COVID-19, Physical Illness, and Depression

It’s no wonder the Disaster Distress Hotline in the U.S. has seen a 338% increase in crisis calls from February 2020 to March 2020.

Yet as a Nurse and a Therapist, I never imagined that deep into April, I’d be sitting at my desk in my Seattle artloft, gazing out the windows that look out over Elliot Bay and the stadiums, and see roads empty of people. An occasional pigeon flies by, the Olympic mountains shout their glorious presence, and all the humans of this city are under a Stay Home Order by Governor Jay Inslee.

More than 17 million Americans have filed for unemployment benefits in the past four weeks. Over 23,000 Americans have died from complications of COVID-19. Children and young adults have had their educations interrupted, their graduations to higher education still promised, yet the immediate future seems difficult to predict as we anticipate a recession. Healthcare workers in some areas are scrambling for appropriate PPE (Personal Protective Equipment) so they can do their jobs with less risk of becoming ill themselves. And the correlations between disasters, financial strain, and a rise in domestic violence calls to authorities are proving to be true as well.

Could it be worse?

Chronic Illness and COVID-19: A Disaster Within a Disaster

Yes, it can be worse. And for many of us, the dangers have been lurking everywhere for longer than the coronavirus pandemic has been in existence in the U.S.

Those who have compromised lung function (i.e. asthma, COPD), are immunocompromised (cancer, HIV/AIDs, malnutrition, some rare genetic disorders), or are otherwise more susceptible to infection (i.e. you get colds, flus, pneumonia easily), are people who have been warned to stay away from public spaces and take extra precautions during the COVID-19 pandemic.

These people have been asked to take more extreme measures than the rest of the public. For example, in the early phase of the arrival of Patient Zero (the first known case of COVID-19 in the U.S.), one of my health team members got my attention by emphatically stating, “You absolutely cannot afford to get sick, do you understand? Do whatever it takes to keep yourself away from the public, starting now.”

Although I already have theoretical and practical training in dealing with infectious diseases, I admit that I left the doctor’s office shaken. I was supposed to schedule another follow-up appointment, but we cancelled it, understanding that there would likely be no point of putting it on the calendar unless it was absolutely necessary.

I began to think along the lines of what this novel coronavirus does to the bodies of those who don’t have the recovery path of the 80% who experience moderate to severe flu-like symptoms but recover over the course of two weeks:

  • You experience shortness of breath and respiratory distress that is absolutely frightening
  • You are separated from your loved ones, taken to hospital surrounded by people who look like astronauts or Peeps with plastic shields
  • You may be intubated and aware of that intubation (before being put under to tolerate being placed on a ventilator), which is uncomfortable and also frightening
  • You may be placed into a temporary coma
  • You may or may not have recollection of procedures, surgeries, medications, or other heroic acts done to you to keep you alive

So on the one hand, it’s very likely that those who experience more complex and complicated illness and recovery from COVID-19 could also become depressed in the short term. And it’s possible that that depressed feeling from what you’ve just been through can lift as your body returns to more and more normal functioning, such as being able to breathe on your own, get out of bed, and leave the hospital.

And, it is also possible that depressed feelings around being ill can linger long after the body has recovered from a primary illness.

As we learn more about this coronavirus, recovery from long-term effects of COVID-19 suggest that many people who survive their battle with this disease will still be feeling the effects of it for one to two years, in the form of secondary organ failures, scarred lung tissues, disability, and chronic depression.

From this point forward, your life has changed due to the trauma of care, the disruption to your life, and the road to recovery afterwards. It’s the kind of recovery path that can wipe out your finances, even with good healthcare insurance, because the cost of recovery goes beyond the billable event.

Speaking as one who lives with an incurable autoimmune disease and a genetic kidney disorder, I can say I experientially understand what a fast and tremendous change, foisted upon someone who was otherwise healthy, can do to your life.

Some of the trouble begins, however, when you realize you’ve survived something like this, but you still feel terrible. You get told you’re one of the “lucky ones,” and behind a grimaced smile, you’re wondering”

…what if I can’t find work again? What if my body never feels normal again? What if I feel depressed and anxious for a long time?

It’s a crisis, a disaster within a disaster. Even if the body heals, the mind might take much longer to pick up the pieces and try to move on. Depending on how you as an individual responds to the trauma you just underwent, you might be feeling grief, sadness, a lack of energy or motivation to return to more pleasurable things, anger, denial, or even, a feeling of nothingness. Meh. Blah.

Post-COVID-19 Depression: A Need for Support

There is a strange relief when you find out you’re feelings are not abnormal, and you’re not alone.

While most of us would never wish another human being to have to face the terror and pain involved with physical illness, we gravitate towards those who have shared experiences with our own. Support groups are a good example of this. So are Social Media groups that gather people with a similar interest or experience. To be a fly on the wall with a group where every member has been struck by lightning, yet lived. Cancer support groups, alcoholics in recovery, victims of domestic violence — all kinds of groups for all kinds of experiences.

I do think that post-COVID19, there will be support groups formed that gather individuals together to help process what happened to them, beyond the facts and figures, beyond the statistics and politics.

We will create safe spaces for people to process their fear, anger, sadness, and uncertainties about what comes next.

We will encourage people to talk about feelings of depression and anxiety as they come to grips with what may be a longer, more drawn out “normal” regarding the way they respond to everyday events.

We will be trying to meet real, human needs, even though others make light of their milder cases of COVID-19. We will meet those with complex recovery issues with compassion and understanding.

Update: as of 08.01.2020 I’ll be assisting with closed debriefing groups among healthcare and healthcare related workers processing trauma, exhaustion, and racism experienced during the pandemic response. I believe that while those interactions will be confidential, what I will learn from the process of helping will be transferable to my work as a therapist in the greater community.

By Imei Hsu

Imei Hsu is a mental health counselor, active retired RN, AIP Coach and PN1-NC, writer, triathlete and arts promoter in the Seattle area and through online services. With 30+ years in healthcare (22+ years in mental health), Imei has a commitment to helping people discover insight into their health, relationships, and connecting. She is the owner of Seattle Direct Counseling and the blog, a presenter and speaker on a variety of psychological topics, and a positive force on the Internet. She launched her personal project, My Allergy Advocate, in 2018. Imei is a two-time Ironman Finisher (Mont-Tremblant 2016, Ironman Canada 2018); she also finished her first ultramarathon in 2017 and has gone on to race the 100K distance while preparing for 100 Mile trail races and a backyard ultra. You can find her running everywhere and eating all the thingz, watching movies, camping under the stars, and cooking real food.

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