The mental health of healthcare professionals has been significantly affected by the COVID-19 pandemic.^{Reference Moreno, Wykes, Galderisi, Nordentoft, Crossley and Jones1} We believe that more research focusing specifically on the long-term mental health of medical students is required. Medical students are an at-risk group, with a greater incidence of anxiety^{Reference Lasheras, Gracia-García, Lipnicki, Bueno-Notivol, López-Antón and de La Cámara2} than the general population, and a higher prevalence of suicidal ideation than physicians and nurses.^{Reference Que, Shi, Liu, Gong, Sun and Mi3} The risk is further compounded by being young,^{Reference Moreno, Wykes, Galderisi, Nordentoft, Crossley and Jones1} having higher awareness of disease severity, and possessing common personality traits such as maladaptive perfectionism and difficulty adapting to disruption in routine.^{Reference Lasheras, Gracia-García, Lipnicki, Bueno-Notivol, López-Antón and de La Cámara2}

Medical students often face a sense of duty to volunteer in hospitals in times of global health emergencies such as the current pandemic, which can bring particular emotional challenges. The subsequent higher risk of transmitting COVID-19 may cause increased social isolation. Uncertainty around medical education due to cancelled exams and placements also increases stress.^{Reference Saraswathi, Saikarthik, Senthil Kumar, Srinivasinapan, Ardhanaari and Gunapriya4}

Although a recent meta-analysis showed no difference in anxiety during COVID-19 in medical students,^{Reference Lasheras, Gracia-García, Lipnicki, Bueno-Notivol, López-Antón and de La Cámara2} isolated studies worldwide have shown increased anxiety in those whose loved ones had contracted COVID-19 and who had interacted with COVID-19 patients.^{Reference Saraswathi, Saikarthik, Senthil Kumar, Srinivasinapan, Ardhanaari and Gunapriya4}

Higher levels of baseline stress and depression are negative predictors of poor mental health,^{Reference Moreno, Wykes, Galderisi, Nordentoft, Crossley and Jones1} so more research must be done to identify those especially at risk. Those with pre-existing mental health issues have reported decreased access to the usual support services during the pandemic.^{Reference Moreno, Wykes, Galderisi, Nordentoft, Crossley and Jones1} To our knowledge, there is no available literature exploring the impact of COVID-19 on medical students with pre-existing mental illness. Experiences in previous pandemics such as SARS show that long-term mental health issues such as alcohol misuse and post-traumatic stress symptoms can persist for several years in healthcare workers who have been quarantined or have worked in high-risk areas.^{Reference Wu, Liu, Fang, Fan, Fuller and Guan5}

The majority of current studies of mental health in COVID-19 have been cross-sectional, and few have focused on medical students. Longitudinal, large-scale, multi-country studies focusing on medical students of all age groups and investigating more variables, such as pre-existing mental illness, are required to identify those most at risk and the long-term effects on this population. The results of these studies could be used to improve future implementation of targeted medical student-specific mental healthcare interventions.^{Reference Moreno, Wykes, Galderisi, Nordentoft, Crossley and Jones1}