Coronavirus Disease 2019 (COVID-19) is classified as an "emerging infectious disease syndrome." This respiratory syndrome is characterized by symptoms such as fever, chills, muscle pain, dry cough, runny nose, sore throat, loss of appetite, and diarrhea. It is also categorized as a class 1 infectious disease [1]. As of February 17, 2022, there have been 530,555,425 reported cases and 6,294,067 deaths globally since the World Health Organization (WHO) declared the pandemic [2, 3]. In South Korea, the total number of infections has reached 18,119,415, resulting in 24,197 deaths [4].

In the initial stages of an epidemic, when evidence is limited, the primary goal is to quickly isolate all confirmed patients in medical facilities. This is achieved through the 3T strategy, which involves extensive testing and confirmation, epidemiological tracing, and isolation and treatment [5, 6]. The purpose of inpatient isolation treatment is to prevent the spread of infection from a patient with an infectious disease, a suspected infectious disease patient, or a carrier of a virulent disease pathogen to other patients or hospital staff [1]. As the number of confirmed cases increased, leading to shortages of hospital beds, medical personnel, and essential patient treatment equipment, a system was put in place. This system prioritized hospitalization for severe and critical patients, while asymptomatic and mild cases were monitored for symptoms in isolation facilities such as community treatment centers. In the early stages, due to a limited understanding of the disease's progression and characteristics, some individuals were isolated in community treatment centers for over a month. As more information about COVID-19 became available, the guidelines for epidemic prevention were continually revised [6].

Patients undergoing isolation and treatment spend the majority of their time alone. This often leads to feelings of shock and estrangement, self-blame or sadness from family and friends, and the experience of exclusion and discrimination when their infection becomes known to others [6, 7, 8]. These challenges continue even after discharge, manifesting as socioeconomic issues due to various lingering effects and the awareness of anxiety, depression, job loss, and social stigma [8]. Studies of patients infected with COVID-19 revealed that symptoms of post-traumatic stress disorder, such as fear of reinfection, social stigma, frustration, guilt, depression, anxiety, and sleep disturbance, can persist for months or even years [9, 10, 11]. To prevent these long-term physical and psychosocial problems in patients recovering from acute diseases, a strategy is needed to mitigate these unhealthy outcomes. Therefore, it is crucial to understand the specific aspects of patients' experiences, from the moment they are isolated due to COVID-19 to the start of their inpatient treatment.

A study examining the attitudes of South Korean COVID-19 patients towards hospital isolation found that some patients adopted a passive stance. Despite this, they were willing to accept and appreciate their circumstances, considering the potential for worse outcomes [11]. Other patients expressed feelings of injustice and exhibited maladaptive behavior due to social stigma, guilt, and fear. These responses suggest that these patients experienced significant confusion and negative emotions during their hospital isolation.

Research on the mental health of COVID-19 patients in China and Italy primarily focused on assessing levels of depression and anxiety [12, 13]. A retrospective chart review conducted in the UK reported symptoms such as sleep disorders, anxiety disorders, suicidal thoughts, mood disorders, decreased concentration, and headaches in patients [14]. These symptoms could be influenced by the impact of COVID-19 on the central nervous system, the severity of the infection, experiences in intensive care, the duration of hospitalization, and other personal characteristics.

Much of the existing literature focuses on developing strategies to overcome the trauma induced by COVID-19. Since this trauma originates from the point of infection, the experiences of patients during their hospital isolation could offer valuable insights. Previous studies have primarily concentrated on patients in the recovery phase following hospital isolation. Given the limitation that these studies do not fully capture the diverse experiences of patients during hospital isolation, it is crucial to investigate patients' experiences, specifically from the time of hospitalization and isolation to early recovery. Consequently, this study examined the experiences of hospital isolation and recovery in COVID-19 patients. Our findings could provide foundational data for devising intervention strategies to address various psychosocial issues that may emerge during hospital isolation and the subsequent recovery period.

The experiences of participants who were hospitalized and isolated due to COVID-19 infection were abstracted into 34 codes, 9 sub-categories, and 4 categories (Table 2). As a result of linking the meanings of these four categories, the overarching theme of "It's okay, but it's not okay" was derived. This theme indicates that the participants navigated the process of hospital isolation in a healthcare setting that prioritized disease control, without being adequately prepared to confront an emerging infectious disease. Despite the challenges, they gradually resumed their normal lives, buoyed by the comfort and support of those around them. However, they were impacted by being viewed as the culprits of the disease. Essentially, this theme suggests that while the physical illness has been overcome, the emotional scars inflicted by negative perceptions have not yet begun to mend.

Table 2
Codes, Sub-categories, Categories, and Theme

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This study aimed to explore and understand the experiences of COVID-19 patients during hospital isolation and early recovery. The goal was to gather foundational data to develop an intervention strategy. This strategy would address the range of psychosocial issues that could emerge during hospital isolation and the subsequent recovery period.

Category 1 represented the participants' disillusionment over the prioritization of protecting the uninfected over treating those who are infected. The participants' confusion during their transfer to hospitals, coupled with the perceived harshness of healthcare workers, contributed to their negative emotions. In the initial stages of an infectious disease, isolation is often deemed the most effective solution. This approach has been adopted by South Korean health authorities in treating patients with COVID-19 [6]. While mandatory isolation is advantageous for public health preservation, it significantly curtails individual freedom [20]. Patients are prone to feelings of anger, confusion, and frustration when they are subjected to the stringent measures of healthcare workers, along with abrupt activity restrictions [21]. Therefore, in the process of implementing isolation measures to shield the public from new infectious diseases, it is crucial to also safeguard the rights of the infected. This can be achieved by providing ample explanation and securing consent, thereby minimizing any violation of their autonomy.

Poor communication within the health system significantly impacted the treatment experiences of COVID-19 patients [22]. The absence of clear guidance on hospital isolation, the deliberate distancing of healthcare workers post-hospitalization, and the feeling of being sequestered in a camp to prevent infection spread rather than for treatment, all contributed to patient confusion and disappointment. Isolation can induce negative psychological states such as anxiety, depression, and aggression, which in turn can negatively affect patients' coping abilities and self-esteem [10]. Consequently, it is crucial to establish a psychological first aid and support system that takes into account the experiences of COVID-19 patients. Additionally, it is important to foster awareness among isolated patients through a precise information delivery system.

Furthermore, the participants believed that residing in a group with other patients exhibiting more severe symptoms, in an inadequately equipped isolation environment, was not beneficial to their health. The adequacy of the isolation space was inversely proportional to the occurrence of mental health-related issues. This aligns with the findings of previous studies, which suggested that inadequate living spaces can negatively impact mental health [23]. The successful operation of isolation facilities hinged on several key factors: the deployment of adequate manpower and medical resources, the provision of therapeutic care, the availability of personal space for privacy, and the maintenance of external connections through various information technologies [24].

Category 2 related to the participants' feelings of physical and mental intimidation, as they unintentionally became agents of disease transmission, despite also being victims of the same infection. This negative perception lingered even after their hospital discharge. As potential infection sources, the participants were isolated from their families and the broader society. Concurrently, their personal information was revealed during the epidemiological investigation, making them susceptible to criticism from mainstream and social media [25]. Physical isolation fosters an "us versus others" dichotomy, with the isolated individuals instantly becoming the "others" and facing stigmatization [26].

The participants in this study felt guilty for unintentionally harming those around them and experienced resentment for being victims themselves. This aligns with the results of previous studies [11]. As their infection led to the closure of schools and workplaces, they developed a strong sense of guilt due to criticism from their families. They were forced to suppress their resentment and frustration [27]. As previous research has indicated, the presence of family members who are vulnerable to infectious diseases, such as the elderly, increases isolated patients' anxiety, requiring emergency psychological interventions [28].

Even after recovering from a novel infectious disease, patients often endure secondary harm in the form of social stigma, which stems from the heightened anxiety society exhibits towards those released from institutional isolation. As recovered patients, they face avoidance within their own homes, making it challenging to discuss their recovery with others [29]. These circumstances not only impede their physical recuperation but also obstruct the restoration of normalcy post-discharge, leading to symptoms such as depression and post-traumatic stress disorder [30]. The escalating concern about the spread and treatment of COVID-19 can muddle societal understanding, generating misinformation and triggering the infodemic phenomenon where unregulated information proliferates [27]. Consequently, it is crucial for public health systems to strive to mitigate the stigma associated with COVID-19 infection. They should advocate for the infected individuals and their families by disseminating accurate information to the public [24].

Category 3 focuses on the care and institutional support provided to patients, which aided their survival and recovery from the challenging periods of isolation and hospitalization they fear to relive. Participants bore psychological scars from the fear of new infectious diseases and negative societal perceptions. These findings align with prior studies that have documented challenges such as shock, isolation, guilt concerning family and friends, and exclusion and discrimination when the community learns of the infection [7, 8, 11]. Notably, over half of the participants in this study were self-employed or freelancers, and they faced criticism and resentment when their infection status was publicly disclosed in local online communities. Regular contact with family and friends was identified as a factor in overcoming a COVID-19 infection [31], aligning with research findings that suggest depression levels decrease as social interaction increases [32]. Moreover, social support was a significant predictor of disaster resilience and post-traumatic growth [32], indicating that social support also plays a crucial role in mitigating the negative effects of COVID-19 and fostering positive adaptation. Consequently, technical support such as remote video calls or the utilization of social resources for disadvantaged individuals should be considered as a strategy to enhance social support.

The participants, whose social interactions were confined solely to healthcare workers within the isolation facility, derived comfort from the warm attitudes of these professionals [31]. These findings underscore the importance of swiftly and effectively implementing empathetic psychological support systems for victims of emerging infectious diseases. Despite experiencing physical and mental exhaustion during their hospital isolation, the participants expressed gratitude for the chance to introspect and appreciate their lives. While the isolation induced negative emotions, the participants managed to avoid dwelling on these feelings by transforming them into opportunities for maturity and growth. A study on Severe Acute Respiratory Syndrome (SARS) revealed the potential for Post-Traumatic Growth (PTG) following an epidemic. Despite the prevalence of negative emotions during the SARS outbreak, some individuals viewed it as a chance to prioritize their family members, leading to "social growth." They achieved "personal growth" by resting, adopting healthier lifestyles, and learning to value everyday life [33]. PTG extends beyond merely returning to a previous state after enduring hardship; it involves a positive reassessment of life. It is crucial to evaluate the potential for PTG following a future COVID-19 pandemic and to identify coping strategies that could predict growth. This would help to mitigate the negative impacts of COVID-19 while fostering PTG.

Category 4 reflected the aspiration for a system capable of rectifying misinformation, eliminating prejudice, and safeguarding those infected. The participants expressed a desire for more precise information from government bodies and measures to prevent negative perceptions and personal exposure, given that anyone could be equally susceptible. The inadequate information supplied by the isolation authorities can induce stress and adversely impact mental health [28]. Consequently, it is vital to provide accurate information about isolation treatment, and relevant organizations must ensure patient anonymity during epidemiological investigations. During patient transportation by ambulance and the isolation process at the patient's residence, personal information often becomes exposed to neighbors. Therefore, patients should be treated with sensitivity throughout the hospitalization and isolation process [31].

The participants expressed a desire for institutional support and prompt psychological counseling interventions to help alleviate their concerns about their livelihoods. The absence of necessary resources and income can lead to ongoing anxiety and anger following isolation [34]. Therefore, institutional support serves as a crucial resource for mitigating additional stress and economic loss for those in isolation. One participant, who did not receive psychological support services during the challenging period of isolation and only received superficial guidance after discharge, highlighted the need for timely psychological support services. The National Center for Disaster and Trauma published specific guidelines for psychological support, including psychological first aid, in relation to COVID-19 in February 2020 [35]. Given that those in isolation often lack prior knowledge about psychological support services and clear guidance [11], it is necessary to provide proactive psychological support services to those experiencing confusion or mental distress due to a COVID-19 infection.

By linking the meanings of categories, this study ultimately derived the theme of "It's okay, but it's not okay." This theme implies that participants, who were inadequately prepared for an emerging infectious disease, experienced a hospital isolation process that seemed to prioritize disease control over their own recovery. Despite the challenges, they gradually resumed their daily routines with the help and support of those around them. However, the lingering trauma of being perceived as the source of infection was not easily overcome. Even after their isolation ended, participants felt the situation was unresolved due to persistent social stigma, which led to their ostracization. They also continued to worry about potentially infecting others [30]. Even after being medically cleared of COVID-19 and discharged, individuals may remain on high alert regarding health management and infection control, leaving a lasting, unhealed wound. Therefore, public health authorities should strive to prevent the exacerbation of mental health issues related to COVID-19 infection by offering ongoing psychosocial support services through local health systems, even after patients have been released from isolation.

After examining the experiences of COVID-19 inpatients during their hospital isolation and early recovery period, several conclusions were reached. In the dire circumstances of the COVID-19 pandemic, isolating infected individuals proved to be an effective strategy to prevent community transmission. However, when implementing isolation measures under the guise of public protection, it is crucial to prioritize minimizing infringements on autonomy and ensuring the human rights of the infected. Rather than focusing solely on their status as isolated individuals, they should be treated as patients requiring therapeutic care. It is necessary to ensure their well-being in hospital isolation by providing a comfortable physical environment, adequate staffing, and resources, as well as offering detailed guidance on institutional procedures and future progress. Healthcare workers should also address the loneliness these patients may experience by maintaining frequent communication.

This study revealed that participants, even after their isolation period had ended, felt overwhelmed by the physical and emotional toll of COVID-19 during the early stages of recovery. They found it challenging to return to their previous daily routines. Therefore, it is crucial to establish a psychological support system that takes into account the experiences of COVID-19 patients. It is also important to formulate a national policy that addresses the concerns of those in isolation, through measures such as emotional support and financial compensation. Additionally, more research is needed to identify coping strategies that could potentially predict growth, in order to minimize the negative impact of COVID-19 and promote PTG. This study is significant as it explores the psychological, social, and policy considerations necessary when implementing isolation treatment for infected patients during the early stages of emerging infectious diseases like COVID-19 in the future.