Difficulty breathing, the loss of taste and smell, overall weakness: Those are the physical symptoms of COVID-19 infections that have been widely reported over a year into the coronavirus pandemic. Caroline, a doctor from Cologne, Germany, was aware of the risks that the virus posed, as well. But she told DW that she worried more about the elderly people close to her and others for whom the illness would likely take a more severe acute course.

"I thought: 'I'm young, I don't have any preconditions, I'm athletic ― if I get it, it probably won't be that bad,'" the 39-year-old said, asking to be referred to by her first name only. "I personally wasn't all that afraid of catching it."

Caroline was diagnosed with COVID-19 in January. The illness didn't initially present severe symptoms. A slightly elevated temperature, mild headaches, a scratchy throat: That was it. What she hadn't expected were the panic attacks and depression. 

One in three COVID patients have neurological or psychiatric conditions

A new study from the University of Oxford, published in the journal The Lancet Psychiatry, found that Caroline is not alone. Far from it: Researchers went through electronic health records of more than 236,000 COVID-19 patients, mostly from the United States, and found that 34% had been diagnosed with a psychiatric or neurological condition within six months of being infected with the coronavirus.

Neurological conditions such as stroke and dementia were rare, but 17% of COVID-19 patients were diagnosed with anxiety disorders and 14% with mood disorders, including depression. The Oxford researchers also looked at two control groups of patients with influenza and patients with any respiratory tract infection (except for COVID-19) to make sure that their numbers didn't just reflect the experience of the general public living through a pandemic.

"Our data really draw attention to the scale of the problem," the study's lead author, Oxford's Paul Harrison, told DW. "This highlights the idea that COVID has consequences for people, even if they ... don't go to the hospital."

'I thought I was having a stroke'

Caroline was never hospitalized, but she struggled severely with mental health issues during and after her COVID-19 infection. It started with the diagnosis. She had driven to a test center in a dark parking garage in Cologne alone, fully expecting to test negative, merely as a precaution before interacting with patients at work. When her results came back positive, "it was a shock. It threw me for a loop," the doctor recounted.

It got worse. Despite her physical symptoms not being bad, "I really struggled psychologically," Caroline said. She was the only one in her family to catch the virus and had to isolate completely from her husband and children. She couldn't fall asleep without sleeping pills and said she turned into a generally more fearful and depressed person than she had been before.

"I kept thinking: 'You have an illness from which all these people are dying,'" Caroline said. "I would frequently wake up at night and go into a panic. I thought I was having a stroke, couldn't move and was stuck in this world between dream and reality. I had never had these panic attacks before." 

'COVID-19 caused my anxiety to come to a peak'

Lawrence, who also asked to be referred to by his first name only, had never struggled with mental health issues before the pandemic either. Once COVID-19 started spreading in the US, the 29-year-old from Virginia began experiencing anxiety, but "it was still manageable at this point," he told DW.

Then his mother-in-law died of COVID-19, and in December, Lawrence and his husband caught the virus, as well. Initially his symptoms weren't too bad, but eventually the virus affected his lungs, "and, since I have asthma, it started to take hold."

"When my breathing became more difficult, I began to have panic attacks, which I had never had before," Lawrence said.

Lawrence suffered from anxiety, as well, and couldn't focus on his work anymore. After a month of struggling, Lawrence finally saw a doctor, who prescribed anti-anxiety medication.

"While I cannot say whether it was directly related, COVID-19 caused my anxiety to come to a peak, to the point where I decided I needed to seek medical help," he said.

Caroline, who found support from her sister, a psychologist, couldn't pinpoint the exact reason for her anxiety either. "I'm not sure whether it was caused by the general situation ― quarantine, how I got the diagnosis and all the media coverage," she said, "or whether it was caused by the illness itself."

Another reason to take COVID seriously

Professor Harrison said that "both explanations are quite possible."

"For anxiety and depression, dealing with the stress of knowing you got COVID, having to isolate, worrying about your job, your future, your health," Harrison said, "that's the most likely explanation for those diagnoses."

The theory that external circumstances are mostly to blame for mental health conditions in COVID-19 patients is somewhat confirmed by another of Harrison's findings. There was no significant difference in the number of people with anxiety and depression found in patients with mild COVID-19, those who had to go to the hospital and those who had to be placed in intensive care units.

Harrison said the possible mental health consequences were yet another reason to be vigilant about precautions and to "avoid COVID by any means you can."

"Take the vaccine you're offered," Harrison implored. "The risks of the vaccine to my knowledge are infinitely smaller compared to the risks of COVID. And if you're ... told to isolate, I would suggest you do what you're told. We would all be better off."