Earlier this week, I went through a process that will soon become commonplace: I quarantined myself. After going to a large journalism conference where someone later tested positive for coronavirus, it seemed like the prudent thing to do. The process is increasingly normal and medically endorsed; it's already clear that limiting social contact is absolutely the best way to reduce the spread of coronavirus. But that doesn't make it easy.
Before shaming others for going to the park or labeling staying indoors as a "minor inconvenience," as has happened on Twitter, know that medical quarantine, and isolation in general, is associated with serious mental health effects. A recent review of research, published in The Lancet, found that quarantine is linked with post-traumatic stress disorder (PTSD) symptoms, confusion, and anger, with some research suggesting these effects are long-lasting. Given that the coronavirus crisis is likely to be with us for some time, the mental health implications can't be dismissed.
Whether in quarantine or not, anxieties are only worsened by confusion and social judgment as people try to figure out the appropriate response. A friend living in Venice recently described the dynamic playing out around her, as Italy enforces strict social-distancing measures. In an email, in she writes:
There is an eerie silence throughout this city now, a drawn look on the face of anyone who is scurrying around the streets (as I still am), an accusatory dynamic between friends and family as each person tries to insist either that they are right in NEVER leaving the house or alternatively that they are right in STILL leaving the house... No-one seems to be able to accept the free decisions of others at the moment, from the government right on down, and I find that worrisome.
Clear information from government sources is a helpful piece of the process. Psychiatry professor Rima Styra and her University of Toronto colleague Laura Hawryluck, a professor of critical care medicine, researched quarantines during the SARS outbreak and found that 29% of those quarantined showed signs of PTSD, and 31% had symptoms of depression following isolation. "Our study really pointed to the importance of reliable, consistent information and updates so that people can understand what we know, what we don't know and how we are trying to close this gap," the professors wrote to us via email.
Public health and government services should provide detailed information about the symptoms of coronavirus, its typical course, how many are being cared for at hospitals, and for how long, Styra and Hawryluck advised. "The ways people in quarantine will be monitored and what to do if they start developing symptoms also need to be crystal clear and be flexible enough to meet the needs of people with different levels of access to and skills in technology," they added.
Public guidance is currently vague, with various health officials offering different instructions. Among colleagues and acquaintances who were potentially exposed to coronavirus at the journalism conference I attended, some were told to isolate themselves entirely, others were told to simply avoid large crowds, and some were told it's ok to get groceries as long as they keep their distance from others.
There's no clear right answer given these contradictory messages, but it's better to find a doctor or public health official you trust over amateur epidemiologists. The one I consulted for my own situation advised taking strict precautions if you come into contact with someone with coronavirus (of course, what constitutes "contact" depends on which health official you speak with). She also recommended stringent isolation for anyone with symptoms of coronavirus.
Despite the confusion over exactly how and when to quarantine, millions of people around the world will inevitably have to drastically reduce social contact and spend time in isolation to combat coronavirus. Frank McAndrew, an evolutionary psychologist at Knox College in Illinois, notes that enforced quarantine is particularly distressing. "Being quarantined gives one a sense of being at the mercy of other people and other uncontrollable forces such as an epidemic. This leads to a feeling of helplessness and uncertainty about the future that can be very unsettling," he tells us via email.
Prolonged periods in situations where nothing changes can push people to turn inward, McAndrew notes. "For those unaccustomed to such introspection and rumination, the experience can lead to negative emotions, and in extreme cases, a blurring of the boundaries between what is going on in one's own mind and what is actually happening around you," he writes. Activities that create a sense of change and purpose, such as rearranging the furniture or cleaning the house, can help create stimulation.
Sue Firth, a chartered occupational psychologist in the UK, says that humans need the ability to make decisions and be in control, a sense of community and connection with others, and purpose or effectiveness. She suggests trying to create all of this while in isolation, whether by Skyping friends, assigning yourself structured work, or exercising indoors with yoga or dance videos. Creative projects such as drawing, compiling photographs, or sudoku can help keep the mind active.
For those who aren't in strict isolation, offering to help others can help create a sense of community. Loneliness is a serious health risk to older people who are vulnerable to coronavirus and are compelled to avoid social contact. Online groups offering to run errands and collect groceries can help those who are suffering the worst of isolation.
Ultimately, though self-care is important, professional treatment is crucial for a wide range of mental health problems. China's National Health Commission released guidelines for psychological care during coronavirus and relocated mental health professionals to Wuhan, where the outbreak started, as reported Bloomberg. Several provinces in China also created 24-hour mental health hotlines to support those suffering from coronavirus and isolation.
The mental health implications of isolation do not mean we shouldn't quarantine. It's essential to follow medical professionals' guidance on combating coronavirus, just as it's important to recognize the difficulties. In times of isolation, we can support each other by recognizing mental health struggles and providing comfort even from afar.
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