Helping patients understand coronavirus and COVID with Dr. Sheldon H. Preskorn

Lorenzo Norris, MD, spoke with Sheldon H. Preskorn, MD, about how to best educate patients about coronavirus.

Dr. Preskorn is a professor in the department of psychiatry at the University of Kansas School of Medicine–Wichita. Neither Dr. Norris nor Dr. Preskorn have any relevant financial relationships to disclose.

Take-home points

• Coronavirus 2019 (COVID-19) is the disease process caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).
• SARS-CoV-2 is different from the previous SARS-type coronaviruses and is having a greater impact on society as a pandemic for three reasons: It's highly transmissible person to person, it can be spread by infected individuals who are asymptomatic or presymptomatic, and it has a high level of morbidity but a lower level of mortality.
• Psychiatrists work with vulnerable populations, including older adults and individuals with medical comorbidities that put them at risk for COVID-19.
• Psychiatrists must understand the pertinent facts about COVID-19 to help their patients who are suffering the consequences of social distancing, a shuttered economy, and changes in their daily lives from COVID-19.

Summary

• While coronaviruses are known to cause the common cold, some are more medically serious – and even lethal – based on their ability to cause a severe acute respiratory syndrome (SARS). SARS-CoV-2 is one in a line of several coronaviruses to make the leap from animals to humans and cause a severe acute respiratory syndrome with devastating effects.
• Previous coronaviruses include SARS-CoV-1, which caused an illness referred to as "SARS" that had a mortality rate close to a 10%, and MERS-CoV, which caused Middle East respiratory syndrome (MERS) and had an even higher mortality rate. The high mortality rate of these SARS-type coronaviruses is thought to be why they did not transition from epidemic to pandemic.
• SARS-CoV-2 is different from the previous SARS-type coronaviruses and is having a greater impact on society as a pandemic for three reasons: It's highly transmissible from person to person, it can be spread by infected individuals who are asymptomatic or presymptomatic, and it has a high level of morbidity but a lower level of mortality.
• In terms of transmissibility, each person infected can infect up to six additional people and individuals can spread the virus even while asymptomatic or presymptomatic. This is why wearing a mask and engaging in social distancing are essential to slowing the spread of COVID-19.
• SARS-CoV-2 is more lethal than influenza and is especially dangerous for certain populations, such as older adults and those with multiple medical comorbidities, including chronic pulmonary obstructive disease, hypertension, diabetes, obesity, and being immunocompromised. In the United States, 80% of COVID-19 deaths are in people older than age 65 years.
• Psychiatrists must understand these pertinent facts about COVID-19 to help their patients who are suffering the consequences of social distancing, a shuttered economy, and changes in their daily lives from COVID-19.
• Psychotropic medications that can lead to metabolic syndrome, such as second-generation antipsychotics, may put patients with serious mental illness at risk of worse outcomes if infected with COVID-19.
• Ultimately, psychiatrists are medical doctors who are helping treat the secondary mental health effects of the COVID-19 pandemic, so we have a responsibility to have a working knowledge of the epidemiology and basic science of the virus to help our patients.

References

Preskorn SH. Coronavirus Disease 2019: The first wave and beyond. Psychiatr Times. 2020 Apr 28.

Preskorn SH. COVID-19: Protecting the vulnerable and opening the economy. Psychiatr Times. 2020 May 6.

Centers for Disease Control and Prevention. Coronavirus Disease 2019 (COVID-19). Older adults.

National Institute of Allergy and Infectious Diseases. Coronaviruses.

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Show notes by Jacqueline Posada, MD, who is associate producer of the Psychcast and consultation-liaison psychiatry fellow with the Inova Fairfax Hospital/George Washington University program in Falls Church, Va. Dr. Posada has no conflicts of interest.

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