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Objective:

This study aimed to explore the transmission of COVID-19 in a U.S. state psychiatric hospital setting.

Methods:

Symptomatic and asymptomatic patients were tested throughout a large psychiatric hospital to determine penetrance. The hospital followed initial Centers for Disease Control and Prevention (CDC) guidelines.

Results:

Seventy-eight percent (N=51 of 65) of tested patients in the building where the first positive patient was housed (building zero) tested positive for COVID-19. Eighty-eight percent (N=14 of 16) of tested asymptomatic patients in building zero were positive, compared with 12% (N=6 of 51) of randomly selected asymptomatic patients in a sample from the rest of the hospital.

Conclusions:

A high percentage of patients can become positive for COVID-19 despite following initial CDC guidelines. As such, use of masks by all patients in close-quarter settings prior to the first positive case appears warranted. Recent CDC guidelines align with this strategy.