In this study, semi-structured interviews (n = 20) were conducted with 14 male and 6 female participants. The total duration of the interview time was 998 min (16.6 h). The age of the participants ranged from 25-50 years. The participants were recruited from different geographical regions of Palestine. The participants were diversified in terms of marital status, number of offspring, family size, educational level, smoking status, occupation, income, and having other comorbidities. The detailed sociodemographic and health characteristics of the participants are shown in Table 1.
The qualitative data collected during the interviews were grouped under nine broad themes. Multiple subthemes have also emerged from the broad themes. Detailed themes and sub-themes are provided in Supplementary Table S3.
Source of infection
One of the participants thought they caught the virus while visiting a dental clinic. Another participant caught the virus while meeting a friend during a short travel. The rest of the participants either caught the virus from a spouse or were not certain of their source of infection.
“I picked up corona virus from the dental clinic” (P1)
Theme one: Feeling about the infection
Subthemes: Awful, hard, shocked, end of life, feeling guilty, but I caught it
All of the participants stated that they felt shocked to learn that they tested positive for the virus. Receiving the diagnosis was met with anxiety, shock, and doubt. The participants described receiving the diagnosis “was awful”. One of the participants shared:
“It was a bit awful and hard that I actually got infected by it... I couldn't believe I had actually contracted the virus... that I tested positive” (P2).
All the participants reported doubt with regard to the symptoms as the symptoms were mild and non-specific. The symptoms typically included sore throat, low-grade fever, muscle ache, nausea, and vomiting. When the participants visited their physicians, the first diagnosis was either common cold or seasonal flu. One of the participants stated:
“I had symptoms of pain in the throat and a high temperature, and the doctor told me that it was not corona and prescribed an antibiotic and a fever reducer, and on the third day, when I began to lose the sense of smell and taste, I did a corona test, and it was positive…..Honestly.... I was shocked and felt that this is the end of life” (P15)
Another participant declared:
“I did not complain of any symptoms of illness, but because of my husband's illness I took the test and it was positive, and on the third day, signs of the disease began to appear, such as a high temperature up to 39.5, nausea, vomiting, pain in the upper back and legs, a strong desire to sleep and emaciation” (P4)
The participants stated that it was hard for them to believe that they have contracted COVID-19 as they reported adherence to hygiene practices, wore masks, and gloves when the pandemic was declared. One of the participants stated:
“I thought I would not get it [COVID-19], but eventually I did. But I took precautions. I wore masks, gloves, I felt confident that I was taking all the precautions, and I did not think I could catch it but I caught it” (P 1)
The participants expressed negative feelings and emotions as they experienced infection with COVID-19. The participants expressed concerns that they might spread the infection to others, especially, their family members. One participant expressed:
“I was the first person to contract the virus and passed it to my wife and children, I feel guilty” P5.
Theme two: Mental issues as result of experiencing infection with COVID-19
Subthemes: Negative and positive mental health issues
The participants reported experiencing negative as well as positive mental health issues during their experience. On the negative side, the participants reported experiencing feelings like anger/frustration, depressed mood, loneliness, boredom, had nightmares, feared death, felt guilty, felt imprisoned, and were worried about the health of their family members. One of the participants shared that they felt guilty and embarrassed as they passed the virus to other people. The participant was prescribed antidepressants by their physician. One participant shared:
“Sometimes I feel like I am in jail” (P1)
“It was a nightmare and in fact every time I slept, I had nightmares and it was the worst period of my whole life” (P6)
“I feel guilty because of the potential risks my family would be exposed to, from catching the virus from me” (P19)
“When I got out of isolation after 23 days, I felt free and as if I was in a prison without jailers” (p6).
“Anxiety about family members being infected and worrying about family members being left alone” (P1)
” I could not sleep, I was afraid to die without being able to see my family and friends, despair overcame me.” (P17)
“I am feeling of guilt and embarrassment from thoughts of having infected people she came in contact with” (P2)
On the other hand, the participants reported positive experiences with regard to their mental health. One of the participants expressed feeling closer to God through prayers and reading the Holy Qur'an as they recovered from the infection. Other participants reported reading more books and receiving support from their relatives and co-workers made them feel loved, improved their mood, and helped them during the isolation period. One of the participants reported changing their perceptions and improved their satisfaction with their life conditions. One of the participants expressed:
“I was always in touch with my family and my wife and being assured of this, which helped me get past the stage safely” (P11)
Another participant stated:
“This disease made me know that my loved ones are increasing and that the people who loved me were standing next to me all the time, communicating with me and relieving of my pain and weakness, and they were part of the treatment and raised my spirits” (P6).
Another participant expressed:
“I do not lose hope in God. I was very happy when I learned that I was cured and that the result of Covid 19 was negative. Praise be to God always and forever”. (P13)
Another participant added:
“My wife and I were tested positive for COVID and we stayed in isolation for 21 days. During this period I relieved the pressure of work, organized my life and came out of isolation in a good mood and imprisonment with my beloved is sweet” (P10)
Theme three: Anticipated social discrimination and stigma
Subthemes: Out casted, changed the road to avoid contact with me, Burning the trash can, "House of Corona", accusation of guilt, Get away from me, public advertising via social networking sites and mosque's headphones, faced backlash.
In this study, the participants reported experiencing social discrimination and stigma in their communities. Some of the participants reported having to take longer walking routes to their homes as they were not allowed by the community members to walk in the main streets. One of the participants expressed concerned that in the future they and their family members would be outcaste.
One of the participants recounted that the neighbors burned the trash can in front of their home as the ambulance came to transfer a patient to the hospital. Even after recover, the participants reported people avoiding any contact with them through changing lanes to keep themselves away from a recovered COVID-19 patient. As one participant shared:
“People were burning a trash can in the street in front of my house where I put the waste when they noticed that the ambulance was coming to take me to the COVID-19 facility” (P1)
The participants reported that discrimination and stigma continued even after their recovery and testing negative. One participant continued:
"I was being stigmatized by being linked to a confirmed case” (P1)
“I faced backlash and harsh comments from the public and even those who know me” (P4)
“The situation was when I came back on my turn (meaning after recovery), many of the employees avoided dealing with me or touching anything about me and this thing made me feel that I was an outcast” (P6)
“After I recovered and got off, I walked in the street, and people used to change the road to avoid me and were away from me” (P20)
“My wife and my four children they caught corona like me. In a situation I will never forget for the rest of my life ... the neighborhood where we live, they mark my house with plague, “a corona house”, and unfortunately no one approached the house or deal with us, and this issue made us feel isolated and bullied. But God forgives them” (P16)
“Some blamed me for being ill of Corona virus and they thought my illness was because I did not take adequate precaution of prevention and safety” (P9)
“The situation that bothered me the most was what some relatives said to me: Get away from me, do not come near me” (P10)
“It was announced on social media the names of those infected with Corona before informing stakeholders about it. We knew from people that we were infected. (P11)
Theme four: The physiological symptoms as matters of experience
Four subthemes: Respiratory symptoms, gastrointestinal symptoms, neurological symptoms and ophthalmologic symptoms
The symptoms experienced by the participants were reported as dry or purulent productive cough, fever, shortness of breath, loss of smelling and tasting, cold like symptoms, symptoms similar to seasonal flu, dry throat, thirst, nausea, vomiting, loss of appetite, muscle ache, fatigue like a rag, intolerable headaches, red eyes, blurred vision, heart palpitation, sweating at night, dizziness, feeling pressure in the ears, insomnia, have frequent night time awakenings, and feeling restless. In this study, all participants experienced respiratory symptoms. The participants shared:
“I had dry constant cough, fever and shortness of breath …… I got severe myalgia, I couldn’t lift arm, hard to get out of bed...body aches...sore throat, difficulty breathing and especially loss of sense of smell and taste” (P17)
“I’ve felt cold-like symptoms at the beginning before diagnosed with COVID-19” (P2)
“I suffered from a high fever and pain that tortured every part of my body…..I kept on coughing specially in the afternoon. I could not sleep at all…It lasted for two days” (P20)
“Last few days for me have been awful. Began to lose the sense of smell and taste. Very high temperature around 39, cough, sore throat, breathlessness, nausea, and vomiting” (P14)
“Utterly exhausted, with whole-body ache and feeling weak in the muscle, feeling tired” (all the participant)
“I am feeling fatigue is literally like a rag. I cannot stay awake longer, I have to go to bed” (P13)
“I feel that my legs are fallen and I cannot rest on them” (P11)
“I feel pain in the upper part of the back, especially the shoulder area. I feel that my shoulders are flared” (P4)
“I have cough which was productive associated with brown purulent mucous” (P2)
“Headache started in upper frontal part (P4), occipital (P1), frontal (P3) severe intolerable headache deeply inside the head” (P2)
“The first hint which could necessitate a coronavirus test is very dry throat feeling like a burn especially at night. The worst sore throat you can imagine, water doesn't quench the thirst” (P19)
“Most of those who saw me asked me why your eyes are red” (P5)
“I did not feel anything because breathing difficulties were the most controlling for me ... As for what I remembered about the symptoms.... I expected to die of suffocation” (P13)
“I suffered from Stomach ache, diarrhea, dizziness and Blurred eyes” (P15)
Theme five: Life in isolation- Coping with adversity
Subthemes: feelings of depression and loneliness, feeling bored and uncertain about the future, keep busy, lack of direct social interaction, keep in touch and keep socially active, keep moving, practice spiritual rituals
The participants reported that they felt loneliness, depressed, boredom, and uncertainty with regard to the length of the quarantine period. The participants shared:
“I am Feeling lonely and depress due to losing touch with others” (P1)
“Despite the boredom and ambiguity of the quarantine period but I was willing to stay to prevent others from becoming infected” (P3)
“The more time I spent, I read and browsed the various websites to find out more information about the disease, treatment methods, recent studies and some time to read the Quran and prayer” (P9)
The participants stated that they have practiced social distancing and obeyed the “stay at home” orders after recovering. The participants reported that they limited their social interactions. One of the participants stated:
“I strictly prohibited any interaction with others” (P20)
Theme six; Supportive treatment, herbs, and rituals
Subthemes: Medical treatment, prone position, Prayer mode- prostration, herbal medicine, Immunity booster, washing down the virus.
In absence of preventive and therapeutic agents for COVID-19, the participants turned to herbal medicines and rituals. The participants shared:
“I used bronchodilator vapors (Ventoline (Nebulizer), Atrovent (Nebulizer), cortisone drugs, painkillers, Azithromycin (antibiotics), Paracetamol” (all the participant)
“I used prone position, it is the position to be in to relieve cough especially during the night” (P1, P4)
“I used Prayer mode- prostration to relieve the dyspnea with good effect” (P5)
“I used grind Black Seed (Habbat Al-Barakah) with honey, boiled dry flowers, anise grain, chamomile, curcumin in the food, lemon and ginger to relieve cough” (all the participant)
“Fruits and juices are important and healthy diet also to build immunity” (all the participant)
“If there is a virus in the body. The virus stays in the throat for four days ... so I washed it with water pipes with high force to send the virus to the stomach” (P3)
“I was eating healthy food, consuming a lot of water, and using various types of natural herbs” (P5)
Theme seven: Personal preventive measures and population-level strategies.
Subthemes: social distancing, the use of masks, sanitizers, and hand washing, eating healthy food, and drinking a lot of water
Recommended precautions of COVID-19 were designed to reduce/eliminate transmission of the virus. These include frequent hand washing, wearing masks, gloves, practicing physical distancing, avoiding/minimizing physical contact, covering the mouth and nose while coughing, and avoiding contamination of the face with unwashed hands. The participants stated that wearing masks, washing hands or using disinfectants, and practicing social distancing can help prevent transmission of the virus.
Masks are an important measure of suppressing transmission and saving lives. Masks should be used as part of a comprehensive "Do it all!" -method including physical distance, avoid crowdedness, avoid closed contact settings, good ventilation, cleaning of hands, covering with sneezing and coughing and more. Masks can be used either to protect healthy people or to prevent transmission. The participants shared:
“One should follow the advice and self-isolate. Protect your colleagues, protect your friends and family, and protect yourself” (P1)
“The use of masks, sanitizers, hand washing, social distancing and proper locking would help prevent the disease” (P4)
Theme eight: Perception of social support and health protective behaviors
Subthemes: social support by the wife, family, dear and close friends, loved ones raising spirits, lift spirit in an exaggerated way.
Perceived social support is a personal subjective assessment of the availability and adequacy of resources and reactions from one’s social networks. Social support received referred to the objective assessments of the personal social contacts and their related functions. The participants shared:
“My wife used to bring me various food and drinks, organize times for my treatment and take care of me in all aspects of life” (P2)
“I was always in touch with my family and my wife and being assured of this, which helped me get past the stage safely” (P1)
“My fiancée used to come and talk to me from behind the window panes, and this comforted me a lot” (P3)
“When they took the second test, and the result was negative, I felt that we were re-created and that this disease despite its difficulty was a god with positive social effects that allowed us to meet as a family and feel our love for each other” (P5)
“This disease made me know that my loved ones are increasing and that the people who loved me were standing next to me all the time, communicating with me and relieving of my pain and weakness, and they were part of the treatment and raised my spirits” (P6)
On the other hand, some people tried to lift the spirit of the participants in an exaggerated way. This was associated with negative consequences. One of the participants stated:
“Some people who communicate with me made me feel like I was going to die and tried to lift my spirits in an exaggerated way. This thing made me think that I feel that the problem is very difficult and that they know something I do not know” (P15)
Theme nine: Life after recovery
Subthemes: Fear of relapse, not expecting to return to normal life, scared, released.
All participants who took part in this study expressed hope to make a complete recovery. The participants stated that experiencing infection with COVID-19 led to adopting of new behaviors like adherence to hygiene practices. Additionally, the participants reported adopting more healthy lifestyle to improve their immunity. Some participants expressed fear of re-infection. One participant shared:
“Actually, the main thing I'm worried about getting the disease again. I do not know if my body builds antibodies, I do not know if the disease damages other organs in my body, I am worried about fertility” (P1)
While some of the recovered participants felt comfortable to go out after their quarantine period, some participants expressed hesitations to go out. Some of the participants felt hesitant to meet people after completing their quarantine period and testing negative for the virus. The participants shared:
“I was not happy because the symptoms were not over and I felt that I could relapse and return to the same suffering at any time. I already felt tired today, even though it is more than 25 days after the recovery of the disease” (P6)
“A rare experience and pray to God not to return back to me. For the first time in my life I experienced such suffering. I did not expect to return to my normal life” (P6)
“I felt it was strange that I would go back and meet people, see the street, go back to my work ... I felt a little scared, especially since I still had difficulty breathing” (P12)
“Release ... As if I was in prison and I was pardoned .... I swear to God, it was good news to be released” (P16)