“They could just come, they peep, then they get back”: COVID-19 patients’ experiences of care in isolation in Nairobi, Kenya

Isolation is a core measure of outbreak control, yet it reduces patients’ contact with health workers and removes the support of family. During the COVID-19 pandemic, health workers became the main human contact for isolated patients while themselves contending with fear of infection and stigma. Little is known about how patients in sub-Saharan Africa experienced health workers’ conduct under these conditions. This study explored how adults isolated with COVID-19 in Nairobi, Kenya, experienced interactions with health workers. I conducted a qualitative descriptive study using in-depth interviews with 15 adults who had recovered from COVID-19 after hospital isolation in Nairobi between 2020 and 2022. Participants were recruited through purposive and snowball sampling and interviewed in February and March 2023. Data were analysed using reflexive thematic analysis, and the resulting codes were mapped onto the Bohren et al. typology of mistreatment. Four themes were developed. First, some health workers offered attentive care, giving patients hope through encouragement and reassurance. Second, contact was brief and distant, a pattern that health workers themselves attributed to fear of infection. Third, care was organised around routine monitoring, so that deterioration and emotional distress often went unnoticed. Fourth, some patients encountered ridicule of their distress and perceived that patients were treated unequally. Most experiences corresponded to existing domains of the typology but distancing driven by fear of infection did not. Isolation increased patients’ dependence on health workers at the same time as it created conditions that drew health workers away from them. Fear-driven distancing emerged as an additional domain of mistreatment in outbreak settings. Unaddressed, these patterns may compromise patient safety and weaken the trust on which outbreak responses depend. Preparedness plans should set minimum contact standards for isolated patients, include psychosocial assessment in routine monitoring and address health workers’ fear of infection.