When China locked a series of cities in January to stem the spread of COVID-19, experts warned that other countries may not be able to pursue the same policy. But in recent weeks, cities, states, and countries around the world have similarly limited people’s movement to stop the spread of the virus.
Some people exposed to the virus need to be away from others in formal quarantine for two weeks. Other communities are full of people who have no documented exposure to the virus, yet have been told to stay at home to slow the pandemic.
Previous research has shown that these decrees, at both individual and community level, can take an emotional toll. None of that research, which focused on the psychological impact of quarantine during outbreaks of diseases such as SARS and Ebola, is entirely consistent with the current global situation, said Neil Greenberg, professor at King’s College London and president of the United Kingdom Psychological Trauma Society . But it provides good guidance for what experts expect to see during this pandemic. Greenberg reviewed the existing evidence in a paper published in The Lancet.
“The main message that came across was that if you quarantine or isolate for longer bad, that instead of just being troubling, it can have some long-lasting psychological consequences, ”he says. “There is evidence of depression and some of the symptoms of post-traumatic stress disorder.”
During a pandemic like this, it is necessary for public health to quarantine some people and ask the rest to stay at home. However, civil servants can structure isolation to minimize the psychological impact of that policy, for example, by not promising that a quarantine period will last for a specified time and then extend it for an extended period of time.
The edge spoke to Greenberg about the best way to manage a shutdown.
This interview is slightly edited for clarity.
What does a poorly executed quarantine look like?
Bad quarantine means that people are not given good information about what they are doing and have no good reason why it is needed. They do not have access to basic necessities or health care and do not have good communication. If people suffer financial losses and feel like they can’t afford to go on with their lives, it can have a bad impact. And if someone changes the length of time you’re quarantined at the last minute and says it should be longer. That is not only a recipe for ineffective isolation, but for poor mental health.
How well officials and governments are doing to safeguard these quarantines are not badly done?
It varies quite a lot. Some countries have draconian policies and some are lax. The most important thing about isolation around the world is that people want to see a good reason why it is being done. In Italy, with the death rates as they are, there is good reason why the government should impose a restrictive regime. That helps.
In a situation where we are deeply concerned about many deaths, but the number of deaths is currently low, people may question the reasoning. At the time, there are concerns that people are not isolating who it should be. There is confusion: why is this happening, why aren’t people holding on to it?
But public health experts say that restrictive measures work best if they come into effect before many people die – how do we ensure that people see that as sufficient reason?
As we do in all aspects of life. We try to draw from previous experiences with when that was important. Certainly among the scientific community there has been discussion about the Spanish flu of 1918. The danger is that people say that we did not have the health care that we have now. The stronger the similarities, the better.
It is believed that when this crisis is over, people will be much more understanding next time than before. It is difficult enough for governments to figure out what to do next. In this case, even clear scientific stories and information are difficult for people to understand.
Psychologically, is there a difference between being quarantined as an individual and being quarantined – or told to hide – as a city or state?
If you look at war or terrorism that hits entire cities, we see that when we’re in it together, it makes things easier. In general, people at risk or those who have been quarantined can be stigmatized. They are considered dirty or contaminated. If everyone has been in it together, you won’t see it. People are less often classified as different or strange, which, if it happened, could cause mental health problems.
If you asked people in Europe in 1938 how they could cope with years of bombing, everyone would say it’s impossible. But as soon as you get a new sense of what is normal as a community, people adapt and deal with it.
What should governments and individuals do next to help people recover from the emotional challenges of their reception?
It absolutely must be part of the recovery process. But it is not inevitable that people will have mental health problems in the long run. Some people will thrive: in a bizarre way, especially health workers, who face extraordinary challenges. They can have the opportunity and have what we call post-traumatic growth. I try not to be too positive, but it is not all doom and gloom.
The challenge is how do you get a population, a family, a team to keep going while also detecting the small percentage of people who experience mental health problems? How do we get help with access to care? Access to care can be difficult at the best of times, and there’s no reason to think it will be easier. In our recovery plan, we need to think about how we can identify and help those people.
As we look for the benefits, we can learn how to better communicate with our loved ones when we are locked up. We can end, if we go back to normal socialization, in a community with a better capacity for the left than before.