The term ‘Long COVID’ first originated in online communities. The people who coined the term had been diagnosed with COVID-19 at some point in 2020, and were experiencing symptoms months later well into the end of the first half of 2021 as well. Some of them felt dismissed by their doctors, workplaces, families and friends and their behaviour was termed as overreacting to a ‘mild’ illness and stretching it too far. However, there is increasing evidence by research that long COVID is indeed a distinct syndrome, which can be caused by a dysfunctional immune inflammatory response.
Most people do make a full recovery from COVID-19. The standard recovery time from COVID-19 is now estimated. About two-third of non-hospitalized patients are symptom-free by 14 days from the onset of the infection, and 90% are symptom-free by 21 days. According to a September 2020 article in The Lancet, those with long COVID may experience memory problems, trouble concentrating, brain fog and dramatic mood changes.
Mental health remains affected for a longer duration
Despite vaccines and a decrease in disease prevalence, some people experience what scientists call COVID-19 anxiety syndrome. Its symptoms mimic those of other mental health conditions, including anxiety, post-traumatic stress disorder (PTSD), and obsessive-compulsive disorder (OCD).
Statistics recorded by the Centers for Disease Control and Prevention (CDC) between June 24–30, 2020, show that around 40% of adults in the U.S. reported at least one adverse mental health concern, including anxiety, depression, substance use, and suicidal ideation.
Profs Ana Nikcevic from Kingston University of London and Marcantonio Spada from London South Bank University have developed the concept of COVID-19 anxiety syndrome. In a paper in Psychiatry Research in October 2020, they outline the characteristics of COVID-19 anxiety syndrome, naming avoidance, compulsive symptom-checking, worrying, and threat monitoring (combined).
This syndrome manifests as the inability to leave the house because of COVID-19 fears, frequent checking for symptoms despite not being in a high-risk scenario, and avoiding social situations or people.
Many psychiatric disorders result from a combination of the effects of the immune disturbance caused by the virus, the brain toxicity of the virus and the associated psychological trauma.
The psychological symptoms include:
• Stress from enduring a potentially fatal disease
• Fear of illness
• Uncertainty about the future
• Stigma of having the illness
• Traumatic memories of severe illness and social isolation
Living through a severe illness like COVID-19 can affect a person’s mental health in several ways. Some people who survive may experience psychological trauma, which is a response to extreme stress. Trauma may cause anxiety, PTSD, depression, or disassociation, which refers to a feeling of disconnection from a person’s thoughts, feelings, or experiences.
What does Research Say
During previous severe coronavirus outbreaks, 15% of survivors suffered from depression and 33% from post-traumatic stress disorder (PTSD). Several studies have indicated that while the focus of healthcare in pandemics is mainly on physical symptoms, the effects of COVID-19 upon mental health may be equally important. People with pre-existing mental health conditions or marginalized in any way in the society are more likely to go through the psychosocial impact of such a long-term ongoing disaster.
There is little data on psychiatric ill-health in adults recovering from COVID-19, especially those who exhibit some or a few symptoms weeks to months after their initial infection.
Psychiatric ill-health at follow-up was associated with persistent physical symptoms such as breathlessness and myalgia. This can be bidirectional: ongoing physical symptoms can impact mental health adversely and conversely increased mental health burden may manifest as physical symptoms.
Recovery in Long COVID is multi-faceted mental health screening to support patients holistically is often advised now. Adults with “Long COVID” are likely to be referred to healthcare professionals specializing in respiratory or rehabilitation medicine.
Fatigue and Depression
A common symptom of COVID-19 survivors is extreme fatigue. Fatigue is extremely common after viral infections such as COVID-19 and normally it settles after 2 or 3 weeks. However, in some people it can linger for weeks or months.
The reasons why people feel fatigued after a COVID infection are- a continuing response to the COVID virus even though the infection has got better and the after- effect of a serious illness. Fatigue caused by pneumonia can last up to 6 months to resolve.
Fatigue is also a common symptom of depression. When someone is depressed, they may feel slow, sluggish, and physically spent after even the smallest tasks. What further complicates things is that some strategies that might help to relieve depression—like exercise and connecting to others are not easy or convenient to do during Covid recovery.
However, if fatigue may be a symptom of depression, there are small but positive steps one can take each day to escape the cloud of depression and improve how they feel.
Addressing sleep problems
Fatigue feels much worse if your sleep pattern is also disturbed. Sleep is the next thing affected adversely by COVID-19. Sleep is needed to support our immune system, energy levels, and mood, but the quality of our sleep is as crucial as its quantity. While several sleep related issues can be triggered by long COVID, they can also exacerbate other symptoms.
Poor sleep impacts how well anyone feels during the day, which in turn impacts how well you’re able to sleep at night. So, this becomes a vicious cycle of sorts. Before you know it, you’re trapped in a cycle of poor sleep and increased daytime fatigue. Some people with long COVID struggle to get to sleep at night or wake up feeling unrefreshed. Many others oversleep for more than nine or ten hours at a time. This can also lead to daytime sluggishness, severe lack of energy, and problems in concentration.
Memory and Concentration
Most people who have had COVID will recover with no long-term impact on their memory and concentration. Some people experience mild difficulties that don’t last for long. Some may find it difficult to hold information required to make decisions, they may struggle to recall something that has happened, or forget to take medication on time, this kind of brain fog is common in people undergoing Long Covid. Anxiety, worry, intrusive thoughts and images can all affect concentration as has been in the case of most survivors.
What can be done
Recovering from an illness like COVID can be an uphill journey, especially when it includes mental health recovery too. You can talk with your doctor to identify what kind of support is needed and how it is available. Your doctor can discuss referral to an occupational therapist or psychologist for cognitive rehabilitation if needed. If you are being followed up by the hospital, do let your health professional know that you are experiencing these mental health problems.
An important part of managing the impact of memory and thinking problems is managing the daily activities, in particular applying the 3 P’s – Pacing, Planning and Prioritizing.
There are ways that you can safeguard your mental wellbeing:
Pace: Do not overexert yourself or push yourself too hard. Go at the pace that is allowed by your body and mind. Do not compare your recovery with someone else’s and do not let someone else try to pressure you into doing things that you cannot manage.
Stay connected: Human connection is imperative to any kind of mentally healthy situation. Try to make time to stay in touch with the people who matter to you. Talk to people you trust about your feelings and experiences. There are several online groups also that offer the chance to get support from people who have had similar experiences. One such group and page on Facebook is known as Long Covid Support.
Spend time in nature: If you are able to safely venture outdoors, connecting with nature can provide enormous benefits for your mental health. If you can’t travel far, you can also just look at easier options like caring for some houseplants.
Try relaxation techniques or mindfulness meditation: There are several resources online that offer guided relaxation exercises that can help ease your body and mind.
Long-term mental health support to COVID-19 survivors, their families and caregivers can help all these people regain routine life and improve their quality of life as well.
Anyone in psychosocial distress can use the following resources:
KIRAN – 1800 599 0019 (24×7) — 13 Indian languages
NIMHANS – 080 – 4611 0007 (24×7) — Multiple languages
ICall – 9152987821 (Monday-Saturday 10:00 a.m. to 7:00 p.m.)
Pallium India – +91 759 405 2605 (Monday-Saturday 9:00 a.m. to 6:30 p.m.) — Eight Indian languages
CoHope Helpline – +91 98185 40802 (10:00 a.m. to 10:00 p.m.)