When  Nontuthuzelo Made was admitted to the intensive care unit after testing positive for COVID-19, she thought it was just a matter of days before she’d go home. But the 42-year-old was actually fighting for her life.

“Initially, I didn’t realise how sick I was even though they were giving me 90% oxygen. I even asked the attending specialist how long she thought I’d stay in the hospital, and she said to me: ‘I can’t tell you right now. We’re just trying to keep you alive,” explained Made. 

Made was diagnosed with COVID Pneumonia in June last year – during the height of the third wave, which was driven by the Delta variant – the deadliest variant yet. 

She had not experienced any symptoms before her test but decided to do it as a precaution after her granddaughter (9) tested positive.

Staying strong

“On the 17th of June, I felt so tired and sick. When I did a home oxygen test, my levels were on 50, so I decided to go to the ER. They didn’t have a bed available, and I had to be transferred to another hospital. They ran tests and confirmed that I had pneumonia.” 

“I just didn’t stop praying and tried to keep a positive mindset believing that I would make it. A lot of people died in the ICU. Nurses would come and close curtains, and then you just knew that someone had died. I knew I could not let my anxiety overwhelm me,” said Made, a Johannesburg-based tax lawyer.

Made lost both her parents while she was in ICU.

“I haven’t truly dealt with my grief because, at the time, I just needed to get better to deal with it, and if I focused on other things, it would delay me getting better,” said Made.

Overwhelmed by anxiety

 She recalled her experiences while sharing a ward with other COVID-19 patients.

“One of the patients had given up, took off his oxygen mask, and refused medical care. He was really old and believed that COVID-19 was going to kill him. They even brought his son in to come and speak to him. The next morning, I woke up, and he was gone,” Made explained.

“Another lady, who was too scared to speak up and ask for help from the nurses, had anxiety and would have panic attacks throughout the day. One night, she had an anxiety attack and a mini heart attack and passed away.” 

Made said that she also struggled with anxiety while she was hospitalised.

The mental after effects

Zamo Mbele, Clinical Psychologist and Board Member of the South African Depression and Anxiety Group (SADAG), explained how stress and anxiety could lead to post-traumatic stress disorder (PTSD).

“PTSD is a mental condition that follows after very traumatic events. The COVID-19 pandemic can potentially increase a person’s stress and anxiety because of the fear of infection and the uncertainty of how the outbreak will affect them socially and economically. This stress and anxiety can be incredibly traumatic and, if not dealt with, can lead to PTSD,” explained Mbele.

“My kids have been sleeping with me because that’s how scary it was for them. They think I am somehow going to disappear. One night I went to the bathroom, and my daughter (7) woke up and couldn’t find me. She didn’t see I was in the bathroom. She started screaming and crying, asking where I am. It showed how scared she was that she might lose me,” said Made.

Trying to cope

Made also has a five-year-old son. She described her children expressing conflicted feelings about their mom coming home because she had been in hospital for such a long time. She decided to take them to consult with a play therapist to help them along with these emotions.

A 2020 review, published by Lancet, showed the results of a study looking into the ‘Psychological impact of COVID-19′, which revealed a long-lasting impact of the pandemic on mental health. These included PTSD, low mood, irritability, insomnia, anxiety, anger, and depression.

The review reveals that the fear of getting infected with the virus, inadequate access to information, loss, and stigma, were some of the most common causes of stress during quarantine. In one study, quarantine periods greater than ten days were associated with worse mental health outcomes, including placing patients at a higher risk of PTSD.

Mbele said that children and teenagers are vulnerable to experiencing trauma from pandemics in the future.

Mbele added that people who have lost a loved one, tested positive or recovered from the virus but still experience stigma, can also be vulnerable to experiencing PTSD.

 “It’s a traumatic experience. But at that moment, I can’t tell you that I was traumatised. My biggest worry at that moment is going home to my kids,” Made added.

Exposure to stressors

Professor Dan Stein, from the University of Cape Town’S Department of Psychiatry and Mental Health, noted that much scientific work had been done on the neurobiology of exposure to stressors. 

“The stress response seems to involve specific brain circuitry and particular brain chemistry. Different people respond to the same stressor in different ways.  People who subjectively feel less traumatised may be quicker to bounce back;  a trait known as resilience,” he said.

Living with long COVID

“My blood pressure is now higher than it used to be before COVID-19. It has been over a year since I had the virus, and have been on medication. I’m still on some of that medication today. It’s still going to be a long journey for me because my lungs were really damaged. I’ve been trying to get them to be a bit stronger, but I know they’re scarred for life,” said Made.

She only stopped taking steroids last month and sometimes still uses oxygen when her levels are low.

Made continued: “My oxygen levels are still not where they should be. When I get the flu, my oxygen levels go down. Over the past week, I have been suffering from sinus, so my lungs get clogged, and I have to use oxygen. There are still days where I feel weak and have to use the oxygen because I have trouble breathing.”

She has recently started pulmonary rehab therapy to help her lungs. She has also started exercising again while ensuring she keeps track of her heart rate when taking a walk.

According to a recent study, comprehensive pulmonary rehab after COVID-19 infection produces improvement in outcomes such as walking distance, even in hospitalized patients with respiratory failure requiring oxygen therapy and mechanical ventilation. https://t.co/UC7uJv45VT

— Continued Respiratory Therapy (@RTCEUs) May 25, 2022

“A part of me has accepted this as a part of my life. There was a point where I was in a rush – I wanted to know when I was going to be off oxygen and when I was going to get better; I wanted exact dates from doctors. But I realised that healing doesn’t work that way. There is an improvement. It just takes a while sometimes,” she said.

Feel-good activities 

Stein emphasised the resilience that human beings have and their ability to use tools to help them cope and heal after traumatic events. 

“Pandemics and other stressors are not new for humankind. We have faced them previously, and we will have to do so again in the future.  The majority of people face traumatic stressors at some stage of their lives, and the majority can bounce back.  Humans have remarkable resilience,” he said. 

He added that good social support in the aftermath of exposure to a stressor is a predictor of good mental health outcomes. 

“My feel-good thing to do is to go out and eat good food. I’m rediscovering fine dining restaurants in Johannesburg and going to a spar. I’m still working from home and spending time with my kids, friends, and family. I have been making an effort to do these things,” said Made. 

Mbele noted three important things to remember during one’s COVID-19 journey:

• “Acknowledge the situation” –  Not minimising it or making it bigger than it is. So that you don’t have that ‘shock moment’, which he said, is an ingredient for trauma.
• “Increase your self-awareness” – Being aware of your thoughts, your emotions, and your behaviour and what they are telling you. So that when you need rest or recreation, you can do that.
• “Care, connect, and communicate” – This starts with taking care of yourself and others. Connect with people you care about as much as possible. Making certain that communication channels are always open in social ways is healthy. – Health-e News