COVID-19 survivors struggle with nightmares, anxiety and other PTSD symptoms, research shows
TORONTO -- New evidence suggests that up to a third of those who fought COVID-19 and recovered are now battling something else — symptoms of post-traumatic stress disorder.
Although more than 800,000 people in Canada have recovered from COVID-19 infections, those who make it to the other side can be left haunted by what they have experienced.
For people like Ashley Comrie, who spent over two months in hospital with COVID-19, the aftermath can be debilitating.
“I think you're just so happy when you first get home, that […] you don't really want to examine the fact that you're not the same,” she told CTV News.
Comrie got sick in April 2020 after her husband caught COVID-19 in a Toronto grocery store and passed it to her.
She developed a fever, and lost her sense of taste and smell. But the most jarring thing for her was the feeling of disorientation that swamped her.
“I was just so confused,” she said. “I've been working like 16 to 18 hour days up until that point. And I just, I couldn't even remember my own birthday. It was such a sudden change."
She went to the hospital that month. “And I didn't get out until July,” she said.
Comrie was in the ICU, and then had to go through inpatient rehab after her ordeal.
But when she was physically well enough to return home, other problems surfaced.
“[It] started with a lot of being unable to sleep, and having this intense anxiety that I hadn't had before,” Comrie said.
When she was able to sleep, she was plagued with nightmares. A common theme was drowning — throwing her back to how she felt when she was severely ill with COVID-19.
“There's nothing like living through feeling like you're drowning in your own lungs and then sleeping through it every night after that when you're no longer in that danger,” she said.
Loud sounds caused her to startle really easily. And any reminder of her ordeal with the virus could trigger horrible flashbacks.
“I was unable to read anything about me having COVID — so any of my patient file stuff — without just sobbing,” Comrie said. “Which is not my normal at all. And I just realized it was all of the stuff was piling up.”
People are considered to have post-traumatic stress disorder when symptoms from a psychological trauma disrupt daily functioning and last for over a month.
According to a study from Italy published in JAMA Psychiatry this month, as many as one third of those who survive severe illness due to COVID-19 could experience PTSD.
The study looked at 381 patients at a single hospital in Rome, and found that patients with PTSD were more likely to be women.
It joins a growing body of evidence that some COVID-19 patients can carry emotional scars from the experience for months in the form of flashbacks, nightmares and agitation.
“This is definitely concerning,” Dr. Delfina Janiri, a psychiatrist with the Gemelli University Hospital and the lead author of the research, told CTV News.
“Post-traumatic stress disorder is characterized by alteration, not only in cognition and mood, but also in arousal,” she explained. “Hyperactivity, [nightmares] about the traumatic event, and flashbacks and avoidance of stimuli.”
The concept of PTSD first emerged after the First World War, when returning soldiers struggled with the memories of their time on the battlefield. Since then, it has been found to apply to going through other traumatic events, such as hurricanes or earthquakes.
“We found percentages that were absolutely comparable and in line with those type of collective traumatic events,” Janiri said.
This data underscores the importance of paying attention to the health of patients not just while they are in hospital, but also in “the post-COVID phase,” she said.
Recovery is all the more difficult because the pandemic is ongoing, and reminders of it are everywhere.
“You can't ever get away from that trauma, so it's everywhere, it's in the public zeitgeist, it's on TV shows, it's on the news,” Comrie said.
“On social media, it's all everyone's talking about right now. And that can be really hard because you don't ever get a break from the trauma that you're trying to recover from.”
‘I NEEDED MORE HELP’
The fear of thinking about her struggle with COVID-19 bled into other aspects of her recovery as well. She faced a lot of issues post-virus, and needed a kidney procedure. But the thought of returning to a hospital — the site of so much trauma for her — was paralyzing.
“I didn't want to go back to hospital,” Comrie said. “And then finally, when I did have to have the procedure, as the anesthesiologist was putting the mask over my face, and they were taking off my gown, I had a flashback. I thought I was in the ICU again. And that's something I'd always heard of, but I didn't really realize just how scary that moment is.
“And so that's when I realized that I was I was having a lot of PTSD symptoms and that I needed more help than what I was accessing at that point.”
Left untreated, doctors have seen post-COVID PTSD lead to depression, anxiety and substance abuse in a bid to cope with the symptoms.
Dr. Sarah Bush, a psychiatrist with Toronto Western Hospital, told CTV News that a lot of patients in Canada are struggling after recovering from COVID-19.
“We're seeing a lot of impact in terms of ability to really manage day to day tasks as simple as leaving the house, getting out of bed in the morning, impacts in terms of ability to work, to go to school, impacts in terms of relationships, and abilities to feel safe in relationships,” she said.
"I've seen a number of patients in our clinic who have full-blown PTSD.”
And family members of those who contract COVID-19 are at risk as well.
“I've seen caregivers of patients who had COVID who are actually also developing PTSD-related symptoms,” Bush said. “Worrying that their loved one in bed next to them will not wake up in the morning, will have challenges breathing at night. And so I think the scope is even greater. Not just our patients with COVID, but also loved ones who are affected. And not to mention health-care workers as well.”
There are effective treatments for PTSD, including medications and therapy, and the earlier they're started, the better the outcome.
That’s why talking about it is important, Bush believes.
“I think some people may not be aware that this is even an issue,” she said. “So recognizing that if patients are experiencing these things, that it's valid, that it's common, and to reach out for help.”
But shame and stigma can still get in the way of accessing help. Comrie is a social worker, but still felt afraid at first of putting a name to her experiences.
“One of the things that really stopped me from accessing the mental health resources, even as a professional, was the worry that I would then be kind of tarnished with that brush, and that all of my physical symptoms would be put down to just, ‘she’s got anxiety’, or, ‘she's having a hard time coping with COVID’,” Comrie said.
“And I realized that if that's how I feel, as a professional, and that's what I was worried about, imagine all of the people who are even more scared to come forward and to talk about it.”
After she reached out to get help, she was able to have access to medication that helps with her nerves and her nightmares.
“And that was such a huge relief to start having those,” she said. “It lets me do the work I need to do to recover, and to kind of get those coping skills back in place so that I can move forward with my life.”
She’s hoping that others who are battling trauma in silence will find the strength to ask for help too — and that the issue of PTSD among COVID-19 survivors will become better understood.
“I think when we talk about people with long haul symptoms and getting health benefits, I think being able to access specific trauma care and trauma psychological supports would be would be a huge benefit,” she said.
Canadians who have had COVID-19 and want to help contribute to research into the aftermath of the virus can enroll in the Canadian COVID-19 Prospective Cohort Study (CANCOV study) at the study’s website.
The researchers are following 2,000 COVID-positive patients and 500 caregivers for a year. Patients who are struggling with their mental health will be referred directly to Dr. Bush from the CANCOV study.
Another national resource which offers free mental health support is Wellness Together Canada.