Survivor identity may help Covid survivors cope with slow recovery

Covid remains very much with us. Though the likelihood of dying from it has — for those able to access it — been mitigated by the rollout of the vaccine programme, swathes of the world's population continue to process the grief, fear, and memories of the early stages of the pandemic. 

Understanding the psychological impact that Covid has on those that nearly lost their lives to it, as well those surrounding them, remains an ongoing effort for psychological researchers. Though many in therapeutic roles expect to hear about Covid for the rest of their careers, at the moment, little is known about how best to support this growing group of survivors. 

However, new research is beginning to bring light to this issue, revealing potential psychological interventions to aid survivors' transition through slow recovery and back to everyday life. 

Using in-depth interviews, a UK-based team of scientists recently explored the experiences of illness and recovery of those admitted to critical care due to covid-19 (N=6), as well as the professionals who cared for critical care patients (N=12), and family of survivors (N=5). Conceived in the earliest days of the pandemic, these interviews took place between May and July 2020, with the team's questions probing experiences of critical care and the first three months of survivors' recoveries. 

In these conversations, participants tended to speak about three main themes. The first related to the experience of health deteriorating quickly, and the downhill journey from symptom onset to critical care. 

Like many of those watching the pandemic unfold in constant media coverage, survivors reported acute awareness and fear of what their symptoms may mean, as well as uncertainty of how to manage or treat it beyond self-isolating. When contacting emergency services, they faced some resistance due to services being overwhelmed, and were only admitted when 'at breaking point'. One 70-year-old male participant described the situation as "getting too near the knuckle, really too close for comfort" in relation to his potential mortality.

Participants reported that short, potentially final goodbyes were said in the backs of ambulances. Many relatives were left fearing for their loved ones, as well as for their own health, having made contact with Covid. Isolation compounded the difficulty coping. 

The second theme centred around facing a novel virus in a remote place. Survivors reflected on coping strategies while on the ward, including support from fellow patients, spiritual and emotional support from staff, and the use of video calling software to communicate with relatives. 

Relatives also reported appreciating video calls, noting that it helped them gain more specific information on their loved ones conditions. Difficulty communicating with the hospital, and then passing on the information they learned, was a trigger for anxiety in them. 

Hospital staff were aware of these communication difficulties, though often found it to be "emotionally exhausting" to communicate with families, if done continuously on top of their already highly increased workload. In the face of a surge in critically ill patients, a novel virus, and significant risks to their own health, many were left physically and mentally exhausted. 

Last, but certainly not least, was the theme of returning home as a survivor. Unsurprisingly, patients were keen to return home, and relatives were often shocked when they were reunified, feeling ill-prepared for the fragile condition of survivors (though hospital staff made efforts to brief them ahead of time). Participants saw recovery as slow and full of unknowns. None of the participants knew how best to do rehabilitation, which brought its own stresses. Lack of available support made this transition more difficult; follow-ups with doctors were greatly valued.

When survivors spoke about their recovery, much of the language they used was rich in words that hinted at a 'war with the virus'. Mentions of fighting, soldiering on, and determination suggested to the authors that patients were adopting a survivor identity in much the same way that has been documented in cancer patients. This comes with a lot of positives; recollections of camaraderie, new outlooks on life, and gratitude for being alive, for example. However, for some, survivors' guilt also weighs heavily.

Though recalibrating to a survivor identity is known to often aid patients' mental health, this study offers an extension to the existing definition, and suggests that it may offer a coping strategy which helps through the recovery process, rather than just upon attempts to return to a normal life. Analyses also offer hints that the process of building a survivor identity was more difficult during the pandemic, due in part to reduced contact with healthcare providers. The authors suggest that assisting with this in mind, and increasing communication between all parties, may be useful for the mental recovery of all involved. 

Due to how time consuming it is to analyse interview data, the sample size of this study is rather small; despite being standard for this method, it does somewhat limits the generalisability of its findings. Further research may be needed to expand upon the themes uncovered. For example, it's possible that those from non-British cultures, those holding other religious or cultural beliefs about mortality, or even different age groups may have different experiences. 

These retellings make it easier to appreciate the life-changing experience of dealing with severe Covid. And, perhaps most relevantly to those recovering from — or supporting those recovering from — Covid, they point to the largely positive role of developing a survivor identity. Framing recovery in this way may provide a largely accessible way to maintaining mental health, and foster determination to continue with what can be a difficult recovery process. 

Read the paper in full: https://doi.org/10.1111/nicc.12779