Only the lonely: Experts warn of dangers of self-isolation
Anxiety, insomnia among long-lasting psychological effects
Some 15,000 Toronto residents agreed to 10 days of voluntary self-quarantine during the outbreak of severe acute respiratory syndrome (SARS) 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. Thousands of Canadians could soon be under self-isolation, instructed to separate themselves from others for 14 days.
It’s highly unlikely home-based quarantines would be enforced as oppressively as in China, where officials in the 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 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.”
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 back then also didn’t have Skype or Whatsapp.
“It was very much an isolating type of experience,” said Dr. Rima Styra, an associate professor of psychiatry at University of Toronto and 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 such practical things as 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. “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 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?”
However, “On the plus side,” wrote Dr. Allen Frances, professor emeritus and former chair of the department of psychiatry at Duke University in an email, “people can learn how much they don’t really need (in order) to be happy and what is really most meaningful in their lives.”
“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; dangers have always been part of the human condition and we’re adapted to deal with them. Still, the outbreak must be taken seriously, “and requires much more competent responses than those so far managed by our leaders,” he said.
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 trigger a lot of solidarity, co-operation, care and spontaneous help between strangers.”