After recovery, Covid-19 survivors battle anxiety, paranoia, depressionUpdated: Aug 01, 2020 23:26 IST
Psychiatrists across the city say survivors of Covid-19, particularly those who had severe cases, may suffer mental health issues while rehabilitating, after recovering from the infection.
Anita Agarwal, 42, tested positive for Covid-19 on June 29, and was admitted to Seven Hills Hospitals where she was kept on a ventilator for five days and spent another week in the intensive care unit (ICU). She was discharged on July 12 and has been since battling severe anxiety. She is afraid of spreading the infection even though she is now Covid-free.
“Even after 14 days in home quarantine after she was released from the hospital, she refused to step out of her room. She wouldn’t allow our son to go near her. She was panicking continuously in fear,” said Anil Agarwal, the patient’s husband.
City psychiatrists say many Covid survivors are experiencing mental health issues, including post-intensive care syndrome (PICS), anxiety, sleep difficulties, depression and delirium. “Covid-19 survivors often develop weakness and fatigue with muscle weakness. This adds to their anxiety levels. Many are showing signs of obsessive compulsive disorder (OCD), where they constantly clean their hands with sanitiser. They even refuse to remove masks at home,” said Dr Avinash De Sousa, a psychiatrist and editor of the Indian Journal of Mental Health.
Ashita Bose, 55, had come to Mumbai to visit her son in June when she was diagnosed with Covid-19. She spent 13 days at the isolation ward at Hinduhridaysamrat Balasaheb Thackeray (HBT) Trauma Care Hospital in Jogeshwari, and was discharged on July 2.
“For seven years, my mother was treated for depression in Kolkata and had recovered gradually. Since her release from hospital, she has once again developed symptoms. She can’t sleep at night and has almost stopped eating. She gets scared even if anyone rings the doorbell,” said Bose’s son, Satadru who works for an IT firm.
Owing to the infectious nature of Covid-19, medical staffers working in isolation wards have to wear personal protective equipment (PPE) all the time, which can make patients feel isolated and yearn for human contact.
“The relationship between doctors and patients relies on trust. But when a patient can’t see the face of their treating physicians, it does sour ties. At the same time, they don’t find their close ones beside them. This can lead to delirium, a confused state of mind post-discharge,” said Dr Gautam Bhansali, consultant physician at Bombay Hospital and in-charge of managing Covid-19 beds in private hospitals.
Patients who were intubated often experience flashbacks or feelings of paranoia. “These patients have seen people die before them in hospitals, which is not an easy experience to forget. Many recovered patients keep checking their temperature in panic,” said Dr De Sousa.
Recovered patients may also face stigma and discrimination from others. “Some neighbours are welcoming while others stigmatise Covid-19 survivors. In fact, often recovered medicos also get humiliated when they return after being discharged. This instigates the sensitive minds of survivors, who are already fragile after fighting against the virus,” said Dr Milan Balakrishnan, secretary of Bombay Psychiatric Society.
A report on psychiatric and neuropsychiatric presentations associated with severe coronavirus infections, which studied patients from China, Canada, France, Hong Kong, Saudi Arabia, South Korea, Japan, Singapore, the UK, and the USA was published in the medical journal Lancet in May. It stated that 65% of discharged patients complained of delirium. “Clinicians must be aware of the possibility of depression, anxiety, fatigue, post-traumatic stress disorder, and rarer neuropsychiatric syndromes in the aftermath,” reads the study in its conclusion.
Another study, by Henk Stam from Erasmus University Medical Center, Netherlands, has also advised continuing medical attention for Covid-19 survivors. “The notion that patients surviving intensive care and mechanical ventilation for several weeks can be discharged home without further medical attention is a dangerous illusion,” reads Stam’s study, which was published in the Journal of Rehabilitation Medicine in April.
What to do after recovery?
1. Keep busy and follow a regular schedule
2. Don’t oversleep or sleep less than eight hours
3. Be physically active
4. Practice meditation
5. Don’t keep discussing Covid-19 with family members
6. In case of anxiety, try to breathe slowly
7. When feeling angry, count backward from 100 to 1
8. If you keep feeling sad persistently for days, consult a psychiatrist
9. Avoid tobacco, alcohol and other drugs
10. Avoid interaction with people who stigmatise or lack knowledge of the virus
11. Maintain a diary or blog
12. Listen to music.
(Source: Guidelines issued by Union ministry of health)