The COVID-19 pandemic, and the sweeping measures of communities around the world to limit its deadly toll, have profoundly altered the way we live and interact. In large swaths of the United States, for weeks on end, schools have been shut down, businesses idled, and the streets of major cities emptied as large populations have been ordered to remain at home.
To most of us, the past several months may have seemed like uncharted territory. But in fact, the COVID-19 pandemic isn’t entirely unprecedented. International outbreaks of deadly diseases have swept the globe before, including other dangerous coronaviruses, such as severe acute respiratory syndrome (SARS) in 2003. During and after coronavirus emergencies, researchers scrambled to better understand the effects of preventive measures such as quarantines and community lockdowns on people’s mental and physical health.
As communities around the world grapple with one of the worst pandemics in the last 100 years, here’s what previous outbreaks have taught us about how to get through the worst—and how to recover from extended periods of quarantine and social isolation.
The psychological toll of social isolation
By now, many of us know firsthand what it feels like to be quarantined or told to shelter at home. We’ve experienced the anxiety, confusion, anger, fear, and even boredom that results. But what about when life begins to return to normal after an extended period of isolation?
As the COVID-19 outbreak was beginning to spread in December 2019, with lockdowns in the epicenter in Wuhan, China, researchers at King’s College London embarked on a rapid review of what previous studies had shown about the short-term and long-term psychological effects of quarantines and extreme social distancing. The findings, published in The Lancet on March 14, 2020, were intended to help guide both policymakers and the public.
In their review, the research team analyzed results from 24 relevant studies. Some of the studies looked at the effects of quarantines on medical staff. Some examined the impact of quarantines on patients and families.
At first glance, the findings weren’t surprising. Many people reported feeling stress, anxiety, and fear that lingered after quarantines ended. In just one example, a study of hospital staff potentially exposed to SARS found that quarantined medical workers were significantly more likely than nonquarantined staff members to report feeling exhausted, detached from others, and irritable, and they were also more likely to report having trouble sleeping, concentrating, and working after the nine-day quarantine period ended.
For some people, the experience resulted in the even more extreme symptoms of post-traumatic stress disorder (PTSD), which included intrusive and distressing memories, nightmares, and flashbacks in which they relived the worst moments of the event again and again. In some cases, PTSD can be psychologically crippling.
The mental health impact of being quarantined can apply to adults and children alike. According to another study that was part of the review, the average post-traumatic stress scores in children quarantined during a health emergency were four times higher than those of children not quarantined. Among their parents, 28 percent of those quarantined reported symptoms of mental health disorders related to psychological trauma, compared with only 6 percent of parents not quarantined.
The ill effects can be long-lasting. In another study of hospital workers during and after the SARS outbreak, researchers found that 9 percent of the group reported symptoms of depression three years later. Among those reporting the most severe depression symptoms, 60 percent had been quarantined. In comparison, among those reporting the mildest symptoms, only 15 percent had been quarantined.
The damaging effects of quarantines and lockdowns can play out in other ways, as well. Findings reviewed by the King’s College researchers showed that three years after the SARS outbreak, for example, hospital workers who had been quarantined were more likely to report symptoms of alcohol abuse or dependency.
Who’s at greatest risk?
People already prone to anxiety or depression may be more vulnerable to harmful psychological effects from being quarantined or living through a lockdown. And the longer a period of isolation lasts, the more likely that people will experience long-term mental health problems such as depression or PTSD. People are also more likely to suffer anxiety or depression if, during a lockdown or a quarantine, they don’t receive adequate support and information about why they are being isolated.
Even before the COVID-19 pandemic hit, older Americans were more likely than their younger counterparts to be socially isolated. Older people are more likely to live alone and to have lost close friends. They’re also more likely to have chronic illnesses that make it difficult to engage with other people and to have sensory impairments such as hearing loss or limited vision, which add to a sense of isolation. Nearly one in four Americans aged 65 and older who live in community settings are socially isolated, according to a 2020 Consensus Report by the National Academy of Sciences (NAS).
Small wonder a significant proportion of older Americans—43 percent of those ages 60 and older—report feeling lonely (defined as a subjective feeling of being isolated). And the ill effects can show up in both mental and physical ways. According to the NAS report, strong evidence links social isolation and loneliness in older adults to increased risk of early death, dementia, heart disease, and other health problems. Social isolation is linked to an approximately 50 percent increased risk of developing dementia, for example. Among older people with heart failure, loneliness is linked to a fourfold increased risk of death.
The public health measures taken to slow the spread of COVID-19 have made many older Americans even more isolated than before. Because of lockdowns in many states, friends and families haven’t been able to visit or be in physical contact with older loved ones. And because the new coronavirus poses the gravest danger to older people, they’re likely to experience the greatest fear and anxiety about their own health and safety.
Adding to that fear is the fact that nearly all persons 50 years and older interact with the health care system in some way because of chronic age-related conditions. For many older people, the health care system may be their only point of contact with the broader community. And because the COVID-19 pandemic has created a situation wherein even routine care poses a real risk of exposure to the virus, many medical centers and health plans have specifically discouraged people from going in for anything but emergency care. For older Americans already feeling isolated, lonely, or worried, the emergency measures can cause those feelings to worsen.
What you can do
For many reasons, the COVID-19 emergency has taken a heavy toll. What can you do to remain as resilient as possible in its aftermath? Here’s what experts recommend:
- Keep in mind that it’s normal to feel anxious, depressed, or fearful. Research shows that the effects of quarantines and lockdowns can last for months or even years. Recognizing that anxiety and depression are normal in the aftermath of a public health emergency like COVID-19 can help you understand that you aren’t alone.
- Connect with others. Reaching out to friends and family is one of the best ways to reduce anxiety, depression, and loneliness. If it’s not yet safe for you to visit people in person, use the telephone, text messaging, or email to be in contact.
- Look for ways to ease stress and anxiety. Stretching, taking walks, doing yoga, or meditating are all great ways to relax your body and mind. If it’s safe to resume normal activities, consider taking an exercise class at a local gym or senior center, where you can combine activity with social contact.
- Seek help if you need it. If you continue to feel anxious or depressed, contact your doctor to schedule an in-person or telemedicine visit. Psychological counseling or medications may help. You can also use the resources in the inset below.
- Be hopeful. An experience like the one we’ve all been going through with COVID-19 brings more than its share of worry and sadness. But there are also inspiring stories of people helping one another. Consider the results of a telephone survey of people in Hong Kong after the SARS outbreak there in 2003, published in the Journal of Infection in 2006, in which researchers found that more than 28 percent of the respondents reported receiving increased support from friends, and 39 percent said they received more support from family members when they were in need. More than 35 percent of respondents said they began sharing their feelings more frequently with family members. In addition, 35 to 40 percent of those interviewed reported spending more time resting, relaxing, and exercising. Many religious individuals reported that the experience deepened their faith.
Resources for Help
Recovering from the fear and social isolation of the COVID-19 pandemic likely won’t be easy for many of us. If you’re struggling with feelings of loneliness, anxiety, confusion, or depression, these resources can help.
This article appeared in the June 2020 issue of UC Berkeley Health After 50.
Also see Suicide Warning Signs.
Published June 02, 2020