Schizophrenia Puts People at High Risk of Dying From COVID. That Finding May Also Change Our Fundamental Understanding of the Brain Disease

Most of the time, the voices in Keris Myrick’s head don’t bother her. They stay in the background or say nice things. But sometimes they get loud and mean — like when a deadly pandemic descends on the world and shuts down society as we know it.

“It's when things go really, really fast and they seem overwhelmingly disastrous. That’s when it happens,” says Myrick, who was diagnosed with schizophrenia 25 years ago. “I literally had a meltdown right here in my house. Just lost it.”

Like a lot of people, Myrick, who lives in Los Angeles, kept a large stash of toilet paper under her bathroom sink in the early days of the lockdown. But when one of the pipes started to leak and her precious TP got soaked, the mean voices emerged and attacked.

“Calling me stupid, and what kind of idiot puts their toilet paper under the sink?” Myrick remembers.

She was able to calm herself down and quiet the voices, and as the pandemic wore on, she kept them at bay by keeping busy: working for a foundation, hosting a podcast, and writing a children’s book. She was able to manage, but worried about others like her — about 3.2 million Americans have schizophrenia, often characterized by hallucinations, delusions and disorganized thinking that can interfere with a person’s ability to work or care for themselves.

“People with schizophrenia were not actually deemed as ‘the priority vulnerable population’ to be served or to be addressed in the same way as people who had other chronic health conditions and who were over a certain age,” she says. “So we kind of got left out.”

This omission occurred even as new data published in the Journal of the American Medical Association showed that people with schizophrenia are nearly three times more likely to die from COVID-19 than the general population, meaning their risk of death from the virus is greater than for people with diabetes, heart disease or any other condition aside from age.

“People's initial reaction to this was one of disbelief,” says Katlyn Nemani, a New York University School of Medicine neuropsychiatrist and the study’s lead author.

Some researchers initially questioned whether the disparate death rates could be explained by the often poor physical health of people with schizophrenia, or because they have trouble accessing health care. But Nemani’s study controlled for those factors: All the patients in the study were tested and treated, and they got care from the same doctors in the same health care system.

Then the other studies started rolling in from countries with universal health care systems — the U.K., Denmark, Israel, South Korea — all showing the same findings: a nearly three times higher risk of death for people with schizophrenia. A more recent study from the U.K., published in December 2021, found the risk was five times greater.

“You have to wonder, is there something inherent to the disorder itself that's contributing to this?” Nemani asks.

The data points to a problem with the immune system, Nemani says. The same immune dysfunction that’s causing severe COVID in people with schizophrenia could also be what’s driving their psychotic symptoms. This suggests that schizophrenia is not just a disorder of the brain, but a disease of the whole body, she says.

Although researchers have been studying this theory already, the data from the pandemic sheds light on it in a whole new way, opening doors for new discoveries. 

“This is a really rare opportunity to study the potential relationship between the immune system and psychiatric illness, by looking at the effects of a single virus at a single point in time,” Nemani says. “It could potentially lead to interventions that improve medical conditions that are associated with the disease, but also our understanding of the illness itself and what we should be doing to treat it.”

In the long term, it could lead to new immunological treatments that might work better than current antipsychotic drugs.

For now, advocates want the data about risk to be shared more widely, so more people can survive the pandemic. They want people with schizophrenia and their caretakers to know they should take extra precautions, and, earlier in the pandemic, they were hoping to get vaccine priority for the population.

“It’s been a challenge,” says Brandon Staglin, who has schizophrenia and is the president of One Mind, a mental health advocacy group based in Napa Valley.

When he and other advocates first saw Nemani’s data in early 2021, they started lobbying public health officials. They wanted the Centers for Disease Control and Prevention to add schizophrenia to its list of high-risk conditions for COVID, which was used to determine priority for distributing the vaccine, the same as it had done for cancer and diabetes.

But they heard crickets.

“It doesn't make any sense,” Staglin says. “Other conditions that are part of the list are much lower risk of dying, but clearly schizophrenia is a higher risk.”

In several other countries, including England and Germany, people with serious mental illness were prioritized for vaccines from the very beginning of the rollout last February. In the U.S., though, it wasn’t until people were getting boosters in October that the CDC finally added schizophrenia to the list.

“We were happy when that happened, but we wish there had been faster action,” Staglin says.

It’s always like this with mental illness, says Keris Myrick.

“It's like we have to remind people,” she says. “It's just sort of, ‘Oh, yeah, oh right, I forgot about that.’”

As scientists learn more about the link between COVID and schizophrenia, and as the potential for pandemic-related research grows, Myrick and Staglin both say mental health must be more than an afterthought.