To say our current times are stressful is a serious understatement. But while we are all in the midst of very real turmoil, for those being quarantined or who fear quarantine, the threat of COVID-19 has additional stressors – also known as psychological effects.
In times of serious illness, quarantine and full isolation are necessary in order to ensure the health of everyone and to slow and stop the spread of dangerous viruses. However, while the mandate to quarantine is a necessary health measure, there are very serious additional psychological effects that pose risks to about 20% of those under quarantine.
The Effects of Quarantine
Based on a qualitative study performed by Dr. Samantha K Brooks et al. at King’s Colledge London, the short and sweet solution to the problem -if there is on- is to arm people with information. The main takeaway from the study is that lack of access to information and communication is crippling. This is so not just for those in quarantine, but for those who worry about being quarantined.
Dr. Samantha K Brooks’ study, which examined over 3500 reports, investigated the potential effects of quarantine COVID-19 by comparing our current situation to other instances of quarantine.
These comparative studies included:
- Severe Acute Respiratory Syndrome (SARS)
- Ebola, H1N1 influenza (swine flu)
- The Middle East respiratory syndrome (MERS)
- and equine influenza (horse flu)
The study recognized the importance of quarantine to contain certain viral outbreaks. But in this case, the focus is on the psychological effects of quarantine and the mental health concerns that need to be considered. By understanding the potential risks of quarantine, Dr. Brooks makes several qualitative suggestions and how to mitigate these negative outcomes, which include longer-term psychological outcomes.
It is important to note that extreme negative effects were exhibited in just under 20% of those included in the studies of those who had been quarantined for past viral outbreaks.
And of that 20%, many of those are medical workers who were infected while treating others for the illness. While others in the set were already at risk for mental health concerns for a number of reasons.
Aside from the concern for personal health, many of those who had been quarantined were concerned about the following things:
- being separated from loved ones
- being contagious and getting loved ones sick
- loss of freedom, the uncertainty of the outcome
- the loss of income
- and boredom
As mentioned earlier, one of the easiest ways to alleviate many of the stressors is to make sure that those in quarantine have access to news and up-to-date information. The information these individuals need includes their medical progress, but also the world around them.
It is equally important for those quarantined to have easy ways to stay in touch with family and friends while in isolation. The key take-away here is the mental health is a health-care matter.
Where the research on psychological effects comes from
In order to understand the effects of quarantine on peoples’ mental health, research was collected from 24 studies previously. These studies included a range from 10 countries that have quarantined parts of their populations after the outbreak of deadly viruses.
The viruses that were used to understand COVID-19 included:
- Severe Acute Respiratory Syndrome (SARS)
- Ebola, H1N1 influenza (swine flu)
- The Middle East respiratory syndrome (MERS)
- Equine Influenza (horse flu).
The results of the examination are based primarily on multiple SARS studies. The study shows that low-end of 20% of people that were quarantined for the virus reported, reported that they being quarantined caused feelings of fear, anxiety, sadness, and guilt. In other reports, some exhibited symptoms of PTS (post-traumatic stress) as well.
And, one study demonstrated that those who were quarantined for longer than 10 days showed much higher PTS symptoms than those who were quarantined for a shorter period of time.
The study also considered the long-term effects of quarantine. Two studies reported that even up to 3 years after the SARS outbreak those who were quarantined had higher rates of alcohol abuse or other dependency symptoms. Negative long-term effects were even more common among health-care workers who had been quarantined.
Details of Concerns
Access to information
Based on a survey of research during the SARS crisis in Toronto, a set of those who were quarantined felt that they were not given adequate information about things relevant to them. This included insufficient guidelines for how to take care of themselves and how to avoid infecting others, and how long the individual would be quarantined.
Individuals were also confused about how exactly to go about quarantine, which included what the necessary daily procedures of the individual for physical and mental well being were.
Many felt that in Toronto, there was poor communication between levels of government. As a result, those who were quarantined were not clear on the Federal government of Canada or the Provincial Government of Ontario’s processes. Both levels of government had a large impact on the local municipal government.
This lack of clear communication between levels of government, and the perceived problems with government transparency, lead to increased levels of anxiety related to the lack of access to relevant information.
All in all, without clear guidelines from places of authority, many of those quarantined found that this lead to more psychological angst during and after quarantine.
Financial and other Stressors
In addition to concerns for access to information, there are very real and very negative financial consequences to those sick and quarantined.
Even for those in countries that have universal health care, there is still an issue of:
- The inability to work
- The lack of compensation in hourly paid and self-employed people without sick or vacation pay
- The long-lasting effects of going without working and earning
The severity of financial stressors varied based on the kind of employment that people had. Nevertheless, in all cases, those where were economically effected felt the strain more grievously. In Toronto’s SARS case, citizens were given government reimbursement. However, these payments often end up being slower than normal income, and therefore, the delay added to financial strain.
Moreover, those who had been quarantined also experienced stigma, and the anxiety of being stigmatized. This is because others, including family, friends, colleagues, and neighbors, were less likely to interact with them once their quarantine was over.
Health-Care workers and the psychological effects of quarantine
Health-care workers who were quarantined had their own specific concerns, and in many cases were more likely to suffer the effects of quarantine in a more serious and long-term way. In general, health-care workers demonstrated that they suffered from the following:
- greater stigmatization than the general public
- greater avoidance behaviors after quarantine
- reported greater lost income
- and were more affected psychologically
Furthermore, this group reported higher levels of the following:
- anger, annoyance, fear, frustration, guilt, helplessness, isolation, loneliness, nervousness, sadness, worry
- they were also generally less happy than others who had been quarantined
Health-care workers were also more likely to think they had the virus (in this case SARS) and were concerned that the would infect others. Furthermore, many had family members who felt that their jobs had become too much of a risk.
Limiting the Psychological Effects
Given the serious and negative psychological effects that quarantine can have on a significant part of the population, experts have made several suggestions and observations that might help to mitigate the short and long-term effects of quarantine.
- To begin, those who are already at a higher risk for psychological and psychiatric issues are at a higher risk. This suggests that special attention be given to those who fall into this category.
- Health-care workers require additional support during and after quarantine. Given that this group has specific and additional stressors, it is important that they get support from their managerial staff. This is especially true given the added concerns that family members might have, in regard to the dangers of their jobs.
- Quarantine should be kept as short as possible. The longer people are quarantined, the greater potential there is for short and long-term effects of isolation.
- All individuals need to be given constant access to relevant information about being quarantined and those in quarantine. This includes ensuring that the infected understand the real rather than believed health risks. This is true of those who are not ill as well. Health officials need to be clear and organized in order to maintain clear communication. It is essential to ensure that only accurate and intelligent information is guiding the treatment of those in quarantine, as well as the concerns of those who are not.
Summary of Issues based on Past Quarantines
The importance of quarantining for those infected with dangerous viruses cannot be understated. However, it is equally important to acknowledge the negative effects that quarantine can have on those individuals.
Based on studies from other viral outbreaks, Dr. Brook’s study draws several important conclusions. The conclusions should be taken seriously in light of COVID-19.
Firstly, the negative psychological effects of quarantine may include any of the following: post-traumatic stress symptoms, confusion, and anger. Based on one study, a history of psychiatric illness was associated with experiencing anxiety and anger 4–6 months after they had been released from quarantine.
Secondly, these psychological effects are reported when quarantine is of a longer duration. Individuals are afraid of infecting others, so they become frustrated due to lack of information. Other stressors include:
- Lack of efficient medical care
- Increased boredom during isolation
- Inadequate supplies due to slow roll-outs or lack of supplies
- Insufficient information.
Finally, to add insult to injury, those quarantined suffer the long-term effects of financial loss. Not to mention the stigma of being contagious longer than in actuality. Long-term effects also include increased risk of addiction to substances. This as in heightened in those already at risk of addiction, as well as in health-care providers.
The psychological effects of quarantine and isolation are wide-ranging and unique. However, for those who are in mandatory quarantine as a safety measure for themselves and for others, it is possible to reduce the effects of the quarantine through the following proposals:
- People should be quarantined no longer than absolutely necessary, which must be determined based on solid scientific evidence. Quarantining longer is not necessary and increases the risks of negative psychological and long-term effects.
- Those in quarantine must have adequate and readily access to necessary material supplies. This requires coordination with medical and commercial centers to ensure both medical and material needs are met. These supplies should be ready expediently so that no one is made to go without, or left wondering when they will be given the supplies that they need.
- Adequate access to information must be made a priority. This includes informational access to personal connections as well as medical officials. The results of quarantine are heightened when people are made to feel that they are in the dark. This means ensuring that there is not only an adequate communication chain between officials but also that the quarantined have regular access to phones and internet connections.
- Health-care workers are at particular risk for negative psychological outcomes. It is advisable that they have adequate support from their managerial staff. Offering support groups for this specific group can also be an effective treatment for the specific concerns that they have.
The events of the last few months of COVID-19 and the outcome of the study demonstrate the importance of adequate access to information. Access to information is not only about access to internet and phone services, although this is proving to be very important at this time.
Quality information is also seriously affected by the primary means of communication on a local and global scale. Currently, comparing the relative success of managing and responding to COVID-19 can be observed based on nations that have been able to act quickly and inform their citizen. Germany is a particular example of a country leading the way in the organization of testing. In this way they’ve been able to control the spread of the virus with limited use of quarantine and isolation.
Regardless, many must self-quarantine during this time. Particularly those who have recently returned from traveling, those who are symptomatic, and those who are recovering from the virus. Many of these people may have a brush with these psychological effects.
Nevertheless, it is important to take your mental health into consideration and to reach out for all levels of support to help one another. This is especially true for the vulnerable and for our health-care workers during this incredibly trying time.