The devastation being wrought by COVID-19 now is reaching levels not ever experienced in the United States—over 1 million new cases per week, and more than 2,000 deaths per day. At-risk populations—persons who are elderly, those with health conditions, those who are poor, and those who are minorities—especially are being impacted. At the same time, we are arriving at the cusp of effective vaccinations from Pfizer, Moderna, Astrazenica, and soon, several others. It is time for us to take stock and consider next steps for persons who have a mental illness or a substance use condition.
Very recently, we have learned that those who contract COVID-19 are at increased risk of developing a mental disorder in the subsequent 90 days. Also, those who have a mental disorder are at increased risk of contracting COVID-19. Specifically, the Lancet has reported a meta-study demonstrating that those who experience COVID-19 have almost a 20% chance of developing a mental condition in the subsequent 90 days.
And like the findings for those who are poor or are minorities, it also is reasonable to expect the reverse relationship: Those with mental illness are at increased risk of contracting COVID-19. This latter relationship can be explained by the broad prevalence of serious chronic health conditions among those with mental illnesses, as well as the risky living conditions many are exposed to in treatment facilities and jails.
Similarly, a recent NIH study has found that persons with substance use disorders have greater susceptibility to COVID-19. This is particularly true for those with opioid and tobacco use conditions. Further, the COVID-19 infection is likely to be more severe in these populations.
We also can speculate that the reverse relationship will occur: Those with COVID-19 conditions will be more likely to develop substance use conditions due to heightened levels of stress, anxiety, depression and fear.
These findings and observations lead to an essential strategic question: Should those with mental or substance use conditions become priority populations for vaccination against COVID-19?
The clear answer is a resounding yes.
Several important observations support this conclusion:
- COVID-19 is leading to a behavioral health pandemic. Prioritizing those with behavioral health conditions for vaccination could slow this eventuality, which threatens to overwhelm the behavioral healthcare system. Immunization can reduce stress, anxiety, depression and fear.
- COVID-19 flourishes in settings where many persons with behavioral health conditions reside—congregate living arrangements, community residential care settings, hospitals, jails, prisons, and even on the streets. Vaccination could reduce the likelihood of super-spreader events in these settings.
- Priority for vaccination should be given to the most vulnerable populations who are most likely to die if they contract COVID-19. Clearly, our behavioral health populations meet this criterion, especially those who have the most severe behavioral health conditions and are cared for by county and city behavioral health systems.
I urge you to reflect on the issue raised here and to support priority vaccination for those with behavioral health conditions. Advocacy will be needed at the national, state and county levels very soon.