Recovering from Covid-19: 'I can't get the images out of my head'

In India, relentlessly rising case numbers are causing another emergency – serious mental health problems among Covid-19 patients, writes the BBC’s Vikas Pandey.

Rajesh Tiwari, 42, has developed a serious phobia for any screen which is bigger than his mobile phone. He thinks big screens, especially TV sets and computer monitors, are giant creatures who can attack him.

Mr Tiwari began experiencing hallucinations after a long stay in an intensive care unit. In early June he had tested positive for coronavirus and he was admitted to a private hospital as his condition worsened. Five days later he was put on a ventilator.

Mr Tiwari recovered after nearly three weeks in the hospital. But he soon realised that his recovery was not complete.

“I am better now because I sought treatment, but the first few weeks after my discharge from the hospital were very difficult,” he said in an interview.

Mr Tiwari’s family was elated to bring him home, but after a while they realised that everything was not right with him. One day, he screamed at the TV set and attempted to smash it. The family had to stop watching TV and nobody was allowed to use laptops at home. Mr Tiwari said he was struggling to forget the images of monitors constantly beeping and flashing numbers in the ICU.

Amit Sharma and his family had a similar experience. Mr Sharma, 49, spent 18 days in the ICU and saw people die every day. Young and old, men and women – all kinds of Covid-19 patients were dying around him.

“One day, two patients around me died and their bodies were there for several hours,” he said. “I just can’t get those images out of my head. I still fear Covid might kill me.”

Mr Sharma is struggling to forget the traumatic experience. He became very quiet at home after his recovery, his uncle said. “And whenever he talked, it was always about the patients he had seen dying in the Covid ward,” he said.

Many recovering coronavirus patients in India are experiencing mental health distress, said Dr Vasant Mundra, a senior psychiatrist at Mumbai’s PD Hinduja hospital, particularly those who were on a ventilator or spent a long time in an ICU.

“The brain is already exhausted by the time you get to the hospital. And then the mayhem of the Covid wards overwhelms your senses,” Dr Mundra said.

Covid-19 patients are not allowed to meet family and they don’t get to see the faces of their doctors and nurses, who are wearing protective masks at all times. That was disrupting patients’ ability to form trust with their doctor, said Dr A Fathahudeen, the head of the critical care department at Ernakulam Medical College in southern India, in turn disrupting their recovery.

Recovery from coronavirus can be a lonely experience, and doctors say when a patient experiences life threatening events as well the chance of post traumatic stress drastically increases. Symptoms include depression, anxiety, flashbacks, and hallucinations, Dr Mundra said.

And yet, mental health issues associated with coronavirus patients are not getting enough attention, doctors warn. There are few mentions in government press conferences or in the media. Prominent mental health expert Dr Soumitra Pathare said he was not surprised.

“What you are seeing during the pandemic is a reflection of India’s poor investment in mental health facilities,” he said.

India lacks facilities and experts to treat mental health patients, and the situation is worse in smaller towns where people are often not able even to recognise symptoms.

Much of India’s mental health treatment infrastructure is concentrated in cities, leaving 80%-90% of the population with little or no access to mental health specialists, said Dr Pathare – adding that the gap is becoming clearer during the pandemic. If the government failed to recognise and address the problem soon India would be facing a “mental health pandemic”, he said.

A good starting point would be making people more aware of symptoms, Dr Pathare said. And the next step would be to improve mental health facilities, especially in smaller towns. “I am aware it won’t happen overnight, but we have to start somewhere,” he said.

Kamna Chhibber, the head of the mental health department at Fortis hospital in Delhi, said she had witnessed a sharp rise in the number of people reaching out for help during the pandemic. A long lockdown, uncertainty over the future, and the need to be constantly alert had made people more anxious, and more people were coming to the hospital to talk generally about anxiety and depression, Dr Chhibber said.

The problem was becoming “more serious with each passing day”, she said.

Doctors are now urging for mental health to be addressed as part of post-Covid treatment protocols. Each hospital needed to do something, said Dr Fathahudeen, or “we may save people from Covid but lose them to depression and PTSD”.

The names of the patients have been changed to protect their identities.