Ananya NS had the most awkward meeting with her mother. Despite being in adjacent neighbourhoods, the two had not seen each other for almost a month since the day Ananya tested COVID positive. “I thought the day we finally meet would be one filled with joy and laughter,” says the HR professional.
It was not. It was a quick rendezvous filled with awkward pauses and little conversation, with emotion barely visible from behind the depths of the masks that the two wore. “I did not even hug her. My 14-day quarantine was over and the doctors said I was fine. But what if....” She leaves unsaid the fact that both she and her mother wondered whether the infection lingered.
The strict quarantine period, sans human touch, can be tough enough. But what is even more difficult, for many like Ananya, is what happens after those two weeks.
“It’s the next month that is even tougher,” affirms Shreya Nagarajan Singh, a Chennai-based arts development consultant. “As much as COVID affects you physically, it also takes a toll on your mental health.”
Shreya tested positive in June along with five family members, all living in the same house. “Suddenly, what we were seeing as news was at our doorstep.” Doctors gave them a choice post the quarantine period to re-test, and Shreya opted for it only because she wanted “peace of mind, and closure. Even after testing negative, I was hesitant to meet anyone. I felt relieved, but I became indifferent to things and happenings around me,” says Shreya, who even chose to show her negative certificate to her household helps and staff members to assuage their fears, if any.
Double burden
The bad news is that there is still stigma for those who have recovered from the virus. The good news is that it is rapidly declining with many more people getting it.
“Stigma adds a burden on those who have already suffered the consequences of the illness and those of its residual symptoms such as lung fibrosis and difficulty in breathing long after recovery,” says Dr Rajesh Parikh, Director of Medical Research and Hon. Neuropsychiatrist at Jaslok Hospital and Research C entre, Mumbai. This stigma begins right at your doorstep — from the time the Corporation authorities put up a ‘Corona Hotspot’ poster and a notice detailing the number of positive people in the household. In many places, tin sheets were also erected near the entrance of these residences. While the intention behind this exercise is to prevent people from going out during the quarantine period, this leads to labelling and gossip. “It is akin to the medieval policy of marking houses of people with plague,” adds Dr Parikh. “Many symptomatic patients are hesitant to get tested due to the marking of their houses and subsequent ostracisation by their housing societies.”
Dr Karthik Deivanayagam, District Mental Health Programme Officer, has been fighting the stigma at Pudukottai. Along with his team of 10 counsellors, he has made more than 19,000 calls in the past few months, providing counselling for people who have tested positive and their family members.
“The strategy we follow is called LEED, which means ‘listen without judgement, elicit symptoms (that includes enquiries about sleep pattern), educate about general symptoms and de-escalate the crisis situation (helping people handle it),” explains Dr Deivanayagam. “While some asymptomatic patients are comfortable after their quarantine period, some, especially those with mild symptoms, fear venturing out. There is some hesitation initially, fearing re-infection. We educate them, but also advise them against non-essential travel.”
- How likely is a person who has just recovered from COVID-19 to develop infections again?
- When a person is infected with COVID-19, they develop antibodies to the virus. The antibodies provide protection for around a period of two months post infection. Post this two-month period, the antibody levels come down, making one equally susceptible to the virus as the general population. Healthy eating and sleeping habits give us a greater chance of fighting the infection.
- Is there any protocol suggested for COVID-positive people after their quarantine and isolation period?
- As set by the Ministry of Health and Family Welfare, three weeks of strict home quarantine is mandatory. After that, one can step out wearing a good mask, maintaining social distancing and practising frequent hand washing.
- Is a second test after the quarantine period necessary and why?
- As per the guidelines from Centers for Disease Control and Prevention, US, and the Ministry of Health & Family Welfare, India, a repeat COVID test is not mandatory because taking it could result in a false positive report. This is due to the dead viral RNA which is present in a person who has recovered, for around three months post recovery.
- Source: Dr K Rajkumar, Consultant Pulmonologist, Fortis Malar Hospital
Testing times
Other than these fears, people who have recovered from the virus also have apprehensions about how the outside world would perceive them. This anxiety is greater among people who reside in areas that have multiple households located near each other, and in apartments and gated communities. That the person does not need to go in for a re-test to prove they are negative makes matters complicated.
Media professional Karthick Krishna’s main worry was the uncertainty that prevailed after his quarantine period. “People bombarded me with so much information. Some said that COVID might come back any time, while others said that even if the body generates antibodies, it came with an expiry date. Even doctors did not seem to have clarity; there was no uniform opinion,” he says.
So, he opted for an antibody test, an indication of the body developing certain proteins to fight off and clear out the virus. Doctors agree that while a favourable antibody test proves that the person has been exposed to the virus, the person may still be a carrier. Also information on the Mayo Clinic website says that “...there's a lack of evidence on whether having antibodies means you’re protected against reinfection with COVID-19.”
Dr Deivanayagam’s team regularly circulates pamphlets and videos in Tamil to educate people about how to fight stigma associated with COVID-19. One of those videos has this message: “Words are powerful... don’t call someone who has tested positive a ‘COVID case’.”
Karthick says that “It will also help if there is uniformity among medical practitioners about exact protocols after, because there are contradictory opinions.” That, and open communication within housing societies about protocols being followed by residents (how waste of the household will be disposed, for instance), support given by neighbours, and the announcement when the family is out of quarantine will all help dispel the stigma.
