Severe mental illness reassessing COVID-19 vaccine priorities.pdf
As evidence mounts that patients with severe mental illness are at increased risk of severe COVID-19, some countries are reassessing their vaccine priority strategies.
随着越来越多的证据表明患有严重精神疾病的患者罹患严重COVID-19的风险增加，一些国家正在重新评估其疫苗优先策略。
“The evidence is really very clear. We have well over six studies now published with data from US, the UK, Denmark, and Sweden all showing the same thing”, Livia De Picker, University Psychiatric Hospital Campus Duffel, Antwerp, Belgium, told The Lancet. “Patients with severe mental illness, which is patients with psychotic disorder, bipolar disorder, or severe depression, are at a significantly increased risk of being hospitalised or dying from COVID.”
“证据确实非常清楚。 比利时安特卫普达菲尔大学精神病医院校园的利维亚·德·皮克尔告诉《柳叶刀》，目前，我们已经发布了六项以上的研究，其中美国，英国，丹麦和瑞典的数据都表明了同一件事。“患有严重精神疾病的患者，即患有精神病，躁郁症或严重抑郁症的患者，因COVID住院或死亡的风险显着增加。”
Currently, however, only four countries have updated their vaccination strategies to proritise patients with severe mental illness. In December, 2020, both Denmark and the UK updated their vaccination guidance. The Netherlands followed in January, 2021, and 2 weeks ago Germany did the same.
但是，目前只有四个国家更新了疫苗接种策略，以改善严重精神疾病患者的病情。2020年12月，丹麦和英国均更新了疫苗接种指南。荷兰紧随其后是在2021年1月，而德国在2周前也采取了同样的行动。
Evidence shows that the severity of outcomes due to COVID-19 in this patient group is similar to that of those with cardiac, pulmonary, or autoimmune issues. “Their [patients with severe mental illness] odds are double that of people without severe mental illness, which is the same range as the highest risk groups”, said De Picker.
有证据表明，在该患者组中，由于COVID-19导致的预后严重程度与那些患有心脏，肺或自身免疫问题的患者相似。 “他们（患有严重精神疾病的患者）的机率是没有严重精神疾病的患者的机率的两倍，这与最高风险人群的范围相同”，德·皮克说。
People with severe mental illness may be more likely to have living circumstances, diet, or comorbidities, such as diabetes or cardiovascular disease, that contribute to an increased risk of severe outcomes from COVID-19. We also need to think about there being an association with severe mental illness and immune system dysfunction, explained Carmine Pariante, professor of psychiatry, King’s College London, London, UK.
患有严重精神疾病的人可能更容易患有生活环境，饮食或合并症，例如糖尿病或心血管疾病，从而增加了COVID-19导致严重后果的风险。 英国伦敦国王学院精神病学教授Carmine Pariante解释说，我们还需要考虑与严重的精神疾病和免疫系统功能障碍有关。
Prioritising vaccination is based on risk factors for having a severe outcome, and so when the evidence shows that people with severe mental illness are at high risk they should be among the prioritised groups, explained Michael E Benros, Biological and Precision Psychiatry, Copenhagen Research Centre for Mental Health, Copenhagen, Denmark. “In a Danish nationwide study, psychotic disorders were associated with an increased 30-day mortality when having COVID-19 by 3·3 times compared with other COVID-19 patients. In the same study, having psychotic disorders was associated with a 2·5 times increased risk of being hospitalised due to COVID-19”. Benros also points to another study in JAMA showing that schizophrenia was a risk factor for mortality in patients with COVID-19.
哥本哈根研究中心生物和精密精神病学迈克尔·本罗斯解释说，优先接种疫苗的依据是具有严重后果的危险因素，因此，当证据表明患有严重精神疾病的人处于高风险时，应将其列为优先考虑的人群。丹麦哥本哈根的心理健康研究中心。“在丹麦的一项全国性研究中，与其他COVID-19患者相比，当患有COVID-19时，精神病与30天死亡率增加有关。 在同一项研究中，患有精神病的患者因COVID-19而住院的风险增加了2·5倍。”本罗斯还指出，JAMA上的另一项研究表明，精神分裂症是COVID-19患者死亡的危险因素。
“Now is the time to act...”
“现在该采取行动了……”
The evidence is new and still emerging and experts do not think countries are necessarily being neglectful. But there is a concern about this group because they are often neglected in policy making. “It is our hope that raising awareness to this disconnect between evidence and policy will lead to more countries to follow suit”, said Marisa Casanova Dias, vice president, European Union of Medical Specialists (UEMS), Section of Psychiatry.
证据是新的且仍在不断出现，专家们认为国家不一定会被忽视。但是，由于该群体经常在决策过程中被忽视，因此对此群体存在担忧。“我们希望提高人们对证据与政策之间这种脱节的认识，将导致更多的国家效仿”，欧洲医学专家联盟精神病学部副主席玛丽莎·卡萨诺瓦·迪亚斯说。
Groups in Belgium are advocating for patients with severe mental illness to be considered in their vaccine strategy.“We don’t want people with severe mental illness to jump over other categories with high risk. The main issue is as always, [patients with severe mental illness] tend to be forgotten”, said Marc De Hert, KU Leuven, Leuven, Belgium.“Our argument is one of equity...people with severe mental illness must enter the line of people with high risk compared with the general population of the same age”, added De Hert.
比利时的团体提倡在他们的疫苗策略中考虑患有严重精神疾病的患者。“我们不希望患有严重精神疾病的人跳过其他具有高风险的类别。比利时鲁汶大学鲁汶分校的马克·德·赫特说：“主要的问题还是一如既往，[重度精神病患者]往往被人们遗忘。 德赫特补充说：“我们的论点是公平的。与同年龄段的普通人群相比，患有严重精神疾病的人必须加入高风险人群。”
Despite patients with severe mental illness being included in the priority vaccination group in the UK, a study of over 23 million National Health Service patients has found that those with severe mental illness were less likely to be vaccinated. “We were very concerned to see that among the over-70s, who are currently being prioritised for vaccination in the UK, people with severe mental illness, such as schizophrenia and bipolar affective disorder, are less likely to have received vaccination”, said Ben Goldacre, director of The DataLab, University of Oxford, Oxford, UK, and one of the authors of the study. “At the moment it is impossible to tell from the data whether this...is due to increased rates of vaccine hesitance among people with severe mental illness, or somehow related to the logistics of service delivery”, he added.
尽管英国将严重精神疾病患者纳入优先疫苗接种组，但一项针对超过2300万国民健康服务部门患者的研究发现，患有严重精神疾病的患者接种疫苗的可能性较小。 本说：“我们非常关切地看到，在英国目前优先接受疫苗接种的70岁以上人群中，患有严重精神疾病（例如精神分裂症和双相情感障碍）的人接受疫苗接种的可能性较小，”本说 戈德阿克，英国牛津大学牛津大学数据实验室主任，该研究的作者之一。他补充说：“目前无法从数据中得知这是否是由于患有严重精神疾病的人的疫苗敏感性增加，还是某种程度上与提供服务的后勤有关。”
Organisations in many countries continue to campaign for this patient group to be prioritised. “At the end of January, the Polish Psychiatric Association shared a position calling for the removal of existing barriers and priority vaccination in a group of people with serious mental illnesses, but it seems it takes much more shared action between different stakeholders to make this voice heard”, said Anna Szczegielniak, Department of Psychiatric Rehabilitation, Medical University of Silesia, Katowice, Poland.
许多国家/地区的组织继续为该患者群体确定优先次序。“1月底，波兰精神病学协会的立场是呼吁消除一群患有严重精神疾病的人的现有障碍和优先接种疫苗，但似乎各利益相关者之间需要采取更多共同行动，以表达这种声音。”，西里西亚医学大学精神病康复科安娜·斯泽吉尔尼亚克说，波兰卡托维兹。
“Different countries are at different stages of developing and putting in practice their plans”, said Casanova Dias.“Now is the time to act. Europe’s main psychiatry and patient organisations call for concerted action to ensure that vulnerable mental health patients are prioritised in vaccination strategies.”
卡萨诺瓦迪亚斯说：“不同的国家处于制定和实施计划的不同阶段。”现在是采取行动的时候了。欧洲的主要精神病学和患者组织呼吁采取一致行动，以确保弱势精神卫生患者在疫苗接种策略中得到优先考虑。”