integrate psychiatric and medical care.4 Our department adopted the Med-Psych approach in treating our SARS-Cov-2 patients. In addition to the standard medical therapy, mental distress was screened for, diagnosed, and treated. The following case may explain the advantage of the Med-Psych approach:
A 50-year-old healthy man was hospitalized because of slight cough after he was diagnosed with SARS-Cov-2 infection. His physical examination, laboratory tests, and imaging studies were normal. From the medical perspective, he was defined as a mild case. Shortly after admission, the patient became extremely anxious and agitated and began hyperventilating. Our integrated approach enabled us to identify the distress without the need of external consultants and while avoiding unnecessary medical intervention. Treating the patient with personal integrative psychotherapy and psychoeducational group psychotherapy allowed us to discharge the patient back home despite the lack of 2 consecutive negative polymerized chain reactions.
Summary
SARS-Cov-2 patients are hospitalized in quarantine conditions. In addition to medical care, these patients require frequent mental assessment. High index of suspicion is required to detect early signs of mental distress. Early diagnosis is beneficial as early intervention may help patients cope with this mental burden.
A Med-Psych specialist on the team or a sincere partnership between the internist and the psychiatrist should be the novel standard of care for these patients.
Acknowledgment
The authors would like to thank Dr. Reuven Mader for his inspiration.
Footnotes
Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Disclosure: The authors have no conflicts of interest to declare.
Authors' Contributions: E.M. designed and wrote the letter. G.D. reviewed the manuscript. Both the authors contributed to and have approved the final manuscript.
References
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