Getting the COVID-19 vaccine feels like a big sigh of relief for many people. But for Lily Hagigat, the long-anticipated moment was shadowed by an overwhelming sense of guilt.

"After the second dose, the guilt really kind of hit me," the 26-year-old nurse from Ohio tells Health. "I thought of all the people we watched die in the hospital, who could've lived another five or 10 years had this not happened, and the many people who needed the vaccine more than I did, who were more at risk, but who died a month before their time came."

This type of guilt isn't the usual kind you might feel when you feel remorse about something you did, like forgetting your best friend's birthday. It's survivor's guilt, a negative feeling that can come after living through something traumatic—like, say, a once-in-a-century pandemic that's killed more than 2.5 million people around the world, per the Johns Hopkins Coronavirus Resource Center.

"Survivor's guilt is this emotional distress that can happen when we go through something difficult or traumatic, and we survive it, and maybe even leave that event unscathed," Ernesto Lira de la Rosa, PhD, a licensed clinical psychologist who works with the nonprofit, Hope for Depression Research Foundation, tells Health. "As this pandemic persists, along with all the things that come with it, I view survivor's guilt as a trauma response."

Not only is COVID survivor's guilt affecting healthcare workers, who've had to watch countless patients die alone, cope with colleagues who've gotten sick, and made tough decisions about who gets limited healthcare resources, it's also "complicating the road to recovery" for people who have had the disease, according to a commentary in NEJM Catalyst Innovations in Care Delivery.

Anna-Kate Howell is one of those people. The 29-year-old theology student from North Carolina nearly died from COVID-19 in May 2020. Since then, she has been managing ongoing physical and neurological symptoms. But it's the emotional impact of COVID-19—the guilt in particular—that has been one of the most challenging parts of her recovery.

"I'm not always glad I survived. I would say that a not insubstantial percentage of time, I wish I had died because of the guilt… and what I feel guiltiest about is not being appropriately grateful for the gift of life," she tells Health. "When I see the numbers about how many millions of people have died, I think 'Why them and not me?'"

What exactly is COVID survivor’s guilt?

Howell and Hagigat aren't alone in their experiences with COVID survivor's guilt. While it's too early to estimate just how many people may be affected by the condition, mental health professionals say they've been seeing an uptick in people showing signs of survivor's guilt throughout the pandemic.

"The key symptoms are rumination, where you're thinking about your guilt on a regular basis, maybe can't turn away from the news or stop reading stories of people who've gone through tragedies. It occupies so much brain space," Lauren Cook, PsyD, a therapist and author of "Name Your Story: How to Talk Openly About Mental Health While Embracing Wellness," tells Health. "The second factor is that feeling of feeling guilty if you're not always feeling guilty. You might not be giving yourself permission to feel happy, or feeling bad if you're in a good place right now."

It can also manifest physically, says Lira de la Rosa. "Our bodies are really good at giving us clues that something's going on before our minds can catch up. People with survivor's guilt may notice a change in their appetite and sleep, headaches, stomachaches, or pains in your body," he says. "The unique part is the guilt—they have a sense of feeling guilty for surviving or doing OK, and they don't want to talk about it because they feel shame."

COVID survivor's guilt is a huge emotional burden to carry during an already taxing time in history. But that's just the beginning—it can also cause insomnia, make it difficult to function in day-to-day life, isolate you from loved ones, and drain your finances if the guilt drives you to make charitable donations beyond what you can afford.

And if COVID survivor's guilt drags on for four weeks or more, it may become a type of post-traumatic stress disorder (PTSD), warns Hackensack Meridian Health. "Over time, our minds and bodies may adjust, and we can forget that this isn't how we're supposed to feel," says Lira de la Rosa.

How can you cope with COVID survivor’s guilt?

COVID survivor's guilt can take a huge toll on you, so it's important to find ways to cope. Experts say that talking about what you're going through with people you trust can be the first step toward finding peace.

"Use this as an opportunity to connect with people who are in your life when you're feeling isolated, lonely, and having that sense of guilt," suggests Lira de la Rosa. "We're social people, and increasing our connections with others safely, even if it's virtual, can help."

A therapist or another mental health professional can also be an invaluable source of support, offering a safe, judgement-free space to share your experience and find ways to manage your emotions. "Especially if you notice the guilt is impacting your ability to be successful at work, or your relationships are suffering because of it, or you notice that you can't move forward, those are signs that it's time to get additional support for this," says Dr. Cook.

Cultivating self-compassion can also provide some relief from the guilt. That often starts with an awareness of how you're feeling, then an acceptance that it's part of your experience as a human. "It's crucial that we have kindness toward ourselves, and take a step back and realize that blaming ourselves is just exacerbating our stress," explains Dr. Cook.

Meditation, breathwork, and journaling can be useful tools for working through survivor's guilt and boosting self-love. Plus, these mindfulness activities can provide a much-needed break from the constant barrage of bad news that can otherwise worsen your guilt.

Finding ways to give back can be an especially therapeutic way to heal from COVID survivor's guilt, as well, according to experts and those living with the condition. For Hagigat, that meant making a donation to a charity. She chose UNICEF because it has a program that distributes vaccines to developing countries, which felt meaningful as she was coping with the guilt of getting her COVID-19 vaccine.

Money isn't the only way to contribute toward the greater good, though. Howell, a self-described introvert, says that she continues to share the impact of COVID-19 on social media and in the news in hopes that it makes a difference in others' lives. "I feel like I owe it to the many millions of people who were not as lucky as me to keep reliving this over and over again, even though it's way out of my comfort zone," she explains.

Overcoming survivor's guilt related to COVID-19 or any other type of trauma can take time, and Howell admits she still "gives into despair fairly regularly." When things feel really dark, she finds it helpful to revisit the advice she received from a friend three years ago after a psychiatric hospitalization.

"She told me that sometimes you can't feel hope, and when you can't feel hope, you have to think hope," says Howell. "That's what got me through that, and that's what's getting me through this, too."

The information in this story is accurate as of press time. However, as the situation surrounding COVID-19 continues to evolve, it's possible that some data have changed since publication. While Health is trying to keep our stories as up-to-date as possible, we also encourage readers to stay informed on news and recommendations for their own communities by using the CDC, WHO, and their local public health department as resources.

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