Case 28-2021: A 37-Year-Old Woman with Covid-19 and Suicidal Ideation

Abstract

T h e ne w e ngl a nd jou r na l o f m e dicine Pr esentation of C a se Dr. Reuben A. Hendler (Psychiatry): A 37-year-old woman was admitted to this hospital because of fever, shortness of breath, and suicidal ideation in March 2020, during the pandemic of coronavirus disease 2019 (Covid-19). Ten days before this admission, fever, fatigue, sore throat, cough, and myalgias developed. The symptoms did not abate after the patient took aspirin and acetamin-ophen. Five days before this admission, she sought evaluation at the urgent care clinic of this hospital because Covid-19 had been diagnosed in two coworkers. A test for Covid-19 was not performed because of limited test availability; tests for influenza A and B viruses and respiratory syncytial virus were not performed because of a statewide shortage of nasopharyngeal swabs. The patient was instructed to quarantine at home. During the next 5 days, the patient quarantined in a room in her apartment. Her husband periodically brought food to the door of the room. The fever, fatigue, sore throat, cough, and myalgias persisted; new shortness of breath and anosmia developed. She had decreased appetite, and she consumed minimal food and drink. One day before this admission, nausea, vomiting, and diarrhea developed, and the patient sought evaluation at the emergency department of another hospital. Intravenous fluid, ondansetron, and ketorolac were administered, and she was discharged home with instructions to continue to quarantine. On the day of admission, the patient had dizziness while standing, as well as shortness of breath, and she returned to the urgent care clinic of this hospital. The temperature was 38.7°C, the heart rate 127 beats per minute, the respiratory rate 38 breaths per minute, and the oxygen saturation 97% while she was breathing ambient air. The patient was anxious and tearful. The lungs were clear on ausculta-tion. Intravenous fluid, ondansetron, and oral acetaminophen were administered. The dizziness resolved, and the fever, shortness of breath, and anxiety decreased. The patient was advised to return home to quarantine; however, she disclosed that if she were sent home, she planned to overdose on medications to die by suicide because of her anxiety and feelings of sadness and loneliness. Owing to concern From Metrocare Services and the Department of Psychiatry, University of Texas Southwestern Medical Center-both in Dallas (C.S.N.); and the Departments of Psychiatry (E.M.S., S.Y.) and Medicine (J.T.C.), Massachusetts General Hospital, and the Departments of Psychiatry (E.M.S., S.Y.) and Medicine (J.T.C.), Harvard Medical School-both in Boston.