Vaccinated but won't go out? The rise of Covid anxiety syndrome

Renee Watson, a healthy 43-year-old, has received both her coronavirus jabs already. Meanwhile, the UK Covid infection rate has dwindled and the size of our vaccinated population has swelled. Lockdown is easing, pavement cafes and beer gardens are teeming, and life is inching back to something more like normality.

But not so much for Watson, nor those like her who may be suffering – to a greater or lesser degree – from what has been termed Covid anxiety syndrome. Watson, an entrepreneur who was once “quite a risk-taker” feels far happier playing it safe now.

“I thought I’d spring back and return to being keen to go to restaurants and shopping,” says the mother-of-two from Oxfordshire. “But I’ve really not wanted to at all. I’m still ordering everything online. It’s not like me, it’s strange: I’m normally a sociable person and like going to festivals but it feels like too much risk at the moment.”

Watson’s response to the easing of lockdown is not all that uncommon, say psychologists. It is not yet known how many people will be affected by residual Covid anxiety after vaccination, but it’s feared a significant minority will struggle to readjust, especially as increased unlocking allows for large groups and big, crowded events to take place again.

While many of us are enjoying the chance to socialise and travel normally, some are clinging fearfully to the safety behaviours enforced upon us during the pandemic. What was once a rational response to danger has become a “maladaptive” response as the danger recedes.

It was Marcantonio Spada, professor of addictive behaviours and mental health at London South Bank University, and Ana Nikčević, a psychology professor at Kingston University, who identified and named the phenomenon of Covid-19 anxiety syndrome.

Early in the pandemic, they hypothesised there would be a number of coping behaviours people would adopt in relation to the perceived threat of Covid, which, while initially helpful, may over time become problematic, especially during the process of reintegration. These behaviours – which may include not touching things, avoiding using public transport, worrying, and monitoring our environment and other people for the presence of the virus – could potentially keep us “stuck”, they suggested.

“In people who use these coping strategies consistently, excessively, daily, with the view they will keep them safe, [it] may inadvertently ‘lock’ them into Covid-19-related fear and distress and hinder their reintegration and return to normal,” say the researchers.

Data they have collected in both the US and UK bears out their theory. Their findings suggest that those at a greater risk from the virus are more prone to Covid anxiety syndrome. But Spada believes as many as one in five people could struggle with the return to normality, and that women under 40 may be particularly affected, since other research has shown this demographic to be worst hit by the pandemic psychologically.

For Watson, who studied immunology, it’s the uncertainty surrounding the virus that troubles her. “I’m a massive advocate of vaccines, but Covid has been so unpredictable, it hasn’t behaved like we’d expect a virus of this kind,” she says. “So although I think vaccination will definitely give me a level of protection, I don’t think we yet know fully what that protection will look like, and with the emergence of lots of variants we don’t know how well the current vaccine will protect us against emerging strains. So I don’t necessarily want to put myself at risk. The children going back to school feels like enough of a risk.”

Thoughts like these are echoed in online messaging forums. “The virus hasn’t gone away,” wrote one Gransnet user last month. “Even if like me you have had both vaccinations, there is no guarantee a variant won’t turn up and require more and different vaccines. I don’t intend to go daft now, just because someone says we can.” Another replied: “I’ve got used to living the way I do now and will find it difficult to live normally again.”

Richard, a 53-year-old from north London who works in property, says his worries centre around the failure of others to stick to the rules - and the fact the vaccine does not guarantee 100 per cent protection. “I had my vaccination 12 days ago, but I could still get Covid,” he says. “Even if I wasn’t [severely] ill I could still have side effects or long Covid. I do feel nervous. You feel a bit ‘bah humbug’ if you ask your friends how many people are going to be there when you visit, but I want to put myself at minimal risk.”

Experts say cognitive behavioural therapy (CBT) can be helpful to “actively break those negative cycles of thought and action,” as Dr Victoria Salem, an endocrinologist and researcher at Imperial College London, puts it.

Salem, who has been working on a study of the syndrome with Spada, has seen evidence of it in her own practice among patients of various ages. “We are seeing it even in people who have been fully vaccinated and that’s worrying because pretty soon we’ll be expecting people to go back to much more normal routines,” she says.

Owen O’Kane, a former NHS clinical lead for mental health and author of Ten Times Happier, predicts an increase in anxiety disorders as we emerge from lockdown, not only centering around the fear of Covid itself but also broader worries about reintegration. “I’m seeing people who weren’t socially anxious now struggling with lockdowns easing and having to socially interact. Also an increase in people finding public spaces claustrophobic or too busy.”

Fear of missing out has, for some, become fear of going out. O’Kane, a psychotherapist, suggests a proportion of the population will suffer from what he calls “post-pandemic stress disorder” and says: “We’re not going to see the true impact until the pandemic is completely over.”

Indeed, the true scale of the problem is likely to be larger than what is evident now. “The trauma aspect of this has been understated,” he says. “Many people, to a degree, have experienced some trauma. We’ve been locked away for a year by and large, all our routines have changed, we’ve been watching horrific headlines every day and are constantly engulfed in a culture of fear. Unquestionably that’s going to traumatise people.”

Clinicians can help by encouraging people to “step out of fear mode” and start making some gradual behavioural changes, he says. “You’d encourage people to drop the safety behaviours and say ‘this is keeping you more anxious.’”

Prof Nikčević is broadly optimistic. “We believe the majority of people will be able to release these coping strategies [eventually],” she says. “We need to gradually encourage [them]...so people can, over time, release these mental controls.”

For Watson, it will be a matter of watching how things play out. “I don’t think rushing to get back to being in densely populated areas at the moment is going to do any of us any favours,” she says. “I’m just going to take it easy and see what happens.”