Quarantine and mental health
Public health authorities should take every measure to ensure home-quarantine ‘is as tolerable as possible for people,’ researchers say
TORONTO — Wear a mask when you are in contact with any family member. Take temperature twice a day. Please record your temperature. We will phone daily. Sleep in a separate room. Use a separate bathroom if possible. Use separate towels and utensils. Do not have any visitors to your home. If you need to walk your dog, use your backyard only. – From the Durham Region Health Department for home quarantine requirements during the 2003 SARS outbreak. Some 15,000 Toronto residents agreed to 10 days of voluntary self-quarantine during the outbreak of severe acute respiratory syndrome nearly two decades ago. When it ended, a notable proportion reported, among other psychological effects, feelings of fear, anger and anxiety-induced insomnia.
Few reported happy feelings.
Like Prime Minister Justin Trudeau and his wife Sophie Grégoire Trudeau, now selfquarantining after Sophie tested positive for COVID-19, thousands of Canadians could soon be under self-isolation, instructed to separate themselves from others for 14 days with the purpose of preventing the spread of the pandemic virus.
It’s highly unlikely homebased quarantines would be enforced as oppressively as China, where officials in the northeastern province of Heilongjiang threatened those who intentionally spread the virus with the death penalty, or in Italy where, according to unconfirmed reports, careless COVID-19 spreaders could be charged with “malicious murder.”
As the virus spreads here, more people will be asked to isolate themselves at home, perhaps even in a dedicated mass quarantine facility, an often “unpleasant experience for those who undergo it,” according to a rapid review published by The Lancet.
“Depriving people of their liberty for the wider good” needs to be orchestrated carefully, the researchers from King’s College London wrote, because the psychological impacts can be substantial and “long lasting.”
Granted, the psychological fallout of not using quarantines and allowing the virus to spread freely might be decidedly worse, they wrote. However, “if quarantine is essential, then our results suggest that officials should take every measure to ensure that this experience is as tolerable as possible for people.”
One 2004 study found that Toronto residents quarantined during SARS displayed symptoms of depression and PTSD. SARS was more lethal than the pandemic novel coronavirus, killing 10 per cent of those it attacked, more than double COVID-19’s currently estimated fatality rate. But SARS burned itself out in relatively short time. Those in quarantine also didn’t have Skype or WhatsAapp.
“It was very much an isolating type of experience,” said Dr. Rima Styra, an associate professor in the department of psychiatry at the University of Toronto and a co-author of the 2004 paper.
There was also a tremendous amount of percolating fear.
People with a pre-existing mental health issue, like an anxiety disorder, would be more vulnerable to experiencing negative psychological effects of self-quarantine, as would the elderly, who may not have the same social contacts younger people do, or even access to practical things like food and clean laundry, Styra said.
“Confinement, loss of usual routine and reduced social and physical contact with others were frequently shown to cause boredom, frustration and a sense of isolation from the world,” according to the British authors of the recent review.
“They also became particularly worried if they experienced any physical symptoms potentially related to the infection.” People can become hyper vigilant, Styra added. “Is it going to be today? Tomorrow? How many more days do I have left in isolation before something happens?”
Many cited woefully inadequate information from public health authorities as a major stressor.
People who are isolated or quarantined need to be told
“if they can walk their dogs, go out to the barn to care for animals, go for a run or a hike in their local park as long as they stay six feet away from other people and wear a mask, or, is it indoors always end of story?” writes medical ethicist Dr. Arthur Caplan of the NYU School of Medicine.
“What about roommates if you’ve still got to share a bedroom and a bathroom, can your partner still go to the store for you, let in workmen, accept deliveries? Few seem to know what to do if they are advised or ordered to stay home. And if they don’t — Tasered, arrested, fined or cited?”
Psychological distress isn’t the highest priority for people facing urgent practical and economic problems, said
Dr. Allen Frances, professor emeritus and former chair of the department of psychiatry at Duke University. There’s no safety net for gig economy workers. Only 40 per cent of Ontarians can work from home.
However, “On the plus side, people can learn how much they don’t really need to be happy and what is really most meaningful in their lives,” he wrote in an email.
“Being socially isolated in our homes can also paradoxically bring us closer together as a community,” Frances said. “We are all in this together and the crisis reminds us how interdependent we are on this tiny pebble of a planet.”
People needn’t panic, he said. The vast majority of infections are mild, many appear not to get sick at all and the risks to any individual aren’t high except for the elderly and those with underlying health conditions. “Dangers have always been part of the human condition and we’re adapted to deal with them,” Frances said. Still, the outbreak must be taken seriously, “and requires much more competent responses than those so far managed by our leaders,” he said.
Without aggressive, proactive steps to control COVID-19’s spread, some doctors in Canada fear we’ll be in the same dire situation as Italy, where doctors working in Milan are reporting that they can’t offer life support to patients over 65 because they don’t have enough ventilators.
People asked to go into self-isolation will need to know what’s involved, and the symptoms to monitor for, Styra said. According to Ottawa Public Health, those instructed to self-isolate shouldn’t use public transit, taxis or rideshares.
They should stay in a separate room away from other people in the home as much as possible, and make sure any shared rooms have good airflow (like open windows). They should keep a distance of at least two metres from others and wear a mask covering the nose and mouth. Sleep alone if possible. Regularly wash hands with soap and warm water for at least 20 seconds.
Anthropologist and cognitive scientist Samuel Veissière of McGill University remains skeptical of the actual level of threat posed by the virus. “It’s a little unfortunate that some places tend to be moving toward too much isolation and really drastic measures,” he said. That increases panic, worry and “fear of the other.” Anyone is seen as a vector of disease.
But he’s also optimistic. “Conditions of extreme danger and disruption of public order — like natural disasters — typically tigger a lot of solidarity, co-operation, care and spontaneous help between strangers.”