All The Pain We Cannot See: Part III

Part 3: The hidden costs of social distancing and lockdowns.

Posted Apr 04, 2020

Zaman Jorj
Source: Zaman Jorj

To read Part I of this post, click here, and Part II here.

Homeless people are suffering particularly brutally during this crisis. The Guardian reported that:

"Homeless people in major European cities are increasingly going hungry during the coronavirus pandemic and suffering in the enforcement of the lockdown, with rough sleepers being issued with police fines for being outside. A shortfall in protective masks, gloves, and hand gels for social workers across the continent has forced the closure of the day centers, food banks, and soup kitchens on which people rely to keep themselves healthy and fed."

Children in homeless families who were attending school now face their own crisis: Many lack access to computers or the internet now that schools have closed, and are unable to participate in the online instruction that their housed peers are benefitting from. It’s important to note that this isn’t just a problem of homeless children; many children in low-income families also lack access to the internet and thus are missing out on the ongoing education that more well-off classmates are enjoying. The closing of schools and the shift to online learning is bringing into stark relief the harsh reality of the digital divide.

Job loss, now pervasive as a result of the closing of all non-essential businesses in order to facilitate physical distancing, isn’t just a financial crisis for millions of individuals and families. It’s also a major risk factor for anxiety and depression, as well as physical health problems (likely due to elevated stress). These problems may in turn increase the risk of maladaptive coping (e.g., substance abuse) and family conflict. In the words of community psychologist Jim Kelly, everything is connected to everything else. One stressor triggers another, which triggers another, and on and on.

“Shelter at home” and lockdowns mean a dramatic reduction in exercise for many people, as access to outdoor spaces become limited, gyms close, and we are increasingly restricted to staying in the close quarters of our homes. We are inundated with articles about the health benefits of exercise, which is linked to better physical and psychological wellbeing and is one of the best-known ways to reduce stress and anxiety. We are living in a naturalistic experiment, in which we may observe the short and long-term effects of a global decrease in exercise, coupled with the risk of eating more due to being at home all day. Temporary weight gain from a short-term lockdown will be transitory and nothing to worry about. As a writer on Twitter said recently, “You’re living through a pandemic. Go have that cookie.” But if the lockdowns and shelter-at-home policies continue for months rather than weeks, we may see a rise in obesity and a corresponding loss of exercise-related health benefits. From a public health standpoint, this is worrisome. Fortunately, governments seem to be mindful of this threat and have generally made exceptions to their shelter-at-home policies for outdoor exercise. This could change, however, if the spread of COVID-19 is not brought under control soon. In fact, Italy just banned outdoor exercise in response to the persistent rise in infections and deaths there.

IT MAY SEEM that I am being something of a Cassandra, predicting doom based on what has been a relatively short-term social intervention. But as a prevention scientist, I prefer to anticipate the negative consequences of social programs, so that they can be mitigated with foresight. And while the physical distancing, shelter-at-home, and lockdown policies have been relatively short-term so far, there is no clear end in sight.

Happily, I am not alone with these concerns. Far from it. Already, many of the harms I have discussed are being addressed in creative and impactful ways. Social and news media are full of strategies for reducing the sense of isolation that many people are experiencing. People are engaging in a host of online approaches to staying socially connected. Online exercise, yoga, and dance classes are helping people stay active while remaining at home. In many cities and towns, in a nice example of “Cell C” planning, governments are keeping parks open and allowing residents to walk or run in them, as long they maintain adequate physical distance, a recognition of the importance of exercise and open space. In a similar vein of anticipating and mitigating foreseeable negative consequences, New York City incorporated meal distribution and child care for essential workers as it implemented its partial lockdown. The loss of meals at school is being addressed by many local governments and non-profit organizations such as No Kid Hungry, which are stepping in to ensure that children are not missing out on nutritious meals.

Other problems are tougher to address. The rise in domestic violence, the increased risk of child maltreatment, the financial and psychological effects of widespread job loss, the isolation of vulnerable groups whose vital social services and access to social contact are now greatly limited, and the worsening plight of homeless people are just some of the pernicious consequences of this global effort to combat the coronavirus. Investment in government safety nets to ensure adequate and affordable healthcare, financial support to individuals and families who are struggling financially, the banning of evictions for the inability to pay rent (with financial subsidies to landlords who face financial hardship), and support to enable businesses to keep workers employed, are all key to mitigating some of the most damaging economic consequences and their physical and mental health effects. For the most vulnerable, innovative solutions are dearly needed to mitigate the impact of a social intervention that appears to be, despite its many hidden costs, our best hope for controlling the spread of this frightening disease.

I wish to acknowledge, with gratitude, the contribution to this post of Rachel Miller, a leader in human services and public health administration in New York City.