Scientists have expressed concern that residual anxiety over coronavirus may have led some people to develop compulsive hygiene habits that could prevent them from reintegrating into the outside world, even though Covid hospitalisations and deaths in the UK are coming down.
The concept of “Covid anxiety syndrome” was first theorised by professors last year, when Ana Nikčević, of Kingston University, and Marcantonio Spada, at London South Bank University, noticed people were developing a particular set of traits in response to Covid.
The anxiety syndrome is characterised by compulsively checking for symptoms of Covid, avoidance of public places, and obsessive cleaning, a pattern of “maladaptive behaviours” adopted when the pandemic started. Now researchers have raised the alarm that the obsessive worrying and threat avoidance, including being unwilling to take public transport or bleaching your home for hours, will not subside easily, even as Covid is controlled.
“Fear is normal. You and I are supposed to fear the virus because it’s dangerous. The difference, however, in terms of developing a psychopathological response is whether you end up behaving in … overly safe ways that lock you into the fear,” said Spada. “My expectation is we’re going to have … chunks of the population that are avoiding re-engagement and constantly worrying about the virus for months to come, whether they are vaccinated or not.”
Researchers used self-reported data in June 2020 from about 500 US participants, and found that the syndrome predicted levels of generalised anxiety and depression above and beyond factors such as personality traits and general health anxiety.
Now, the same researchers, along with Ian Albery, professor of psychology at London South Bank University, have gathered preliminary data from self-reported surveys of nearly 300 adults in the UK in February 2021, suggesting Covid anxiety syndrome was an independent predictor of generalised anxiety and depression during the pandemic.
In the study, which is still to be peer reviewed, researchers presented participants with two sets of words – some Covid-related and some non-Covid related – finding that the attention tended to be biased towards the Covid-related stimuli.
Factors such as the participant’s age, whether they had been vaccinated, recently tested positive for Covid, or lost a loved one to Covid, were expected to affect the attention paid to Covid-related stimuli but, surprisingly, that hypothesis was not borne out by the data. In fact, higher Covid anxiety syndrome scores were significantly correlated with the size of this “attentional bias”.
People in the study were mostly white and university educated; about 22% considered themselves to be at high risk of Covid and about a fifth said they had received at least one vaccine dose.
Dr Victoria Salem, an endocrinologist and senior research clinical fellow at Imperial College London, who is working on a separate study with Spada, said she had seen some evidence of the syndrome in her practice, particularly in patients with high-risk factors for developing severe Covid. “I don’t think we know how big this syndrome is yet … we’re only going to start to find that out as lockdown eases,” she said. “I think that Covid syndrome is not going to be a huge problem, but it will affect a significant minority and we need to be mindful of it.”
Dr Tim Nicholson, a clinical lecturer at the institute of psychiatry, psychology and neuroscience at King’s College London, who is not involved in Spada’s work, said the concept of Covid anxiety syndrome was interesting but needed to be ratified with further research. He said the self-reported survey approach made it difficult to ascertain whether a participant was predisposed to such behaviour owing to undiagnosed conditions, such as obsessive-compulsive disorder. OCD can be triggered by specific events and can manifest as anxiety, he said: “You need semi-structured, long interviews to pick up on the fact.”
Further research into Covid anxiety syndrome continues. Spada and his colleague are using a sample of 6,000 adults across China, Europe and the US and collaborating with researchers from Imperial College to assess the prevalence and impact of the syndrome.
Dr Giovanni Mansueto, of the University of Florence, is investigating the syndrome in Italy and says he has seen some evidence of it in his clinical practice. It was important not only to identify the syndrome but to find ways to treat and prevent it, he said, “otherwise, this could be a big problem”.