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Having schizophrenia is the second biggest risk factor for dying from COVID-19

ELISSA NADWORNY, HOST:

In the first year of the pandemic, we learned that older people are more likely to die from COVID-19 than younger ones, making age the biggest risk factor for dying from the disease. But did you know that the second biggest risk factor is schizophrenia? The pandemic has posed grave danger to people with this serious mental illness, but it also presents a unique opportunity for researchers to increase their understanding of schizophrenia itself. April Dembosky at member station KQED in San Francisco explains.

APRIL DEMBOSKY, BYLINE: 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.

KERIS MYRICK: It's when things go really, really fast and they seem overwhelmingly disastrous.

DEMBOSKY: Like the outbreak of a worldwide pandemic.

MYRICK: I literally had a meltdown right here in my house - just lost it.

DEMBOSKY: It happened early in the lockdown. Like a lot of people, Myrick kept a large stash of toilet paper under her bathroom sink. One of the pipes started to leak, and her precious TP got soaked. That's when the mean voices came out, and they attacked.

MYRICK: Calling me stupid and, you know, what kind of idiot puts their toilet paper under the sink?

DEMBOSKY: Myrick was able to calm herself down and quiet the voices. As the pandemic wore on, she kept them at bay by keeping busy. She works for a foundation, host a podcast and wrote a children's book. She was managing OK, but she worried about others like her.

MYRICK: People with schizophrenia were not actually deemed as, quote, unquote, "the priority vulnerable population" to be served or to be addressed in the same way people who had other chronic health conditions and who were over a certain age. So we kind of got left out.

DEMBOSKY: This happened even as data emerged showing people with schizophrenia were nearly three times more likely to die from COVID than the general population. The risk of death was greater than people with diabetes or heart disease or any other condition besides age. Katlyn Nemani is a researcher and neuropsychiatrist at NYU.

KATLYN NEMANI: People's initial reaction to this was one of disbelief.

DEMBOSKY: They said it must be because people with schizophrenia are already worse off health-wise, or because they have trouble accessing health care. But Nemani's study controlled for all that.

NEMANI: Same doctors, same health care system. Everyone's tested. Everyone's treated.

DEMBOSKY: Then the other studies started rolling in, repeating the same findings, a two- to five-time higher risk of death for people with schizophrenia. These were studies from the U.K., Denmark, Israel, South Korea - countries with free universal health care.

NEMANI: You have to wonder, is there something inherent to the disorder itself that's contributing to this?

DEMBOSKY: Nemani says these findings point to a problem with the immune system. This could be what's causing severe COVID in people with schizophrenia, and it could also be what's driving psychotic symptoms like hallucinations or delusions. This would mean schizophrenia is not just a disease of the brain, but a disease of the whole body. It's a really promising area of research, and Nemani says it's the pandemic itself that's opening doors for new discoveries.

NEMANI: 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. We had really never had the opportunities to do this before.

DEMBOSKY: Down the line, there could be meaningful changes for people with schizophrenia.

NEMANI: It could potentially lead to interventions that improve not only 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.

DEMBOSKY: Like finding new immunological treatments that work better than current antipsychotic drugs. For right now, advocates for people with mental illness want the new data to be shared more widely. They want patients and their families to be aware of the elevated COVID risk so they can take more precautions.

BRANDON STAGLIN: It's been a challenge.

DEMBOSKY: Brandon Staglin has schizophrenia and is the president of One Mind, an 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 CDC to add schizophrenia to its list of high-risk conditions for COVID, which would make it a priority for vaccines, the same as they'd done for cancer and diabetes. They heard crickets.

STAGLIN: It doesn't make any sense. I mean, other conditions that are part of the list are at much lower risk of dying. Clearly schizophrenia has the higher risk.

DEMBOSKY: It wasn't until people were getting boosters in October that the CDC finally added schizophrenia to the high-risk list. Meanwhile, in other countries like England, Germany and Denmark, people with serious mental illness had been prioritized for vaccines from the very beginning of the rollout. In England, they got their shots right after 65-year-olds.

STAGLIN: So we were happy when that happened but wish there had been faster action.

DEMBOSKY: So does Keris Myrick.

MYRICK: It's like we have to remind people because it's just sort of, yeah, oh, yeah. Oh, right, I forgot about that.

DEMBOSKY: They both hope scientists will keep exploring these new findings because the pandemic isn't over yet, and they say mental health needs to be more than an afterthought. For NPR News, I'm April Dembosky in San Francisco.

NADWORNY: This story comes from NPR's partnership with KQED and Kaiser Health News.

(SOUNDBITE OF MUSIC) Transcript provided by NPR, Copyright NPR.