Xinia Campos has been depressed twice in her 62 years of life. The first time was when her son was deported 18 years ago. The second time, she says, was when she fell ill with Covid-19 in April 2020.
"I've constantly felt like I wanted to cry," Campos said. "I think I don't want to be around people, and I don't even know what I want to do."
For more than a year, Campos has suffered not only from the painful long-term physical effects that linger in some patients recovering from Covid-19, but also from the emotional and mental effects. Several studies, according to the Center for Health Journalism at the University of Southern California, estimate that 10 percent to 30 percent of patients report "a host of debilitating and persistent symptoms — from extreme fatigue, heart problems and shortness of breath to brain fog, depression and even psychotic episodes" and anxiety.
In response to a Noticias Telemundo online questionnaire asking Latinos whether they were experiencing long-term Covid-19 health effects, 51 of 214 respondents in one week reported depression or anxiety. Although it wasn't a scientific survey, it offers a glimpse into the prevalence of those conditions among Hispanics.
Campos contracted the coronavirus and suffered a textbook case: A severe cough, fever, headaches, vomiting, diarrhea and chills arrived. Her senses of taste and smell and her appetite were gone, and she lost weight. When she felt she couldn't breathe, she went to the hospital. She was medicated and surrounded by nurses, and after five days she was discharged. But some things lingered, including a cough, fever and a feeling of unease — of being lost, displaced.
'My life is not the same'
Claudia Maricela Méndez says that she fell ill in August, was hospitalized for 11 days and recovered but that to this day she continues to suffer from fatigue, memory loss, hair loss, eye fatigue and "fear."
"The truth is my life is not the same since I got Covid," she said. "It's not easy dealing with the consequences. ... This disease causes a lot of sadness and uncertainty."
Arnold Amaya, who contracted the disease in April 2020, said that when he recovered seven days later, "the ordeal was only beginning." He was diagnosed with hypertension, and he said he has suffered from "severe depression, post-traumatic stress and generalized anxiety."
For some, losing smell and taste, often seen as a bizarre but temporary and minor symptom, can be deeply distressing. "I cry from sadness," Patricia Perea Arredondo said, "because it is very sad not to be able to smell or enjoy any food."
For others, memory loss can be very worrying, striking a blow at their self-esteem. Isabel Fuentes contracted Covid-19 in May 2020, and since then she has felt fatigue, tachycardia and pain in her lungs, and she said it is difficult to work.
"Sometimes I forget what I'm doing until minutes later, when I remember again," she said.
"And I feel bad, because I feel people around me think that what is happening to me isn't serious. I feel like I'm falling into depression, because there's days when my eyelids feel heavy and I don't even want to open them. What used to make me happy doesn't matter as much to me anymore. It has been sad for me, because I feel I'm alone in dealing with this," she said.
Covid-19 has hit Latinos hard
According to a Red Cross study in October, Covid-19 has affected the mental health of about half of the world's population regardless of race, ethnicity or health status. A survey by the American Psychiatric Association found that the anxiety and stress caused by Covid-19 have affected the daily routines of 59 percent of the American population.
Across the country, Latinos have been disproportionately affected by Covid-19.
According to the Centers for Disease Control and Prevention, Hispanics are twice as likely to be infected and three times as likely to be hospitalized. And they're 2.3 times more likely to die from it than non-Hispanic whites. Many have suffered the most direct blow from Covid-19 as essential workers.
Job losses have also contributed to higher stress levels. Many Latinos lost work that can't be done remotely, and they also lost their benefits. Latino families have been evicted from their homes because they're unable to pay the rent.
The CDC reported in May 2020 that "Hispanic adults reported a higher prevalence of psychosocial stress related to not having enough food or stable housing than did adults in other racial and ethnic groups."
The lack of contact with loved ones during the pandemic has been difficult. "Hispanics are very family-oriented," said Paul J. Shaker, a Latino program clinician at Rushford Mental Health Center in Connecticut. Many families are going through a difficult time as grandparents see less of their children and grandchildren.
Suffering in silence amid high stress
The mental and emotional symptoms of the coronavirus can be the most difficult to treat, particularly for Latinos, for whom mental health is often a taboo subject.
"Some clients tell me they're not going to get psychological treatment because they're 'not crazy,'" Shaker said. "There is a stigma about what people in their community are going to think if they tell others they went to a mental health center."
Latinos who primarily speak Spanish may be unaware that services are available in their native language. That has made it difficult to diagnose the disorders early.
The Rushford Center in recent months has seen a decrease in referrals to see Latino patients as some hesitate to seek help.
That happened to Campos. She has lived in Boston for 33 years, apart from most of her family in El Salvador. Her children have cared for her during her illness, and her 36-year-old daughter has encouraged her to seek psychological help, even if it isn't in person.
"She tells me to do it over the phone, but I haven't had the courage to do it," Campos said. "I'm from El Salvador, and sometimes I think I want to go back. But I can't seem to know what to do."
When people enter a state of depression, they can sometimes cross a threshold from which it is increasingly difficult but not impossible to return, said Andrew Huberman, a neurobiology professor at Stanford University who has explained the science behind depression in talks and through his podcast.
Entering that state of desolation isn't a personality defect, and it doesn't reflect a lack of willpower or say anything about someone's value, Huberman said. Clinical depression or anxiety — unlike a fleeting moment of sadness, which is a normal part of life — can last for weeks, and it impairs a person's quality of life. It takes in processes and experiences that are "as physical as mental, involving in equal measure the body and brain," Huberman said.
In the case of the coronavirus, some symptoms can start out as purely physical and quickly affect mood, such as chronic fatigue.
The deep fatigue, which worsens with increased activity but doesn't improve with good sleep or a good diet, is a symptom of both the coronavirus and clinical depression, according to a study by the National Institutes of Health, or NIH, and it is also "a predictor of future depression."
"The presence of fatigue increases the chances of developing depression in the following year 2.6 times for women and 6.8 times for men," according to the report.
Trauma, the virus and the brain
Having a debilitating and possibly life-threatening illness creates emotional trauma, which has real health effects. But the question is whether the virus affect the brains of patients who suffer long-term effects at a structural or molecular level and whether it causes depression or anxiety.
"These questions are very difficult to answer," said David Putrino, director of rehabilitation innovation at the Icahn School of Medicine at Mount Sinai in New York City. Putrino, a physical therapist with a doctorate in neuroscience, has treated patients with long-term Covid-19 effects.
It can profoundly affect mental health when "suddenly you have to deal with the fact that you now have a chronic disease, that out of nowhere your whole body tells you that, and although you used to run marathons, now you can't even get out of bed to open the door, and no one can tell you whether this will go away or not," Putrino said.
Although research indicates that it's rare for the virus to enter the brain directly, Putrino said, it can't be completely ruled out that the virus causes imbalances in the neurochemicals that regulate mood (such as dopamine and serotonin), although he said that with what experts know so far, that is less likely.
A hypothesis is that inflammation in the brain due to the immune response affects physiological mechanisms that can weaken both physical and mental health.
'I never lost faith or hope'
Not everything that affects the brain affects mental health, and having a traumatic illness doesn't necessarily impair it. A case that illustrates this well is that of Hernando Rodríguez, 45, a Colombian who contracted Covid-19 this year and consequently developed Guillain-Barré syndrome, which often is fatal.
The syndrome usually occurs after the body defeats a viral infection, according to the NIH's National Institutes of Neurological Disorders. Instead of shutting down, defenses go haywire and attack healthy cells, particularly myelin, the layer that lines the connections between neurons in the nervous system, including the brain.
There is no known cause for it or explanation of why it afflicts some people and not others. There is also no known cure.
In a matter of days, Rodríguez went from being an energetic businessman, husband and father to being paralyzed, unable to move his eyelids or swallow hard. He had to be intubated, because even his breathing was paralyzed, as was his digestion. Rodríguez lost consciousness and was in an induced coma for a month.
But in the fleeting moments when he regained consciousness, “I never lost faith or hope. I never thought I was going to die,” Rodríguez told Noticias Telemundo at his home in Doral, Florida, where he has lived with his wife, Solangi Urueña, and their three children for three years.
In a matter of weeks, Rodríguez was already taking some steps and even a few bachata dance steps, which doctors had predicted he wouldn't be able to do for six months to a year. His recovery, which continues to amaze the teams of doctors who treat him, is distinguished by many things, but what stands out the most is his attitude.
"Throughout this time I've stayed happy, cheery, with a good disposition," Rodríguez said.
His wife, Sol, would send him funny videos, and there was a lot of laughing, joking and interacting with the medical staff. "Everyone developed an affection for me that was really beautiful," he said.
His story touched many beyond his family and friends, because "people said in the midst of this serious crisis this guy acts as if he were partying," Rodríguez said. As he got better and started speaking with other people, he said, others' reaction was: "This guy, how does he cope with this? I can walk and I complain, but this guy doesn't complain. This guy is only grateful."
Rodríguez's case shows how, because of circumstances that vary widely from person to person, a physical ailment doesn't always translate into an emotional and mental ailment. It also shows how vital the support of loved ones can be to maintain a patient's mental health.
Experts agree that if people suffer from clinical depression, they should seek professional help as soon as possible. That can include treatment with certified psychiatrists, accompanied by therapy with psychologists, antidepressant medications or specific dietary or behavior changes. Every person and every situation is different.
Huberman, the Stanford neuroscientist, offered several tips that can help prevent and relieve symptoms of depression. They include getting morning sunlight, moving and exercising, trying to get a good night's sleep, avoiding bright lights from 11 p.m. to 4 a.m., taking credit for small steps toward recovery and maintaining a feeling of gratitude.
"My philosophy is first try modifying behavior, then diet, then try supplements, and then try more aggressive interventions, such as medications," he said. "But each person is different."
If you or someone you know is in crisis, call the National Suicide Prevention Lifeline at 800-273-8255 or 1-888-628-9454 to speak in Spanish, text HOME to 741741 or visit SpeakingOfSuicide.com/resources for additional resources. They provide free and confidential support 24 hours a day, seven days a week.