Since Covid-19 flattened him in Southern California in late June, Jarrod Castillo fears that every tickle in his throat and every twinge of pain in his limbs means he’s getting sick again. On Long Island, the thought of enduring the illness a second time fills Sadie Nagamootoo with such dread, she gets sick to her stomach. In upstate New York, where Martha Barrera suffered for more than two months with crushing respiratory symptoms, the idea of reinfection gives her such panic, she’s unable to enter a supermarket.
Anxiety about the coronavirus is widespread, and not just among older adults and those with weakened immune systems. But that fear is especially strong among people who have already experienced the severe symptoms of Covid-19, and are desperate to avoid getting reinfected. Those worries were inflamed this week by news of three confirmed cases of reinfection in Hong Kong, Belgium, and the Netherlands. While the Hong Kong man’s second illness was much milder than the first — something many scientists think will likely be the case for most people who get infected again — we still know very little about the likelihood and risks of reinfection.
That leaves recovered Covid-19 patients on edge. Nagamootoo, a 44-year-old personal trainer in Valley Stream, N.Y., was sickened in late March, and while she has tested negative for the virus three times since, she battles ongoing asthma and fatigue. When she reads reports about reinfection in the news and on message boards, her mind reenvisions her most desperately ill self. “I remember myself at my worst and I get nauseous,” she said. “I believe if that were to ever happen again, I may not be so lucky.”
Psychologist Mary Moffit, an associate professor at Oregon Health and Science University in Portland, said the news about reinfections raises questions about the duration of immunity and increases uncertainty about the future. But she urged caution about drawing the most fearful conclusion.
“This may not represent the ‘worst-case scenario,’ although that may be the initial reaction of patients traumatized by this virus,” Moffit told STAT. “Focusing on what we can control today, attending to what we need to improve our well-being here and now, is the most effective strategy to cope with future uncertainty.”
That is a message Abhishek Jaywant, a psychologist and assistant professor of neuropsychology at Weill Cornell Medicine in New York, tries to impart to the dozens of survivors he treats at the hospital’s Covid rehabilitation unit.
“Part of patients’ anxiety is rooted in the very real fact that we’re still learning so much about this disease,” Jaywant told STAT. At times, he said, worry about reinfection surfaces among his patients, which mirrors their anxieties in general about Covid-19, an illness that is unpredictable.
“We just can’t provide answers for what life is going to look like long term,” Jaywant said. “Adding to that we have the profound alteration of diminished social connections that we know are a buffer against anxiety and depression.”
In his work with patients, Jaywant tries to be reassuring while acknowledging their fears. Many have ongoing breathing difficulties, which can fuel anxiety, and in turn, aggravate their shortness of breath and rapid heart rate. “It creates a vicious cycle,” he said. As treatment, Jaywant, his fellow psychologists, and respiratory therapists use a range of mindfulness, cognitive therapy, and breathing techniques that can slow heart rate and quell fears.
Castillo, a 24-year-old recent journalism school graduate in Cerritos, Calif., who was sickened along with his parents and brother, uses cognitive behavioral therapy to try to redirect his worried thoughts. “I’ve recovered, but I’m even more afraid of going out today than I was in March,” he said.
His mind races through a series of worries when he goes out. He is anxious that people he sees might carry the virus and reinfect him — or that he might harbor vestiges of the illness, and unknowingly sicken them. He checks and double-checks his mask, wondering if he’s wearing it right, or if he should put on a second one. When his allergies make his nose run, or when he wakes up sore from the previous day’s weight-lifting session, he sometimes thinks the worst. “Do I have Covid again?” he wonders. “What did I do that could potentially cause this?”
Barrera, a so-called long-haul survivor, shares his fears. A bank manager in Maybrook, N.Y., Barrera, 51, who tested positive for the illness for 64 days, is now well enough to have returned to work. Covid left her with a range of new conditions, including diabetes, hair loss, and ongoing shortness of breath. It has also left its mark on her psyche.
In June, she mustered the courage to go to the supermarket for the first time since she became infected in mid-March. She got out of her car wearing gloves, a mask, and sunglasses for extra protection. Her heart raced as she entered the same store where she has bought groceries for years — and that was before she took a look around. “I went in and saw how different everything was since early March, with plexiglass, masks, arrows everywhere,” she said. “I felt like I couldn’t breathe and walked out.”
Before the coronavirus, Barrera was laid-back; she took everything in stride. Now, it’s not only going to the grocery store that makes her panic. Her fears of getting reinfected sometimes overtake her, and she finds herself tearful at the thought of struggling through the illness again. “Sometimes I just burst out crying. I’m so scared I’m going to get it again, so scared my son’s going to get it, so scared something might happen to my parents. I think about how I wasn’t sure I had the breath to make it to the next day and my heart starts racing.”
Jarrod’s mother, Leticia Castillo, a 57-year-old ICU nurse, is also frightened about the virus again striking her family members, including her husband, Nestor, a licensed psychiatric worker, and her other son, James, 29, an airport security consultant. In July, Leticia, who has diabetes and a vitamin D deficiency, suffered the worst symptoms in her family. She had two weeks of a 104-degree fever, and has ongoing fatigue and shortness of breath.
She is especially afraid that the renewed exposure she will undoubtedly experience now that she is back at work will bring on a reinfection. “I’m so anxious every time I go out, my heart starts beating fast and I have even more trouble breathing,” she said. “I’ve developed something like a phobia.”
Her fear is compounded by the Covid-19 deaths of her patients, as well as a 37-year-old colleague who left behind a young son and her husband, who is now in the ICU battling the virus. Another close colleague has been hospitalized with the illness since April.
“Being an ICU nurse, I’ve seen so many different illnesses,” Leticia said. “Often you cannot do anything, but usually there is at least hope. Now, once someone goes into the ICU, there’s little hope they’ll make it out.”
Confusing news reports and medical studies do not help allay her fears. “I read the literature, and that they still don’t know how to handle it makes me feel really sad. America is the most powerful country in the world, and still we don’t have any answers?” To calm her nerves, she turns to gardening, 1980s love songs, and prayer.
“I pray and pray, but I’m so sad about it all,” she said.
Many survivors who fear reinfection are also grappling with effects of post-traumatic stress disorder, which can cause feelings of intense fear and helplessness.
“There’s not a lot of things more traumatizing than not being able to breathe,” James Rachal, a psychiatrist at Atrium Behavioral Health in Charlotte, N.C., told STAT. Rachal, who served as a psychiatrist in the United States Air Force, has long studied the causes and treatments of PTSD.
“If an adverse event happens once, it’s not nearly as likely to traumatize you than something that is ongoing,” Rachal said. But the breadth of the virus’s consequences — the rising death rate, the devastating economic effects, the necessity to remain socially distant — are a relentless reminder of everything that is still wrong. “We’re in August now, with the days getting shorter, and no signs of letting up,” he said. “Fears of what will happen in winter, when we will be more isolated, are growing.”
For Jarrod Castillo, recovering emotionally from Covid-19 is ongoing. He keeps busy with freelance writing about sports, uses a meditation app, and in bi-monthly appointments with his therapist, is learning how to prevent his fears from taking over. He tells himself that there are just three known reinfections out of more than 24 million reported Covid-19 cases worldwide.
“I check myself, and decide if what I’m thinking about is actually worth spending time on,” he said, “or is it just a thought that pops into my head? I’m learning that lots of thoughts are just thoughts, and if I stay focused, they leave.”
“It might be trite to say,” he said, “but it’s a process.”