key: cord-0734871-oy2b3sjm
authors: Sommer, Iris E; Bakker, P Roberto
title: What can psychiatrists learn from SARS and MERS outbreaks?
date: 2020-05-18
journal: Lancet Psychiatry
DOI: 10.1016/s2215-0366(20)30219-4
sha: a80a57998c62d1861963412b62c45a26235ba0d6
doc_id: 734871
cord_uid: oy2b3sjm

nan

. The meta-analysis showed that the point prevalence in the post-illness stage was 32·2% (95% CI 23·7-42·0) for post-traumatic stress disorder, 14·9% (12·1-18·2) for depression, and 14·8% (11·1-19·4) for anxiety. As the COVID-19 pandemic is so recent and ongoing, few studies reported on psychiatric disorders complicating this particular disease and those that did reported only short-term aspects. Rogers and colleagues circumvented this knowledge gap by taking together the few studies on psychiatric disorders in patients with COVID-19 with the much larger body of literature on psychiatric disorders accompanying two previous coronavirus epidemics: the 2002 SARS and the 2012 MERS outbreaks. From a biological perspective, it makes sense to merge data on SARS coronavirus 2 (SARS-CoV-2), which causes COVID-19, infections with those of SARS coronavirus (SARS-CoV) and MERS coronavirus (MERS-CoV) infections because resemblance between these three types of coronaviruses is high. 2 SARS-CoV-2 is structurally and genetically highly homologous to MERS-CoV (>50% similarity) and SARS-CoV (>79% similarity). 3 Even the spike proteins that SARS-CoV and SARS-CoV-2 use to attach to the target cell membrane (spike protein S, which interacts with the angiotensin-converting enzyme 2 receptor) are largely similar. 4 Coronaviruses have been shown to be potentially neuroinvasive, neurotropic, and neurovirulent. For SARS-CoV and MERS-CoV, the presence of virus in the brain has been confirmed with RT-PCR, immunohistochemistry, and in-situ hybridisation. 3 Such confirmations have not yet been provided for SARS-CoV-2, but symptoms such as confusion, seizures, and anosmia during acute infection might reflect CNS involvement. Thus, in terms of virus properties, SARS-CoV-2, SARS-CoV, and MERS-CoV are largely comparable. 4 However, treatment of patients admitted to the hospital for SARS-CoV-2 infection seems to be different from treatment of those admitted for SARS-CoV and MERS-CoV infections. Furthermore, the social situation to which COVID-19 survivors return is completely different from that of SARS and MERS survivors. These differences are relevant for the prevalence of psychiatric disorders in both acute and post-illness stages. Patients with COVID-19 who are admitted to hospital might be older than patients admitted for SARS 2,4 (although not all studies show this 5 ), and the mean duration of their stay in the intensive care unit (ICU) is longer. 2, 4 In the COVID-19 era, unlike the previous SARS and MERS outbreaks, fear for shortage of medical facilities such as ventilators can further increase stress. All three factors increase the risk for psychiatric complications such as anxiety and delirium in the acute stage for patients with COVID-19 compared with those with SARS or MERS. Staying at the ICU is a risk factor for developing psychiatric disorders by itself. In 2018, a large study among almost 5000 ICU survivors showed that prevalence of post-traumatic stress disorder was 46%, that of anxiety was 40%, and that of depression was 22%. 6 These prevalences are well above the upper ranges of the confidence intervals reported by Rogers and colleagues. As prolonged ICU stay and use of mechanical ventilation are both risk factors for psychiatric disorders, 7 patients with COVID-19 who need admission to an ICU are an ultra-high-risk group for developing acute psychiatric disorders, especially delirium. 8 Finally, COVID-19 survivors, unlike SARS and MERS survivors, return to a society in deep economic crisis, with shortage of basic needs such as food in some

Epidemiology, causes, clinical manifestation and diagnosis, prevention and control of coronavirus disease (COVID-19) during the early outbreak period: a scoping review

Human coronaviruses and other respiratory viruses: underestimated opportunistic pathogens of the central nervous system?

COVID-19, SARS and MERS: are they closely related?

Long-term outcome of acute respiratory distress syndrome caused by severe acute respiratory syndrome (SARS): an observational study

Anxiety, depression and post traumatic stress disorder after critical illness: a UK-wide prospective cohort study

Delirium in critically ill patients

COVID-19: ICU delirium management during SARS-CoV-2 pandemic