How to Manage the Psychological Effects of Quarantine
How quarantine affects people and what we can do.
Posted Mar 20, 2020
By Gabriel Banschick
The first confirmed case of coronavirus appeared in China on November 17, 2019. By the end of December, Chinese doctors were sounding the alarm on WeChat. Yet the Chinese government tried to stop information regarding the virus from getting out and arrested doctors involved in the chat (they were later acquitted). People in China continued their usual activities unaware of the danger of coronavirus.
Background: Quarantine in China
It took two months for the Chinese Center for Disease Control to acknowledge that the virus can be transmitted between humans. On January 22, the Chinese government finally declared a state of emergency and suspended transportation to and from Wuhan in the Hubei district, which was perceived as the epicenter of the epidemic. By January 28, the entire Hubei region was under quarantine.
Eventually, the Chinese government imposed stricter and stricter measures, using its considerable authoritarian powers to enforce them.
It worked. By mid-February, the curve of Chinese cases had started to flatten (while the number of cases in the rest of the world continues to rise and by now exceeds China’s).
Quarantine in the USA: Not the Chinese Model
Although political conditions in the Western world are not as severe as in China, there is a real possibility for a prolonged quarantine period for a substantial number of people.
Some people are already under self-imposed quarantine. This is particularly true of older people.
Many nursing homes have imposed a lockdown of their facilities to protect their vulnerable population. Schools and universities have closed their doors, sports events were canceled, and restaurants and theaters have been shut down. As a consequence, economic activity has slowed down substantially as people are confined to their homes, although for now, it’s mostly voluntary.
By the end of January, the federal government started imposing mandatory 14-day quarantines on people coming back from China. People who came in contact with an infected person were required to stay in self-imposed quarantine. But things quickly got tougher in many parts of the U.S. as well as in other countries. As of March 17, The governor of California imposed a state-wide lock-down. In some parts of the Western world, the quarantine is forcefully maintained.
Recently, France deployed 100,000 police officers to enforce military-style quarantine across the country. Without question, people feel penned in. The question is, how do they cope?
Psychology, Quarantine, and Consequences
Although social media can mitigate the effects of quarantine for many people, it can’t replace human interaction in physical space. Compound that with being confined to a small area—perhaps a room in an apartment when an infected person needs to isolate from family—and then consider the many worries about the possibility of getting infected, or infecting other people, not to mention the financial consequences. You get a recipe for real psychological distress.
A recent review of the psychological impact of quarantine reports that most studies of quarantined subjects observed effects such as confusion, anger, and post-traumatic stress symptoms, sometimes lasting even three years after the end of the quarantine.
A study from Canada examined the psychological effects of quarantine during the SARS outbreak of 2003. The median duration of quarantine was 10 days. They found a high prevalence of psychological distress symptoms. Twenty-nine percent of participants reported symptoms of post-traumatic stress and 31 percent of respondents reported symptoms of depression. Participants in this study described a sense of isolation and were particularly affected by the lack of social and physical contact with family members.
Being quarantined at home with other family members can be a blessing or a curse. It is an opportunity for families to come together and strengthen their bonds. But being constantly together involuntarily can put considerable stress on relationships. Small children may be overjoyed at the opportunity to be with mom and dad almost all the time; adolescents, on the other hand, may be less enthusiastic, and tensions can arise.
The Mentally Vulnerable, the Elderly, the Hospitalized
People who are particularly vulnerable to suffering psychological distress during and after quarantine are those with a history of psychiatric illnesses.
If a person is already suffering from anxiety, the sense of helplessness and lack of control induced by a forced quarantine can only exacerbate the anxiety. For people who are claustrophobic, being confined to a small space can be extremely stressful. People with suicidal ideation can be particularly at risk under these circumstances.
Another vulnerable population is the elderly, who are confined to their homes or in facilities, where infection can spread easily if not prevented. Because older people are more at risk for mortality, their quarantine must be more complete. And, since they are often dependent on others as it is, their increased helplessness can lead to elevated anxiety and depression.
Also, people who are confined in hospitals, whether because of the coronavirus or for other reasons, can find themselves isolated from their family and friends when hospitals impose restrictions on visitors, which is already happening.
Mitigating the Effects of Quarantine
Research shows that quarantine is better tolerated and compliance improves when people get information about the nature of the disease and the benefits of quarantine.
It is far better to get people to agree to quarantine by convincing them and offering information, than by forcing them. That increases their sense of agency and reduces helplessness as they become active participants in their circumstances. This is an important psychological concept. When faced with external pressures, the feeling of agency enables a person to feel more like a survivor than like a victim—increasing their sense of control.
Keeping people informed about the consequences of breaking the quarantine and explaining how isolation can actually save lives and benefit the community can turn quarantine from a scary nuisance into a truly meaningful act of altruism—a form of self-determination in the face of tremendous pressures.
- It is critical not to abandon those who are most vulnerable. People who suffer from mental illness need to have access to therapists and medications—with telemedicine if need be. Mental health professionals, community and family members need to be aware of the challenges that isolation presents to the people under their care—or those in the community—and check on them often.
- Older adults, living alone, need to be contacted often and reassured, while at the same time making sure they are not unduly exposed to the virus, given their health vulnerability. If there aren’t family members around, it becomes the responsibility of the community.
- Those in nursing homes or hospitals still have access to people who care for them, as long as they are able to understand and interact. Phone, texting, email, even posted letters can make a difference. The act of reaching out is more important than anything that needs to be said. Patients who are isolated need to know that they still count.
We are facing an epidemiological crisis of great magnitude with the coronavirus spreading throughout the world. Quarantine has been found to flatten the curve of infection, allowing better health care and outcomes.
Quarantine, while necessary from an epidemiological point of view, has its effects on the well-being of all involved. It is the responsibility of the community to help the vulnerable in our society get through this hard time.
Taking agency is not just for the vulnerable. It applies to you and me as well.
Gabriel Banschick is a third-year medical student at Tel Aviv University. He has been a research assistant on this blog over the past few years.