The Covid-19 Symptoms No One Talks About
In early July, Dr. Inbar Cohen was diagnosed with Covid-19 in a small city in the southern part of Israel. Her first thought was her patients. Dr. Cohen, a psychologist working in a private clinic, met with dozens of patients in the days before her test. All appointments were held according to regulations, meaning strict social distancing and wearing masks at all times. She was, at that time, pre-symptomatic. Her symptoms appeared days after she was tested. To keep confidentiality, Dr. Cohen didn’t give the Health Ministry the names of her patients. And so, there she found herself, on the heels of a positive test, mentally preparing for the difficult phone calls ahead.
“The first 24 hours were spent calling patients and friends, telling them I’m positive and that they need to go into isolation. It was terrible,” she recalls. “A day before I was diagnosed, I took a car ride with a good friend who’s pregnant. It was a short trip and unfortunately, we weren’t 100% following guidelines. My biggest fear was that I infected her, I couldn’t sleep at night. It is an awful feeling. Luckily, I didn’t infect anyone, but even to cause people to go into isolation, lose work days and money, it’s a terrible feeling of guilt.”
Coughs, fever, loss of taste and smell — these are all familiar Covid-19 symptoms. They are being researched, measured, and carefully tested by experts all over the world. Lately, however, another set of symptoms are starting to get noticed: mental ailments caused by the disease.
“It was harder than coughing, fever, or isolation. Everyone who had to go into isolation because of me was constantly in my mind.”
These symptoms are not caused by a biological reaction of our brain to the virus but are indirect consequences of Covid-19. Similar to the physical symptoms, in some cases long-term effects persist. I have spoken to dozens of Covid-19 survivors, and many share the same difficult mental challenges wrought by the disease. Specifically: shame, anxiety, and guilt. Some I spoke with asked to remain anonymous — a testament not only to how common this phenomenon is, but also to its intensity.
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“I was diagnosed two weeks ago,” Nick (not his actual name) told me. “At first it felt like a common cold, three days later I lost my sense of smell and was tested.” Nick then informed family members who had been in contact with him; they informed people who were in contact with them. The cycles grew, and with each new layer, Nick’s anxiety also grew. “Many of my family members had to go into isolation because of me. We had to cancel my grandfather’s 70th birthday party. It made me feel absolutely terrible.”
All this time, Nick himself was in isolation, sitting in an empty room, unable to take his mind off how he affected the people closest to him. “Later on, I found out I infected my girlfriend as well. Her father is in a high-risk group and I was completely anxious at the thought that he might be sick because of me. I kept thinking about him dying and couldn’t bear it.”
“For me, it was the hardest symptom of the disease,” said Doron Bainhorn, who has since recovered. “It was harder than coughing, fever, or isolation. Everyone who had to go into isolation because of me was constantly in my mind. I kept calling them — asking how they were. I couldn’t sleep at night until they all got negative test results. The thought of me infecting my elderly in-laws didn’t let go. The pressure was killing me. I was completely terrified.”
This year has been difficult for everyone. The financial uncertainty, the fear of the pandemic, the media coverage, and the constant talk about it have all made the Covid-19 pandemic ripe for stress and anxiety. Even people who are fortunate enough to be healthy and employed might, according to experts, feel guilty for their circumstances.
In addition to all those feelings, Covid-19 survivors carry some extra-heavy baggage. In a study done in Milan, Italy, 402 Covid-19 patients were surveyed after being discharged from the hospital. Of these, 28% showed symptoms of PTSD, 31% suffered from depression, 40% had insomnia, and 42% had anxiety. Overall, 56% of participants manifested at least one mental disorder following the disease.
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Similar patterns are emerging around the world. “I had totally healthy people sitting in front of me, with no mental background,” Dr. Guy Choshen, head of the post-Covid-19 department in Tel Aviv Sourasky Medical Center reported. “People once full of spirit that, after finishing treatment, suffered a deep depression. They lost all joy of life, lost any motivation, they sat in front of me and couldn’t stop crying.”
Research of these phenomena is still fresh. These are less discussed issues compared to the physical ones. However, when speaking to experts, it is very clear that Covid-19 brings about unprecedented mental health challenges. An article about the role of social workers treating Covid-19 patients in Israel concludes: “While social work services in Israeli hospitals are experienced in complex crises, including traumas and terror attacks, the Covid-19 pandemic created an unfamiliar reality under restricting conditions.”
“There is a stigma. People are afraid to be socially tagged as if they didn’t follow guidelines, or weren’t careful enough. There’s an element of shame to being sick.”
“We had women, mothers to small children who, while being treated at the hospital were constantly busy doing grocery shopping online for their families. They had an emotional difficulty — not being able to fully act as a parent, and were trying to make up for that,” reports Dr. Sigal Gat-Lazer, a psychologist in charge of Covid-19-patient treatment in Sheba Medical Center Tel Aviv. “The experience itself, being hospitalized for Covid-19, is full of mental difficulties. The patient is isolated from his family, sometimes from his careers too. It’s a very emotionally draining experience.”
One of the major issues people infected with Covid-19 have to deal with is how society sees and treats them after being diagnosed. Dr. Oren Tene, head of the psychiatric ward at Ichilov Hospital Tel Aviv explains, “There is a stigma. People are afraid to be socially tagged as if they didn’t follow guidelines, or weren’t careful enough. There’s an element of shame to being sick.”
And indeed, Shawn (not his actual name), who was infected in early July by a co-worker, told me, “a good friend of mine was very mad at me after hearing I was sick. We met a few days before my test. He had to postpone proposing to his girlfriend after being told he needs to go into isolation. He hasn’t spoken to me since.” Facing an angry friend was not the only source of Shawn’s anxiety. Dealing with people’s Covid-19 curiosities was very stressful as well. “I was treated like a lab rat by people I know. Dozens of people, literally dozens, people I haven’t spoken to in years, called me and started interrogating me about the disease. People are curious, people are afraid, but they fail to understand you are ill and have to fight this virus. These calls just made me feel so stressed.”
Andy (not his actual name) told me that after getting better, and over a month after his initial diagnosis, people were still afraid to come near him. “It just made me feel depressed,” he said.
In countries that have experienced a high number of deaths, there are Covid-19 survivors who also report suffering what is known as “survivor’s guilt.” Christopher Marshall from Texas, for example, told CNN: “The hardest part, for me, initially, is seeing how many people died from Covid-19. It was like ‘why did I live and everybody else died?’”
Some experts insist the mental health fallout from Covid-19 infection is much more complex (and potentially more harmful) when it comes to children and teens. “I have seen more and more positive-Covid-19 kids get ghosted by other kids once others realize they had it,” said Roseann Capanna-Hodge, EdD, a licensed professional counselor and certified integrative medicine mental health provider in Connecticut. “In particular, more and more teens are concealing their exposure for fear of being shut out of their quarantine-related, ever-decreasing circle of friends.”
Dr. Cohen, an expert in rehabilitative psychology who usually treats patients with chronic diseases, witnessed the same issue in her family. “My niece was found positive and went through a very complex time with her friends. Some parents from her school even called her mother to complain and pass judgment.”
In an effort to help her niece (and others), Dr. Cohen got involved and, along with a local childrens’ mental health center, printed pamphlets explaining that “those who are tested first are not necessarily those who were infected first.” “Children and teens with Covid-19 are facing grave mental issues potentially harming them for a very long term. Now, when schools are reopening, and the disease is still spreading, the danger is very apparent,” Dr. Cohen warns. While the potential physical symptoms of Covid-19 are less serious for kids than for adults, the severity of the mental impact should be taken into account. Children infected with Covid-19 could face peer pressure, harassment, and abuse from others in school. A vital way to tackle this is proper education about the behavior of the virus and transmission.
So what should we do?
According to experts, we must change the dialogue to increase understanding that getting infected with a disease is not a person’s fault. “We hardly encounter a viral disease with such a mental and social effect on patients. In recent years I can only think of HIV,” noted Dr. Choshen.
We should talk openly about the psychological implications of a Covid-19 infection — just as we talk about physical ones. We need to make it clear to Covid-19 survivors that they are not alone. We need to watch after them and ourselves. We need to remember that behind the statistics and numbers, there are human beings. A cough will pass, the sense of smell will return, but a mental scar might last forever.