Aim: Many health-care workers exposed to coronavirus disease 2019 (COVID-19) are psychologically distressed. This study aimed to investigate the psychological impact of the COVID-19 pandemic on hospital workers under the emergency declaration in Japan.Methods: This cross-sectional, survey-based study collected sociodemographic data and responses to 19 stress-related questions and the Impact of Event Scale-Revised (IES-R), which measures post-traumatic stress disorder (PTSD) symptoms, from all 3217 staff members at Kobe City Medical Center General Hospital from April 16, 2020 to June 8, 2020. Exploratory factor analysis was applied to the 19 stress-related questions.Multiple regression models were used to evaluate the association of personal characteristics with each score of the four factors and the IES-R. Results:We received 951 valid responses; 640 of these were by females, and 311 were by respondents aged in their 20s. Nurses accounted for the largest percentage of the job category. Women, those aged in their 30s-50s, nurses, and frontline workers had a high risk of experiencing stress. The prevalence of stress (IES-R ≥ 25) was 16.7%. The psychological impact was significantly greater for those aged in their 30s-50s and those who were not medical doctors.Conclusions: This is the first study to examine the stress of hospital workers, as measured by the IES-R, under the emergency declaration in Japan. It showed that women, those aged in their 30s-50s, nurses, and frontline workers have a high risk of experiencing stress. Health and medical institutions should pay particular attention to the physical and psychological health of these staff members.

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The neurological symptoms of the coronavirus disease 2019 (COVID‐19) can be prolonged or intensified. Many patients experience “brain fog” after recovery, termed as post‐acute COVID‐19 syndrome (PACS) or long COVID. Here, we describe the case of a male patient with post‐COVID‐19 encephalopathy and psychotic symptoms. He developed delirium and behavioral abnormalities associated with PACS after the COVID‐19 infection resolved. He was admitted for sexually inappropriate behavior and catatonia symptoms. His cerebrospinal fluid tested positive for severe acute respiratory syndrome coronavirus 2 on polymerase chain reaction testing. Brain magnetic resonance imaging showed no abnormalities; however, single‐photon emission computed tomography showed increased uptake in the bilateral thalamus, septal regions, and posterior cingulate gyrus. In our patient's case, the course of events led to the diagnosis of PACS with psychosis related to post‐acute COVID‐19 encephalopathy. Surprisingly, COVID‐19 encephalitis is not caused solely by direct brain injuries; autoimmune paraneoplastic or post‐infectious encephalitis can occur after viral clearance. PACS is known to cause delirium, brain fog, and depression within 4–12 weeks of the onset of COVID‐19. COVID‐19 is frequently associated with delirium. However, encephalopathy is overlooked owing to the lack of testing. Missed encephalopathy may progress to PACS.