Diagnosed with COVID: Now What?
How to manage the anxiety of the diagnosis.
Posted December 21, 2020
You’re under quarantine at home for COVID. I’ve been there. Last spring, at the end of a full day of telehealth counseling, I noticed on the webcam that my cheeks were flushed. It was the first sign that I was developing symptoms of COVID. And I was anxious.
I went for a run – normally an activity that would reduce stress – and my lungs felt tight. I came home feeling more anxious than when I’d set out. As a Licensed Mental Health Counselor who treats anxiety and the mental health impact of physical illness, I had a toolbox full of strategies for exactly this kind of situation. Over the six weeks of my illness (and many months of recovery), I had lots of opportunities to try them out… when I wasn’t sleeping.
There is a wide range of COVID symptoms you may experience. Especially at the beginning, when you don't know what symptoms you will develop, the uncertainty may contribute to the anxiety.
As someone who has survived COVID and as a mental health professional, here are the strategies I would recommend for coping with the stress of a COVID diagnosis:
First, take a deep breath
This sounds cliché, but taking a deep breath is always a good first step. As best you can, take a nice easy breath in and exhale slowly. When we exhale slowly, we send a message to the brain that it’s okay for the body to calm down and decrease the internal stress response (Zaccaro, Piarulli, Laurino et al, 2018).
If you know that you are positive for COVID and are having symptoms, it can help to feel prepared. When I was sick, I had a “go-bag” ready in case I needed to go to the hospital. I had discussed with a family member what measures I would want taken in case I needed ICU-level care or ventilation. This may sound extreme and may for some people increase anxiety. To that, I would say: complete the level of preparation that fits your needs at that time. Some of these things (like discussing healthcare wishes for life support with a loved one) may be good to talk about regardless of the pandemic.
To be prepared, if you are able, it can help to prepare for someone to cover for you at work, establish childcare or pet care, accept help for food delivery, and have a healthcare proxy in place.
Differentiate between physical and mental symptoms
It can be really easy to mistake anxiety for a physical symptom, or vice versa. There’s a reason for this – our physical and mental systems are not totally separate from one another! And our physical and mental health interact with one another. That being said, it can be really helpful to know yourself well enough to know what might be a red flag for worsening physical health versus anxiety.
How do we tell the difference?
Consider what your normal response to stress is. Some people may feel nauseous, others may feel hot or like their heart is racing. Make a mental list of how you normally respond to stressors. Then, consider whether there is an overlap between what you are feeling physically in the moment and if it is the same feeling as your stress response. Finally, use data to check; this could mean taking your pulse or checking your heart rate, or if you have other tools, you can also use those to check your physical vital signs (such as pulse oximetry, blood pressure, temperature, etc).
When I felt short of breath while sick, I would use a pulse oximeter to check if it was anxiety or a physical symptom. This can also give you good information to share with your doctor and to know when you might need a higher level of care (such as if your pulse oxygen level drops). Check with your doctor to see what they would recommend regarding when to go to the hospital.
Note: If you have a history of OCD or are experiencing intense obsessive thoughts, engaging in this kind of checklist may not be productive. Differentiating between physical and mental health symptoms may need more outside assistance from your doctor and psychotherapist.
Take care of yourself physically
Follow your physician’s advice for how to take care of yourself while you are sick, and follow CDC guidelines for quarantining. If there are things you find comforting that are healthy, now is the time for those, too. A favorite blanket or soup, your softest pair of sweatpants… things that bring you comfort will help the anxiety as well as encouraging physical rest. If you have unhealthy coping strategies currently (such as substance use), you may consider connecting with appropriate supportive resources (such as Alcoholics Anonymous, or your doctor or therapist) to manage.
… to your doctor, your family, your friends, and your co-workers. Zoom to see a person face-to-face, even if you’re sick of screen time. Or have a neighbor or friend drop off an item for you and greet them from behind a window. These things are not the same as seeing people in real life, and may make you feel sad as well as connected; but it’s important to have human contact and feel connected outside of the walls of your home. For those who live alone, this connection is especially important. Those who live with others in the home may have a unique set of challenges, too, in staying separate from other family members. No quarantine situation is easy.
Part of staying connected means sharing with your support system what you need. When I was sick, friends or family would text when headed to the store to ask what items they could pick up. It was my job to tell them what I needed. There were also days I was too tired for even a window visit or FaceTime with my friends and family. Communicating when you need rest, or setting a boundary when you are too tired to visit, is important too.
Let go of what you can’t control
Once you are prepared, you can focus on the current situation. By managing your symptoms, taking care of yourself, and staying connected, you are controlling the things you can control. You can choose your actions and manage your thought-paths. And then there are the things you don’t get to control. The course of your illness, how other people react, the resources available in your community… these things are outside your control. If it doesn’t serve you to think about it, let it go. How do you let it go, you may wonder? You can distract yourself with other thoughts or activities; visualize a stream of thoughts flowing away from you; or disengage from the news outlet that is perpetuating your thoughts.
Be intentional about your language
This one is not as vital when you’ve just been diagnosed, but it can help to set you up for success as you move forward. The language you use – whether in conversation with others or for your internal self-talk – determines your narrative and how you make sense of your experience. As you talk about your diagnosis, it’s important to acknowledge and validate the bad stuff (like physical symptoms and negative emotions). It’s also possible to consider the good stuff; and by that, I don’t mean silver linings that make it all okay. It’s not all okay. You have COVID. By good stuff, I mean considering areas of enjoyment, meaning, or gratitude, despite being ill. This could mean appreciating a good nap when you have been up coughing the night before, or FaceTiming with a family member. You can both validate the negative and consider the positive as you move through your illness.
Going forward, keeping these things in mind will help build your resilience in managing COVID.
Zaccaro A, Piarulli A, Laurino M, et al. (2018). How breath-control can change your life: A systematic review on psycho-physiological correlates of slow breathing. Frontiers in Human Neuroscience. 12, 353. doi:10.3389/fnhum.2018.00353