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Disease and treatment

New research will monitor COVID-19 among socially disadvantaged people

So far, most of the most socially disadvantaged people in Denmark have avoided contracting COVID-19. However, this situation may change. A professor of psychiatry will monitor COVID-19 among vulnerable social groups by investigating the trends in hostels, shelters, crisis centres and sheltered housing for people with mental health problems. The results can be used as a monitoring tool and to evaluate the initiatives being taken to prevent transmission. The Municipality of Odense has experience in tailoring health services for socially disadvantaged people who do not have access to a general practitioner or NemID (Denmark’s digital identity) to enable them to access COVID-19 testing.

When the COVID-19 pandemic erupted in the spring, one major concern in Denmark was how it would affect socially disadvantaged people who, for example, live with alcohol or drug abuse or are mentally vulnerable. In Denmark, these people have not been strongly affected by COVID-19 so far, but this may change in the future.

To investigate how COVID-19 affects some of the most vulnerable people in Denmark, Merete Nordentoft, Chief Physician, Mental Health Centre Copenhagen and Professor of Psychiatry, University of Copenhagen, has initiated a research project to determine the prevalence of COVID-19 among socially disadvantaged people in Denmark.

Specifically, the project will monitor how widespread COVID-19 is among people who are in inpatient mental health facilities, sheltered housing for people with mental health problems, hostels, shelters, crisis centres and institutions for young offenders as well as people in prison.

Vulnerable people at greater risk of severe COVID-19

Many people with mental disorders also have chronic somatic diseases and therefore have a greater overall risk of becoming severely ill and dying if they get COVID-19.

“A preliminary study shows that people with mental disorders are twice as likely to contract COVID-19 as people not diagnosed. We have good reason to believe that people with mental disorders would have excess mortality since people with pre-existing chronic diseases have excess mortality if they get COVID-19,” explains Merete Nordentoft.

Merete Nordentoft and her colleagues have just accessed the data they will use to monitor the prevalence of COVID-19 among socially disadvantaged people, and the research can now begin.

“The results can be used to develop a monitoring tool that can track transmission among specific population groups. We can also use the research in the longer term to evaluate more generally whether the initiatives taken to prevent transmission have been sufficient,” says Merete Nordentoft about the potential applications.

No vulnerable people have COVID-19 so far in Odense

The Municipality of Odense has made a targeted effort among socially disadvantaged people. In the spring, the Municipality, in collaboration with DanChurchSocial and Odense University Hospital, decided to set up an emergency shelter for socially disadvantaged people with COVID-19. The emergency shelter is intended for such people as homeless people, who do not have a home in which they can self-isolate, and people who cannot self-isolate in their home for other reasons.

The COVID-19 situation has continually changed since the spring, and the task has therefore been complex but was nevertheless carried out very rapidly.

“We established an emergency shelter in Odense in record time in close collaboration with civil society and Odense University Hospital. After we had established the shelter and arranged for personnel, we found no socially disadvantaged people with COVID-19. We are naturally happy about this, which means that instead of having the emergency shelter at a separate site, we have now located the unit in our homelessness shelter and alternative care home, where we have better physical settings and can act more flexibly if socially disadvantaged people with COVID-19 become homeless or risk becoming homeless,” explains Henriette Korf Graversen, Manager of the Department of Employment and Social Services of the Municipality of Odense.

Tailor-made health services for vulnerable people

DanChurchSocial played a major role in establishing the emergency shelter in Odense. The people who regularly use DanChurchSocial’s services, such as hostels and day centres, will be among those who can use the new emergency shelter if they contract COVID-19.

The work of establishing the emergency shelter has had other benefits, enabling some health services to be tailored to the people the conventional healthcare system has difficulty accommodating.

By establishing the emergency shelter and the resulting collaboration between the healthcare system, the Municipality and civil society, the Municipality of Odense has had the opportunity to give people who do not fit well into the existing health services an opportunity to be tested for COVID-19 and especially be able to get the result, according to Heinz Wolf, Manager, DanChurchSocial in Odense.

“The healthcare system has great difficulty in accommodating the people who do not fit in: those who do not stay in bed and medicate themselves and who smoke continually – which you cannot do in a hospital. We established really excellent collaboration with the Municipality of Odense and Odense University Hospital that has removed many obstacles during the entire COVID-19 crisis. How do you arrange testing and provide the results to someone who does not have the digital log-in NemID? What if you do not have a general practitioner – how do you get the results? These people do not have access to Denmark’s online eHealth portal Sundhed.dk, so we have developed response and consent options, and it was really great that we had to sit down and find some good solutions because of establishing the emergency shelter,” explains Heinz Wolf.

Discover more about Merete Nordentoft’s research project and the experience with helping socially disadvantaged people in the Municipality of Odense during the COVID-19 pandemic in the podcast Research Stories (Forskningsfortællinger), which you also find on Apple Podcasts, Spotify, and other podcast apps (only in Danish).

The Novo Nordisk Foundation awarded grants to Merete Nordentoft for the project “Monitoring of the Spread of COVID-19 among Vulnerable Groups, Focusing on Individuals with Mental Illness, Alcohol and Drug Abuse as well as Homeless People” and to the Municipality of Odense in collaboration with Odense University Hospital and DanChurchSocial for the project “Establishing Emergency Shelter in Odense for Socially Disadvantaged People with COVID-19”.

Merete Nordentoft
Clinical Professor
Merete Nordentoft is an expert in epidemiology, suicidal behavior, psychopathology and early intervention in psychosis. She was PI for many large randomized clinical trials, evaluating the effect of psychosocial intervention, of which the Danish OPUS trial (specialized assertive intervention in first episode psychosis) is the most well known. She has worked with suicide prevention at a national level since 1997. Together with a group of epidemiologist from Nordic countries, she has proved that life expectancy in schizophrenia is 15 to 20 years shorter than in the general population. She is involved as one of the PI’s in iPSYCH, the Lundbeck FoundationInitiative For Integrative Psychiatric Research, which aims at investigating genetic and environmental causes of mental disorders. The initiation of the large Danish High Risk and Resilience Study VIA 7 is an important part of iPSYCH. She was given the prestigious award “Global Excellence in Health” in 2012.