Alcohol abuse along with difficulties in communication has led to increased morbidity and mortality among patients with psychiatric disorders. This issue has a higher importance during the COVID-19 Pandemic. Standard recommendations to prevent the spread of infection such as self-quarantine, hand washing, covering mouth and nose while coughing may be difficult to enforce in patients with mental illnesses. There is a controversy in discharge and management of patients with history of alcohol abuse and psychiatric disorders when they come to the Emergency Departments (ED) with mild presentation of COVID-19. We discussed a 39 years old patient known case of paranoid schizophrenia who came to the ED with mild fever, cough and headache. She was soon discharged from the ED after having a normal chest radiograph. She was recommended to be in self-quarantine for at least 14 days. Her COVID-19 condition deteriorated rapidly in a week, and she was brought back to the ED after she had an altercation with her friends while drinking. Patients with psychiatric disorders especially schizophrenia or those who have been diagnosed with alcohol abuse may have a higher risk for progression of their mild COVID-19 to a severe form. On the other hand, they have a role in the spread of COVID-19 in the community due to lower compliance with preventive measures. A higher rate of alcohol abuse in psychiatric patients and their lower compliance to self-quarantine calls for a different approach when they come to the ED with COVID-19 presentations.