No half-time for COVID-19.

COVID-19 have caused many deaths worldwide. Previously, Taiwan had fully controlled COVID-19 infection.1, 2, 3 The stress reactions elicited by COVID-19 include anxiety and depression. In patients with bipolar disorder (BD), it may precipitate a manic episode. We report a case who experienced a manic episode during the pandemic and nearly started an infection cluster.

A 65-year-old businessman was brought to the emergency room (ER) by police. He had symptoms of decreased sleep time, delusions, and irritability. He had a 20-year history of BD and had been admitted to the psychiatric ward several times. His medical records indicated that he had not attended any follow-up visits for ten months. Mental examination revealed delusions of grandeur, racing thoughts, and pressured speech. Psychological instability precluded the collection of further information. He was admitted to the psychiatric ward.

Owing to emotional instability, he was isolated for 4 days. On day 5, he was still hyperactive, but his manic symptoms were partially relieved, so he was moved to the general psychiatric ward, where he actively and passionately interacted with others. At that time, the ward had 26 patients. On day 7, Taiwan's Centers for Disease Control and Prevention (CDC) informed us his being listed as a high-risk case due to contact history with confirmed COVID-19 patients. He was instantly transferred to the negative pressure room for quarantine.

Footprint tracing by the CDC revealed that he visited the airport to try to go abroad but failed because he had not booked any flight beforehand, further indicative of mania. Later, he checked into a nearby hotel overnight and was soon brought to the ER due to psychological symptoms. However, that hotel also served as a quarantine hotel for flight crew and passengers, which later turned out to be the center of a COVID-19 cluster infection. He was thus listed as a high-risk case. We were informed only 7 days later. Fortunately, two polymerase chain reaction tests for COVID-19 were both negative, and another cluster infection was avoided.

This case highlights that people with mental disorders are vulnerable to infectious diseases because of decreased awareness of the risk and poor self-quarantine measures. Our patient, in a manic episode, visited a high-risk area but failed to tell us that, which could have led to an infection cluster at the hospital. Although the vaccines for COVID-19 are a silver lining, it should be remembered that there is no half-time for COVID-19.

Declaration of competing interest

The authors have no conflicts of interest relevant to this article.