Long COVID and mental health - helping loved ones

Literature describes long COVID as a range of symptoms that can last weeks or months after first being infected, or can appear weeks after infection.

It can happen to anyone who's had the virus, even if the illness was mild or they had no symptoms. People with long COVID report experiencing different combinations of the following symptoms:

• Tiredness or fatigue
• Difficulty thinking or concentrating ("brain fog")
• Headache
• Loss of smell or taste
• Dizziness while standing
• Heart palpitations
• Chest pains
• Difficulty breathing or shortness of breath
• Cough
• Joint or muscle pain
• Depression or anxiety
• Symptoms that get worse after physical or mental activities

According to a report published in The Lancet, almost one in five COVID-19 patients develop a mental health condition such as depression, anxiety or dementia within three months of diagnosis. "There's no doubt that there's a link between COVID-19 and mental health," explains counselling psychologist, Dr Robyn Rosin. "As a mental health worker, I've observed increasing numbers of people who have survived COVID-19 who have not only suffered physically, but their mental health has been affected too, with many of them experiencing problems long after their physical symptoms have disappeared. When it comes to long COVID", she adds, "Emerging science is showing that there's a huge impact on mental health too. Many patients say living with long COVID is like being on a roller coaster in the dark, unsure of what's around the next corner, which can be extremely worrying. As a result, you need to reset your self-expectations depending on your physical ability - almost like what happens when you break a leg. You have to give the bone time to heal before you can run on it and even once it's healed, you then need to run with caution for a while."

Mental health symptoms of long COVID

Dr Rosin explains that long COVID patients are developing a whole range of symptoms that are not only common in patients who have been hospitalised, but in those who had very mild cases of COVID-19 too. These include:

• Anxiety (characterised by dry mouth, sweaty palms, shaking, feeling butterflies in the tummy, feelings of nausea, dizziness, and shortness of breath)
• Depression
• Insomnia
• Fatigue
• Confusion
• Memory and concentration difficulties

Cassey Chambers, Operations Director at The South African Depression and Anxiety Group (SADAG), says they are receiving more and more calls from people who have had COVID-19 and are now struggling with mental health symptoms long after their diagnosis. "Many people don't realise the mental health impact of COVID-19 and often don't prioritise their mental health or seek help until it starts to really impact their daily functioning and relationships. The process of testing, having to isolate, and being hospitalised all have an impact on mental health and can add to your anxiety, trauma, depression and stress".

The frustration of 'COVID fog'

Long COVID patients are also experiencing cognitive and neurological impairment - which is now being referred to as 'COVID fog' - in response to lingering symptoms, says Dr Rosin. "This manifests in the form of nausea, dizziness, headaches, confusion and nerve and body pain, all of which have a severe impact on your ability to function in work-related or daily activities".

This can also lead to great frustration for patients who have expectations of being the same person they were prior to contracting the virus.

Many COVID-19 survivors also run the risk of developing post-traumatic stress disorder (PTSD). Symptoms of PTSD include:

• Flashbacks
• Nightmares
• Replaying the event in your mind
• Hypervigilance (easily startled or constant symptom checking)
• Depressed mood
• Emotional bluntness (feeling numb)
• Feelings of hopelessness and helplessness
• Difficulties with memory and concentration.

Helping your loved ones deal with the effects of long COVID

As frustrating as it is for the long COVID patient, family members may also become frustrated with loved ones no longer being able to fulfil the roles they played before their COVID-19 diagnosis as well as their own feelings of powerlessness about their inability to make things better. "However, there are many ways that you can help', says Dr Rosin. "Because, as with any traumatic experience, this is a time when they could really benefit from the support of the people around them - their family, colleagues and friends."

She offers the following general guidelines:

• Do not stigmatise. Many COVID-19 survivors describe being stigmatised and feeling that people are afraid of them because they might still be contagious.
• Don't go on a witch hunt. Nobody is to blame so please avoid trying to find the 'culprit' who made them ill.
• Be patient. Keep in mind that your loved one could take many months to fully recover.
• Verbalise. Ask them what they need from you.
• Provide words of encouragement when things are hard for them and validation when they've passed a recovery milestone.

Practical tips for you to consider

Dr Rosin and Cassey suggest the following practical tips to help support a long COVID patient:

• Make sure that any lingering physical symptoms are not overlooked and simply written off as emotional or psychological. Make sure they check in regularly with their treating doctor.
• Help them to keep track of their physical healing and to set realistic expectations for themselves. A diary could be extremely useful here.
• Organise a good support team and encourage your patient to keep them updated on both their progress and their challenges. Talking really does help!
• Encourage your loved one to be kind to themselves and to try not to expect too much too soon: "It will take time to get back to being who you were before COVID-19".
• Avoid saying things such as "snap out of it" or "just think positively". Acknowledge that it may be hard for them, that "it's OK not to be OK", and that they don't have to do it on their own.
• Encourage them to join a support group with other people who have gone through similar situations. SADAG has several online COVID-19 and mental health support groups available.
• Learn as much as you can about self-help tips for depression and anxiety at www.sadag.org and share those resources with your loved one. Learning and empowering yourself and the patient will make a huge difference.
• Rope in the assistance of a mental health professional - this journey cannot be travelled alone!