Infection control measures during the COVID-19 pandemic triggered extensive changes affecting societies and private lives worldwide. Facing a new disease caused fear and distress for patients with COVID-like symptoms.Reference Hoste, Wanat and Gobat 1 Few studies have explored the fears and worries among the directly affected, but not severely ill patients. In this study, we aimed to explore concerns and feeling of safety among quarantined and non-hospitalized COVID-19 patients.
Methods
We conducted a qualitative study of free text answers from participants of an anonymous online survey recruiting COVID-19-positive adults in home isolation and adults in quarantine (March 2020-June 2021). Participants were asked a range of questions regarding their own and others’ health, symptoms, and about their concerns and worries related to different aspects of the pandemic (Table 1).Reference Fossum, Brænd and Heltveit-Olsen 2 Six hundred and ninety-eight participants (Table 1) answered one or more of the open-ended questions, resulting in 590 free-text answers from the COVID-19 group and 603 free-text answers from the quarantine group (average length of answer: 144 characters, range 7-1912).
Table 1. Questions and characteristics of participants
We analyzed the free-text answers using thematic analysis.Reference Braun and Clarke 3 We created codes within each category based on the recurring themes and discussed the initial codes within the team. Each answer was tagged with the matching codes, then grouped and reviewed to find patterns of meaning. Three themes with subthemes were created capturing similar aspects of the data and essence of the themes.
Results
We identified 3 main themes: (1) Fear of the unknown, (2) Views on personal care and public health measures, and (3) Concern for the future of a country in crisis (Figure 1).
Figure 1. Overview of identified themes and subthemes with selected quotes.
Fear of the Unknown
Many participants were concerned about their own health, as well as the health of friends and family. Well into the pandemic, participants also started worrying about possible long-term consequences of COVID-19.
Concerns about personal, immediate, and long-term risks
Participants in the COVID-19 group conveyed fear of clinical deterioration, dyspnea, hospitalization, or death. Many participants stated that they belonged to a risk group, and they were particularly worried. Immediate concerns for their own health were less commonly expressed by those in quarantine. A prolonged course of the disease seemed to increase concerns about long-term impact on own health and function. Concerns were centered around whether they would make a full recovery, or whether they would ever be able to return to work.
Worrying about others
Many participants expressed concerns about the health of family members, especially elderly family members and others at high risk for serious disease. Many expressed a fear of infecting others. Health care professionals participating in the survey expressed worries about the health of their patients as well as their colleagues. They were particularly worried about transmitting the virus to their patients, especially frail residents in nursing homes.
Views on Personal Care and Public Health Measures
Some participants reported to be satisfied with the health care system, while others expressed that more health care follow-ups, testing, vaccination, and information would be reassuring.
Varying patient experiences
The patients had different experiences of follow-up by the primary care services. Some were confident that they had received adequate health care, but some called for a closer follow-up by their GP, addressing both the need for easy access and availability as well as follow-ups initiated by their GP or other primary health care personnel.
Enhancing feeling of safety through testing and preventive measures
It was a common opinion in the quarantine group that early testing would increase their feeling of safety. Even though vaccines were perceived as “the solution” for the pandemic, the participants highlighted that several conditions had to be met: the vaccine had to be safe, and given to prioritized groups, such as health care professionals and people with higher risk of severe illness, before it became available for everyone.
Opinions about regulations and how people comply
While some participants were worried that the regulations were not strict enough and that people did not comply, others were satisfied with the authorities’ decisions. Some participants stated that they would feel safer if infection control measures and penalties for breaking the rules were stricter. Participants also had opinions about the implementation of regulations and stated that adequate, updated, and understandable information would increase their feeling of safety.
Concern for the Future of a Country in Crisis
There were several concerns regarding the hospital capacity during the study period, alongside concerns for the long-term impact of lockdown for vulnerable groups. Other worries were repercussions for the economy and increased unemployment, both in society and for individuals.
Health care service capacity
Participants in both groups expressed fear of a breakdown of the health care system, especially exceeding the national hospital patient capacity. Several were worried about COVID-19 affecting many health care workers simultaneously, resulting in inadequate care capacity for themselves.
Consequences of social isolation
There was a general worry about own or others’ psychosocial health. They expressed concerns about the consequences of lockdown, restrictions, and isolation on mental health and solitude. Some were also worried about how the situation and the infection control measures would affect children and youth. Some participants shared that they were lonely.
Impact on employment and economy
Many participants were worried about their own economic and employment situation. People laid off from work were concerned about the duration of the leave, and some were concerned about losing their job. Concerns about the economy and society’s situation both nationally and internationally were frequently highlighted.
Discussion
We found that participants’ feelings revolved around health-related and societal concerns.
Participants in our study voiced concerns regarding the infection itself alongside possible long-term health-related consequences, consistent with other studies.Reference Amberger, Müller and Lemke 4 , Reference Soomägi, Meister and Vorobjov 5 , Reference Mertens, Engelhard and Novacek 6
Several European studies have shown high levels of trust in the health care and the pandemic response.Reference Amberger, Müller and Lemke 4 , Reference Helsingen, Refsum and Gjøstein 7 , Reference Tishelman, Hultin-Rosenberg and Hadders 8 Our data were collected during a long period with variable disease burden and infection control measures, and participants asked for adequate, updated, and understandable information to increase their feeling of safety.
Facing an unknown disease causes health-related fear and a need for information and follow-up. General practitioners and primary health care services have a unique opportunity to meet individual needs for information and attention to increase the feeling of safety.
Acknowledgements
We wish to thank all participants for contributing and Norwegian municipalities with their municipal chief medical officers for informing about study recruitment.
Author contribution
All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Malene Svaland, Anja Maria Brænd, and Guro Haugen Fossum. The first draft of the manuscript was written by Malene Svaland, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
Competing interests
The authors declare none.
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