The Second Strongest Mortality Risk for COVID-19 Is a Mental Illness. Here’s Why.

Did you know that the strongest risk factor for COVID-19 mortality (read: whether or not you are likely to die of coronavirus infection) is advanced age? Probably.

Did you know the second strongest risk factor is a schizophrenia diagnosis?

I originally drafted a version of this mini-article that was rather academic. I laid out my sources, but in doing so I had the implicit expectation that academic verse comes easily to you and that you find comfort in that language. And while I might find some comfort hiding in the poetics of academese, I realized that was enacting a little bit of selfishness on my part — sacrificing you to save me. 

So why don’t we storywork this a little bit, while I have you here, just you and I?

When COVID-19 entered our collective consciousness in early Spring 2020, the data we strip-mined from the stories of thousands of bodyminds flowed with it: these survivors, family members, friends, and coworkers were quickly made into inscrutable data points, and these data points — over the course of a long time — became statistics that were too easy to dismiss for the arbitrary values they represented. Underneath those numeric values are people like:

Dr. Chant’s “list” (a public health physician) briefly described the deaths and circumstances of 210 COVID-19 deaths in New South Wales over the course of one week in January 2022. Though this list does not humanize these statistics with names, it gives more information than many datasets more easily available to news listeners: Chant describes one patient with asthma, two with chronic kidney disease. It is easy to glaze over an interesting statistic she presents: “one person had severe mental illness.” This is the buried statistic that Gilgamesh, above, picks up on.

How is severe mental illness a critical comorbidity with a condition that attacks the respiratory system? I started doing a little more reading as someone with schizophrenia and obviously concerned that this illness was appearing alongside recent COVID-19 deaths. Was the virus somehow able to detect severe mental illness? How could it accomplish that?

Health investigation journal JAMA Psychiatry recently published a study that demonstrated a clear relationship between schizophrenia diagnosis and mortality rate — the rate at which people actually die of infection. This New York study demonstrated, among other things, that “schizophrenia was found to be a distinct, and more deadly COVID-19 risk factor than heart, lung and kidney disease” (Conversation 2021), by a factor of almost 3. This was after a number of “controls” were accounted for, which means that they normalized data for socioeconomic conditions (i.e. poor access to health care) and comorbidity rates (i.e. concurrent conditions commonly seen in schizophrenia). There was no reasonable explanation as to why schizophrenia was producing a higher mortality rate than lung disease in a virus that became infamous for the ravaging of respiratory systems.

I kept reading — this study result was repeated in a number of other journals in other countries, including the UK’s Manchester University, the University of Warwick, South Korea’s national HIRA database, Wuhan (CHN)’s national EMBASE database, and a combined study of BioBank demography statistics from Public Health England and Public Health Scotland. While some studies reported a three-times risk multiplier for dying of COVID-19 if you were schizophrenic, France, China, and South Korea posted even higher multipliers: the likelihood of dying of coronavirus was five times higher in some areas if you were previously known to be schizophrenic. 

The only predictive trait that was able to beat schizophrenia’s multiplier was age — a well-known metric that takes long-term care and respite care facilities by storm. 

This is where the storyweaving gets complicated, because while age has a number of easy understood narratives that “make sense” of senseless death tolls, international speculators have not been able to come up with believable reasons as to why severe mental illness — and schizophrenia particularly — has such a close relationship with mortality when controlling for external factors.

It is well-known that despite our honest efforts as a community collective, we treat schizophrenics differently: we are disproportionately represented in institutions, long-term psychiatric wards, prisons, and care facilities. We are disproportionately represented (alongside other illnesses with psychotic traits) in the homeless population and the unemployed population. If we take as true that this virus has no inner consciousness and cannot rapidly “detect” schizophrenia, we have a tough alternative narrative to face when humanizing these statistics: if it can’t do it, we’re the ones detecting it.

And we detect it over and over and over again.

A particularly pernicious narrative is the “seeking care” ability narrative, as explained well by Canadian physician Dr. Sediqzadah:

“They don’t get the best access to health care first and foremost. And secondly, when they present to the emergency department, there’s always a concern on my end about diagnostic overshadowing in the sense that when the average person who may not have a psychotic illness presents with a health concern, their health concern is taken a lot more seriously than someone with a psychotic illness […] they’re doubly hit because they also have challenges with insight to go and seek care for health conditions.” (Conversation 2021).

Now I suppose I am an unreliable narrator, given I am three-to-five times more likely than you to die of coronavirus infection. But I would challenge the master narrative that schizophrenics have a prevailing “challenge with insight” — this inability to seek care presents itself because of the very stigma Dr. Sediqzadah is discussing with The Conversation,  the notion that these people aren’t believed when they walk into a hospital with symptoms. There are plenty of examples of mental illness clients being denied emergency care due to stigmatizing conditions revealed on their charts.

When I walk into an emergency room, I don’t see the same care you do. When I don’t see the same care you do, that fault and responsibility is placed back on me: as “insight challenged,” as “stigmatized,” as “unable to seek care.” Was I unable, or were you disabling me from receiving life-saving care?

I am 30 years old this year and I contracted coronavirus in early January 2022. Facing down these statistics with no names, these prevalence rates no one has heard of, these mentally ill patients who died for nothing, I became quite scared (and quite ill). I knew if I got sick enough to need emergency care, I would become one of those distancing numbers you see but don’t quite believe. If you happen to notice my number at all, in a list thousands and thousands of names long, with increasingly complicated comorbid conditions that “explain away” why some people die, and why others get better. That mortality multiplier only makes sense when you add eugenic dialogues to the story.

I should not be 30 years old and two, three, or five more likely than you to die of a respiratory illness. This is not a biology problem, this is a treatment problem. When hospitals hit their maximum patient load (as they regularly do in the American context), some of the stories we aren’t being told is who is being sacrificed to save the lives of more promising individuals, individuals who will go on to storyweave their own survival narratives. We don’t have to face, or sit through, or contend with the narratives of patients with severe mental illness denied care and dying of a treatable infection. Those narratives are much more uncomfortable, they hurt our ears and cause deafening silence.

As it stands, there is no compelling reason besides eugenics — the human act of choosing who gets to live or receive care — that can adequately explain the control numbers, these numbers devoid of stories. Those stories aren’t there on purpose, to flatten a narrative that whispers some hard truths about hospital conditions, triage care, and the fact that not everyone is equal in the eyes of health services. Why is my life worth less than yours?

Schizophrenics are being left out in the rain as the omicron variant feasts, and a lot of people are looking the other way. They might not even know they’re looking the other way, because they’re looking at numbers: not stories. I told you my story. 

Look at me now, and tell me you won’t sacrifice me to save you.