Introduction

The experience of the past two years has shown that COVID-19 has affected the global community both physically and psychologically [1–3]. The emergence of the COVID-19 pandemic was associated with massive changes in all aspects of society. This has impacted the healthcare system worldwide as huge global efforts have been directed toward combating the COVID-19 pandemic. Much of this effort has focused on developing therapeutic and preventive medical measures to treat those affected [4–6].

The scientific literature has been enormously enriched with data, experiences, and success stories from the global medical community and the general [1, 7, 8]. However, studies mainly focused on the physiological aspects of COVID-19, and fewer looked into the psychological outcomes for those affected by the virus. Available evidence suggests that the disease affects not only the physical condition but also the mental health and well-being of the individual and society, leaving the individual with long-term consequences [6, 9]. During COVID-19, in addition to the stresses during the disease, various factors such as disruption to the daily routine, lockdowns, and long-term health conditions after recovery from the virus significantly and profoundly affected the mental health of the global community [5, 6, 10].

A study in northern Italy found that 17.2% of COVID-19 survivors had post-traumatic stress disorder (PTSD) symptoms four months after being discharged from the hospital [4]. An earlier study by Maunder et al. (2003) exploring patients’ experiences during the SARS outbreak in Toronto and found fear, loneliness, boredom, and anger [11]. In contrast, a qualitative study conducted among Spanish patients showed that patients easily adapted to the situation and trusted medical professionals [12]. The isolation of patients was perceived as a necessity, and technology helped keep patients and their families connected. Furthermore, a qualitative study among Turkish survivors found denial and adaptation, fear, and hopelessness associated with patients’ psychological health [13].

Taking into consideration patients’ experience, healthcare professionals should be mentally resilient, trained, and experienced in dealing with patients’ health condition, death, and mental health [3, 14]. However, stress and the unique demands of the COVID-19 crisis put healthcare providers at additional risk of mental health issues, indicating increased levels of depression, anxiety, and post-traumatic stress disorder. A systematic review of 46 quality papers by Billings et al. (2021) sought to better understand the experiences of frontline healthcare providers and their perspectives on support during COVID-19 and previous epidemics [3]. Meta-synthesis has identified that participants in all studies were deeply concerned about their own physical safety and/or the physical safety of others. This was the largest in the early stages of the pandemic and was exacerbated by inadequate personal protective equipment (PPE), insufficient resources, and conflicting information. In addition, workers struggled with high workloads and long shifts and wanted adequate rest and recovery [3].

A similar systematic review among healthcare providers in the Kingdom of Saudi Arabia, aimed at assessing their mental health outcomes while coping with the COVID-19 crisis, found that more than 50% of healthcare providers experienced a psychological impact in terms of depression, anxiety, and stress during the global pandemic emergency [2]. As such, the earlier study by Almutairi et al. (2018), studying the experiences of healthcare providers who survived MERS-CoV, reported four main themes related to the psychological impact of the disease [15]. These were caring for others in the defining moments, perceived prejudice behaviors and stigmatization, lived moments of traumatic fear and despair, and denial and underestimation of the seriousness of the disease at the individual and organizational levels. The survivors suffered from the traumatic experience, which could have had a negative impact on their productivity [2, 15].

Despite the existence of a number of works on the main topics related to the psychological consequences of the COVID-19 pandemic and earlier epidemics, there is a lack of research on the subjective meaning experience among healthcare providers who survived the COVID-19. Therefore, this qualitative study aimed to further understand and describe the life experiences of healthcare providers infected with COVID-19 in Saudi Arabia.

Methods

Results

Ten healthcare providers participated in this study; six were Saudis, three were Philippines, and one was Jordanian. Eight participants were nurses and two food servers. The age of participants ranged from 26 and 39 years, with an average of 33.4 years. The participants worked in secondary hospitals, in medical, surgical, and Operating Theater departments, with an experience of 10 years and above.

The descriptive thematic analysis resulted in five themes, and four sub-themes (see Table 1) from participants lived experiences:

1. Physical and psychological signs and symptoms
2. Self-healing, hiding pain, and family
3. Fear of complications
   1. Self and family’s reaction and fear from death
   2. External interference in the face of breaking news
4. Disease stigma & long-term psychological outcomes
5. Emotional support, mental well-being & resignation
   1. The vital role of emotional support in healing
   2. Work resignation

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Table 1. Themes and sub-themes from the qualitative analysis of the lived experiences of COVID-19 survivors in Saudi Arabia.

https://doi.org/10.1371/journal.pone.0289131.t001

Physical and psychological signs and symptoms

Most of the symptoms and signs reported by the participants were common. These include severe flu symptoms, loss of smell and taste, difficulty getting out of bed, increased coughs and colds, headache, and fever.

"… heavy flu symptoms, loss of smell and taste."

"I have difficulty getting out of bed because I felt like I was a victim of physical abuse. Aside from the worsening cough and colds, headache, and fever, the pain all over my body was excruciating. Even taking a bath was so difficult because I felt like my skin was about to be lacerated when touched. I was forcing (myself) to eat a little just so I can take medications. I wanted to cry but I was pushing myself to be strong because, at this time, I can only depend on myself.”

Participants also associated the loss of their sense of taste and smell with shock, which led to mind games and hesitations about whether it was the first day or whether the loss of taste and smell happened the day before or even earlier. In some cases, participants lost the desire to talk or interact with others.

“On that same day at lunch time, I was shocked when I could no longer taste my food. I couldn’t even smell it. I took my perfume to smell it but nothing. I started asking myself. Did it really start today? Or it was already there from the beginning but because I constantly remind myself that I am negative that I didn’t notice it? Did my mind play a trick on me during the previous days? That I was just imagining the taste of my food because I keep telling myself that my result will never become positive?”

"I lost the desire to talk to anyone… I felt like tired, exhausted, I don’t want to talk to anyone even if it’s only to say “hello”… sometimes I can’t sleep at all to the point I cry for help asking for pills".

Some cases were severe and required admission to the intensive care unit and intubation. Of these cases, some participants reported that they could hardly hear and see things during intubation, but they had hallucinations, and often the forms of the people seemed to be ghosts or dark shadows. This resulted in less sleep due to fear of new hallucinations.

“Yes, (I was able to hear suctioning sound and staff). I remember one voice. The voice, I assume, of the respiratory therapist. I do not know his name, I used to hear him talking to me. Whenever they do the ABG from time to time, I see them. When I woke up, I felt the needles and I heard sounds like suction”; “I did (have illusions), I imagined a lot of things in the hospital, seeing shapes and ghosts. I told myself that it is the death angel. I saw a lot of things to the point I could not sleep so most of my time after, After I woke up, most of the time, I could not go back to sleep. I felt tired, I imagined black shapes around me”.

Fear of complications

Disease stigma & long-term psychological outcomes

When hospitals no longer had the space or staff to care for large numbers of COVID-19 patients, they often transferred infected patients to designated hotels for quarantine until recovery. Some patients felt more comfortable and relaxed in these hotels, while others felt social stigma and how, in some cases, they were treated like criminals who could escape without police protection. In addition, stigmatization was reflected in the service and care at the hotel, as well as the staff’s fear of infection.

“As soon as I arrived, the first thing I saw was the Police car, I did not like that, because I felt like a criminal, all that is left is to handcuff me. It was not a nice scenario, maybe, some people may try to escape, but I do not think so… It was not right, as if I was a criminal. They guided me to the waiting area, we sat there till they finished the process, and they took the ID then went to the Nurses’ station.”

“Now I moved to the next stage which is the hotel. There, of course, they specified rooms for patients “there is your room” and so on… the food was left on the door outside, I am understanding that they are afraid of being infected, they are not coming to the room or whatever but forgive me for the word, but you feel like impure! You have to give them the trash can, leaving it on the door to change it for you even walking in the corridor can criminalize you, the bright side is the quietness but the instruction is a bit, I don’t know. Of course, they will not come to you but whatever you need, they will put it on the door for you so it was okay.”

The way people look at and treat infected patients was a real stress for some of the participants, while others did not experience any backlash from colleagues or the community.

“I did not go through situations with anyone, everyone knew that I have COVID-19. In the end it is not something I need to hide. Honestly no one made me feel as if “oh, she has COVID-19… Wow…” or anything of that sort, it was normal.”

“It’s really a consuming thing for the mind… I mean, from a social point of view and people. How do they look at a person who is infected with this thing as if he is not sick, as if she is the one who brings shame. I mean, in my whole life whether the social or my work life, there’s no (such reaction to) disease that spread… I mean, the ways of transmission are known. They are not, may Allah forbid it, through forbidden things or things that are not good or something. I mean the feeling, look or words that are spreading, as if this person is a shame, it is a crime, it is a forbidden thing.”

Some participants felt that people were avoiding and running away from them, even colleagues and closest friends as if they were the source of the infection. Even during treatment, other healthcare providers were reluctant to come closer. Although participants considered it somewhat normal, the facial expressions and energy emanating from friends and medical professionals were shocking.

“I went out of the room down to the elevator and when they saw me as if they saw a beast. You would never imagine what happened even if I stood now and imitate what they have done, they all took a step behind and lift their hands away, far away, stay there. That was on the next day when my mental health was down. Just imagine how your feelings are at that moment. I don’t know how to cry; I don’t know how to be silent. I mean, I sat like a piece of wood. They saw a chair then they brought it to me, they told me to sit on it. I don’t know how to express such… sadness”.

“No one wanted to come close to me… you (the nurse) are already wearing a face mask, what will you do!”

“They were also shocked but I understood if nobody came near me, nobody comforted me but I know from their voice that they were worried and concerned. I felt what they were saying it’s just that they cannot come near me physically in particular but the words they said comforted me.”

Social stigma and people’s attitudes led to feelings of guilt in some participants. In addition, those who worked in high-risk areas and had daily contact with patients fear becoming carriers of the disease among family members and colleagues.

"Psychologically, things were very difficult because even my wife is pregnant, and I began to think about her a lot, what could happen to her as I am the reason behind her infection."

"I wasn’t worried about myself rather worried about my kids and the staff who I was with, so I was daily asking the group if the result came out… Alhamdulillah, they were all negative… If anyone of them were positive, I could have died. I feel guilty for, what did I do wrong?! Why did I get infected in the first place?”

Emotional support, mental well-being & resignation

Discussion

A number of studies have examined the experience of healthcare professionals in caring for patients with COVID-19. However, only a few studies have been conducted to examine the experience of healthcare providers as patients. Since the discovery of the first case of COVID-19 in Saudi Arabia and around the world, treatment protocols in hospitals in all countries have focused on treating the physical symptoms of COVID-19, often overlooking the psychological impact. This study examined the life experiences of Saudi and foreign healthcare providers who work in hospitals in the eastern region of Saudi Arabia and have recovered from COVID-19.

In this study, one of the main aspects of the patient’s experiences encountered was the psychological impact of the disease, which often impaired their physical health and recovery. Thus, while the participants consciously chose to be isolated, the consequences worsened their mental health, including fear, constant feelings of loneliness, and being away from home. These stressors had a profound effect even when returning to normal life due to fear of being a transmitter of disease, consistent with studies conducted among the general public [21, 22]. Moreover, loneliness due to family absence is considered one of the main risk factors for depression and anxiety in patients with COVID-19 [23, 24].

The fears of the participants in this study about returning to normal life were not only associated with the transmission of disease but included a whole range of factors that, in some cases, led to depression and resignation. For example, fear of serious complications and possible death, leaving the children at home alone, and worrying about what might happen and who would take care of them were important stressors. In addition, some participants were worried about how to break the news to their children, siblings, and family members, especially the elderly. The latter was related not only to the fear of disease transmission but also to how society, including family and friends, would perceive this news. This forced the participants to hide their pain from others and pretend they could easily tolerate the disease. As a result, despite the constant need for emotional support to reduce stress and look after their own well-being, participants in this and earlier studies had to take on increased responsibility for comforting others and demonstrate or pretend that they were doing well and stable [25–27].

One of the main findings of this study was the negative stigma toward patients with COVID-19. This attitude was criticized by the participants, who were surprised by the reaction and felt stigmatized and shamed. It was expected to find fear and anxiety among non-specialists, but surprisingly, similar responses were found among many healthcare professionals with medical backgrounds. Participants felt that social media played an important role in shaping this perception, especially during the first few months of uncertainty about the severity of the infection and its complications [24]. This fear has led people to believe that COVID-19 is a deadly infection and has led some to flee isolation or hide their travel history to protect themselves. As a result, even those who voluntarily went into isolation were treated most disrespectfully and intolerantly [28, 29].

It is well-known that healthcare providers are the cornerstone of the health system, regardless of their position and status. Therefore, to provide good care and support to patients during and after pandemics, efforts must be made to ensure that they are in good physical and mental health. However, the experience of the past two years and this study showed that, in addition to the workload and caring for others, healthcare professionals experienced personal drama and stress that will have a long-term impact on their future work and communication with family and colleagues. All of the negative physical and mental signs reported in other studies, such as exhaustion, fear, anxiety, and sadness, can affect patients who end up feeling more tense, desperate, and hopeless. Such feelings can affect the immune system and make patients feel worse [21, 30, 31].

This stigma can lead to losing trust in the employer, colleagues, and family. Therefore, it is recommended that future research explore the role of social media and society in both positive and negative impacts on the health of a patient or healthcare provider as a patient. Furthermore, hospital leaders and policymakers must invest their efforts and hospital resources in improving these aspects, which can improve the physical and mental well-being of healthcare providers.

Further data from this study showed that foreign workers experienced an even greater burden since they were away from family and had no support other than occasional support from colleagues. Similarly, data from previous studies have shown that the experiences of COVID-19 survivors in the intensive care unit were dominated by themes of fear of intubation, death alone or away from family, feeling insecure about their families if they died, wishing they could die near close ones [3, 21].

When mental health support was mentioned, participants tended to talk more about employer support, pushing participants to return to work immediately after a negative test result, not allowing enough time for a full recovery. As a result, some foreign workers had to resign and leave. Given the lessons learned from COVID-19, the shortage of healthcare providers in times of crisis, and the importance of how employers relate to their staff, future research with this population could help focus on what support they should have received and what might make them stay or leave. In addition, the healthcare system and hospitals should consider standard support for healthcare professionals in the long term, as a worker who has not fully recovered or has an emotional disability cannot be a strong asset to the team [13, 32]. Conversely, a motivated worker who experiences not only occasional care from colleagues but also comprehensive support from the employer can become a mentally healthy workforce for the sustainability of health services.

The findings of the current study have made a significant contribution to the existing literature and future research. First of all, this study showed that healthcare providers, as patients, experience the same difficulties and stressors as the general public. In some cases, these factors are even worse, as a new type of stigma is developed by family members, colleagues, and employers. Secondly, although employers treated foreign employees unfairly, colleagues treated them well. At the same time, some participants reported outright insensibility of colleagues after hearing about a positive test. Therefore, in future research, it is recommended to study the attitude of medical workers toward their colleagues, depending on whether they are local or foreign. Third, this research has created a range of frameworks for designing and implementing educational projects among different levels of society to educate them and likely influence their attitudes and perceptions during a health crisis. Finally, given the impact of social media and the flow of information of any type, more research is needed to examine the sources used to obtain information by the general public, whether these sources are reliable, and how the public can be taught to use only scientific data and not social data.

Limitations

In addition to the added value of this study, certain limitations warrant discussion. Given the sensitive nature of the topic under study, future studies may consider a mixed methods approach that will study the allostatic load of healthcare providers, study their daily workload using quantitative approaches, and develop a qualitative phase based on quantitative data. This will create a broader picture of the research topic in a more comprehensive perspective beyond COVID-19. Lastly, the sampling method also did not allow full blinding of the participants, an inherent limitation that needs to be kept to a minimum as much as possible.

Conclusions

Understanding the experience of healthcare providers as patients during the pandemic has allowed to look at the feelings and needs of people during illness from a new perspective. As expressed by participants, being a healthcare provider does not reduce the fear of the disease and does not mitigate its consequences in the form of stigmatization and isolation. In addition to its added value, this study has set the stage for future similar studies that can explore the social and occupational stigma and challenges faced by healthcare providers when dealing with any health condition, not only COVID-19. This wide-ranging approach to research will allow the development of educational programs and initiatives to increase the knowledge of colleagues and management about the dangers of a given health condition for those who treat patients, regardless of their occupational or demographic characteristics.