Psychiatry hospital management facing COVID-19: From medical staff to patients.

Dear Editor,

In the past 3 months, coronavirus disease (COVID-19) epidemic has challenged global health and rapidly spread over many countries. By Apr 7, 2020, it has resulted in more than 1,250,000 infections and over 70,000 deaths worldwide. The coronavirus spreads from person to person through mouth or nose generated droplets from sneezes and/or coughs. The coronavirus can also shortly survive on surface of different objects and is transmitted through direct contact. The COVID-19 epidemic has caused severe psychological pressure to common public population, medical staff in most clinics, and anyone with suspected symptoms.

General hospital services face severe challenges in public emergency events, often due to the shortage of beds, hands, and supplies (Kang et al., 2020, Kim and Su, 2020). Specifically, psychiatry hospital is unique since they serve for patients of impaired mental functions, with isolated and locked wards services, and has difficulties in executing the protection policies (asking patients to wear masks). The patients also have insufficient cognitive abilities to recognize the risk of infection and to actively avoid related activities. Notably, in late Feb 2020, a cluster infection is reported at 101 out of 103 patients in psychiatric ward at South Korea‘s Daenam hospital. Last but not least, medical staff are facing significant psychological pressure during this special period (Joob and Wiwanitkit, 2020, Li et al., 2020, Montemurro, 2020).

Shanghai Mental Health Center represents one of the largest psychiatric services in the world, with more than 2400 inpatient beds and nearly a million outpatient visits per year. By Apr 7, 2020, we reported 0 cases of in-patient infections. Here we would like to share our ongoing management strategies in facing this global challenge:

At outpatient clinic, the infrared thermometer system is used to monitor body temperature for each patient and the accompanying family members. The ID card and travel e-record are checked to identify any epidemic area traveling histories. Any identified subjects at fever (>37.5 degree) is transferred to designated fever clinic by Shanghai City at nearby general hospitals.

For inpatients, the face-to-face visitation is transiently suspended, instead by video or on-line connections. For any inpatients with suspected fever, a temporary isolation ward is employed for observation. The isolation ward is strictly organized as required, with a special team prepared to taking suspicious patients with infection. Another isolation ward is prepared for medical staff who have in direct contact with suspected patients as well.

Execution of the fever report system: Any fever or suspected symptoms were reported daily from each wards and each departments by specialized staff every 24 h. The data is summarized and reported to the infection management office of the hospital. Specialized line number is provided for emergency report with staff on duty 24 h per day.

All doctors, staff, medical students must report their traveling history and health status before start working. Anyone who has left the city has to pass the home isolation for 14 days observation before returning to work; anyone who has visited epidemic area has to report the details to the management office.

All staff has to report body temperature and health status every 24 h during the epidemic period. The conferences are conducted online and the external visitors requires authorization for entrance of the hospital.

The hospital provides online mental health services and relaxing courses to staff and the public. The topic includes psychological status survey, psychological consultation, and mental health education contents. This aims to prevent the occurrence of new mental illness cases during epidemic for both general public and our medical staff, and to facilitate scientific dissemination.

Taken together, psychiatric wards or hospital are more fragile when compared to other general hospitals. By applying strict regulatory rules and performing careful screening of risk factors, it is hoped that we can prevent infection occurrence and spread via improved hospital management.