ALBANY — The COVID-19 virus is stalking another vulnerable population — this time in state psychiatric hospitals and their lonely, confused patients who often can't communicate symptoms and can't do without the daily socializing and group treatment that is the bedrock of their care.

Ten patients in the Pilgrim Psychiatric Center in Brentwood are among the 40 in the state’s 23 psychiatric hospitals who have died during the coronavirus outbreak, state and medical officials said.

Although medical hospitals have drawn the most public attention during the outbreak, psychiatric hospitals caring for 3,484 patients statewide face added obstacles and threats. Officials say staff often face resistance from patients who can become combative when forced to wear masks, to safely handle sanitizer, and to adhere to other precautions against the spread of the virus in densely populated facilities behind locked doors.

The concern is nationwide.

“They are repeatedly exposed to high concentrations of virus, often without any regard for proper infection control or social distancing measures,” said Peter Katona, clinical professor of infectious diseases at the University of California Los Angeles Schools of Medicine and Public Health.

The Rockland Psychiatric Center in Orangeburg, which has 486 patients, has had 12 deaths from the virus and Creedmoor Psychiatric Center in Queens, which has 429 patients, has had six deaths. Of the 40 deaths, including patients who died after being transferred to medical hospitals, all were confirmed to be caused by the virus or presumed to be, according to the state Office of Mental Health.

There have been five or fewer deaths in the other centers. State officials say health care privacy laws prevent them from identifying the centers because it could lead to identifying the patients. Fifteen of the hospitals reported no patient deaths.

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Statewide, there were at least 353 confirmed cases of the virus in psychiatric hospitals from March 20 to April 27, the latest date for which data was released.

On Long Island, Pilgrim Psychiatric Center has about 278 beds and four outpatient treatment centers. The imposing facility — at one time the largest in the world — opened in 1931.

Spokesmen for Pilgrim and Rockland hospitals didn’t return requests for comment.

The state Office of Mental Health has taken steps to protect patients and staff. The state has provided masks, eliminated group treatments, modified meal and medication distribution, quarantined new admissions, screened employees for the virus daily, restricted visits to essential treatment planning or legal procedures, limited visits to child patients, expanded online telehealth programs, postponed nonessential training and limited class sizes for essential training.

While such steps are needed to combat the virus, the long-term impact of losing group therapy and activities isn’t clear, because progress is difficult even in normal times.

“There are a lot of people in a confined space and a lot of treatment is socializing,” said Jessica Gold, a psychiatrist and assistant professor of psychiatry at Washington University in St. Louis. “These are all the therapeutic methods that involve socializing and getting up and out of your room.” She said the group activities are key to battling depression.

“The treatment of psychiatric illnesses involves more — not less — social interaction and patients attend groups and occupational therapy session,” said Dinah Miller, a psychiatrist and assistant professor of psychiatry and behavioral sciences at Johns Hopkins University.

“They dine in communal areas and watch television together in day rooms,” Miller said. “Cellphones are typically not permitted for issues of privacy, and patients may use communal telephones. Patients who are very ill with psychiatric disorders may resist hygiene measures, and they may intrude on the personal space of others.”

Workers also face added difficulties.

“Some patients on an acute psychiatric unit may be agitated, uncooperative, or even violent, and it’s not hard to imagine the distress of anyone who has a patient spit on them as we’re all trying to remember not to shake hands,” Miller said.

The workers’ union, the Public Employees Federation, has worked with the state to improve conditions for employees and patients.

“These are difficult areas to work on a good day,” said Randi DiAntonio, PEF vice president. “We want to do the right thing … our members care deeply about their patients.” She said some workers have contracted the virus.

“I think it’s really easy to forget about them,” Gold said of psychiatric hospital patients. “It’s an out-of-sight, out-of-mind thing. It’s really important psychiatric patients don’t get forgotten."