The effects of quarantine, self-isolation, social distancing and panic buying on mental health during the novel coronavirus COVID-19 pandemic.
On 11th March 2020, the World Health Organisation declared the novel Coronavirus COVID-19 a pandemic, stating that the virus had spread to over 110 countries around the world with a total of 118,000 confirmed cases of the disease (WHO, 2020). Many health experts around the world, are using the terms 'quarantine', 'self-isolation' and 'social distancing' in their guidance on how to avoid contracting the disease or spreading it to others. Implemented measures have been multifaceted and varied, across many countries. Religious, sporting and entertainment-related gatherings, including weddings and church services, have been cancelled either by government dictate or voluntarily. Individuals and small groups of people have been quarantined and are known to have self-isolated and be practicing social distancing. Panic-buying of food, toiletries and other essentials ensued immediately after the social distancing strategies were announced, despite reassurances that supplies were not low. While these responses to the virus can be considered reasonable actions, it possible that they have their own particular adverse effects. Therefore, this literature review will examine the possible psychological and mental health effects created by the implementation of some of the measures used to help reduce the spread of COVID-19. In particular, it will focus on the issues of quarantine, self-isolation, social distancing and panic-buying.
Forms of Social Withdrawal used with a Pandemic
There are three main forms of social withdrawal used in relation to COVID-19. These are: quarantine, isolation (or self-isolation) and social distancing. Quarantine is medical term used to refer to the physical isolation of a person who is known to have been exposed to a communicable disease but has yet to develop the symptoms of that disease, to monitor the development of that disease in the person (Centers for disease control and prevention [CDC], 2017). In the case of COVID-19, the standard quarantine period is 14 days. Isolation refers to a situation where infection or contact with an infected person is not confirmed, but separation from others in society occurs as a preventive measure. Isolation can be mandatory or self-imposed. Social distancing is used to refer to behaviour that keeps people physically distant from each other, to avoid the spread of contamination. This can function on an individual or group basis (CDC, 2020). The remainder of this research paper will examine mental health issues relating to quarantine and self-isolation in tandem, as the literature reports that they have similar consequences for those being detained mandatorily or voluntarily. Social distancing will be discussed separately because, while it does have potential for mental health repercussions, it does not involve a period of isolation.
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The Effects of Quarantine on Mental Health
The practice of quarantine originally came into use for outbreaks of leprosy and the Black Death, in 12th century Venice. It was over 300 years later that it was first used in the UK, in relation to the outbreak of plague (Newman, 2012). Quarantine has been found to be an often-unpleasant experience for those it is imposed upon. It can entail loss of freedom, uncertainty regarding the outcome of the suspected disease and enforced separation from family and friends. As a consequence, there have been reports of suicide, outbursts of anger and lawsuits following quarantine procedures during previous outbreaks of infections (Barbish et al., 2015). A study of hospital staff who were quarantined because they may have come into contact with the SARS virus reported a range of symptoms related to acute stress disorder. These symptoms included exhaustion, detachment from others, anxiety, irritability and insomnia. Several staff complained of being unable to concentrate and some considered resignation (Bai, 2004). There are a number of stress-related factors related to quarantine and post-quarantine situations in the current literature. People with a history of mental illness were reported to experience symptoms of anxiety and were exhibiting anger four to six months after the end of quarantine (Jeong et al, 2016). Poor mental health, including post-traumatic stress disorder and avoidance behaviours have been reported in those being quarantined for long periods of time. Typically, periods of more than 10 days produced higher levels of post-traumatic stress symptoms (Hawryluck et al., 2004 and Reynolds et al. 2008). A major issue for those being quarantined is the sense of boredom they experience during the period of confinement. The reduced social and physical contact with others, and the sense of being isolated and cut-off from the rest of society are especially distressing elements. Not being able or allowed to take part in normal daily activities, such as shopping was also a commonly reported stressor (DiGionvanni, et al. 2004). The lack of basic supplies, including food, water, clothing, accommodation and medical prescriptions was found to be a source of frustration (Blendon, et al., 2004). Some studies have found that those quarantined received their face masks late or not at all and others showed that food and water were not regularly distributed or took a long time to arrive (Cava, et al., 2005 and Pellecchia, et. al., 2015). Lack of information from public health authorities and unclear guidelines in relation to actions that need to be taken during the quarantine period have also been reported as a source of stress (Braunack-Mayer, et al., 2013). People quarantined during the Toronto SARS virus epidemic complained of being confused by different approaches in relation to information provided by public health officials (Cava, et al., 2005).
According to a number of recent studies, there is potential for mental health problems to be sustained, even when the period of quarantine is concluded. Some people experiencing financial loss have reported socio-economic distress, with related feelings of anxiety and anger several months after the conclusion of quarantine (Taylor, et al., 2008). Several studies have highlighted the potential for stigmatisation and rejection arising from quarantine or self-isolation. One such study, comparing healthcare workers who were quarantined with those who were not, found that the quarantined group reported being treated differently after the quarantine period had ended. They complained of social invitations being withdrawn, critical comments being made and that they were treated with fear and suspicion by people in the neighbourhoods (Robertson et al., 2004). Healthcare workers who were quarantined during the Ebola outbreak in Senegal reported family disputes arising from their work being considered too risky. Other participants, in the same study, were unable to return to work after the quarantine period ended because their employers were concerned about contagion (Desclaux et al., 2017). While it is too soon to evaluate studies related to COVID-19, it is suggested that the current pandemic will yield similar issues related to the stigmatisation of those being quarantined and isolated.
Social Distancing as Response to the COVID-19 Virus
While the term 'social distancing' may be considered relatively new jargon, it is not a new phenomenon. Keeping a distance from others, for reasons of physical and psychological protection, is a well-documented function of human behaviour. Katz (1937) introduced the term 'personal space' to describe a psychological 'territory' that people put around themselves. It acts as an invisible barrier to prevent others from coming too close. This is often seen operating in public places, such as a railway platform or a park, where people will avoid standing or sitting near strangers (Williams, 1994). This type of behaviour is generally ameliorated by personal relationships and close-range interaction is a 'tie-sign' that signals that a couple is together (Sommer, 1969). Generally, children tend to seek out less personal space than adults and those with mental ill health issues tend to need more space (Hall, 1959). If personal space is invaded, the person can respond with a 'fight-or-flight' reaction, in that they may physically take themselves away from the situation or exhibit aggressive behaviour. A typical peremptory defence against personal space intrusion is depersonalisation (AMA, 2013). All actions that might be construed as a social signal, including making eye contact and looking in the direction of another person are avoided. In addition, 'barrier signals', such as crossing the arms in front of the body, raising the hood on a coat or wearing dark glasses may be employed to reduce the potential personal space violation (Williams, 1994).
The use of social distancing, in relation to the COVID-19 pandemic, is a measure designed to limit the availability of the virus to spread. Social distancing measures, when used on an individual basis, can include keeping a minimum distance from others, wearing face masks in public and choosing to work at home. Advice from the World Health Organisation to older adults and people with pre-existing health conditions included, when having visitors to their home, to exchange a '1 metre greeting, like a wave, or a bow' (WHO, 2020: p.2). On a wider scale, social distancing can involve the cancellation of public gatherings, including sporting, religious and other social gatherings (Bates, 2020). Some mental health clinicians are concerned that social distancing will prevent people from interacting in ways that are known to foster good mental health and offer psychological soothing such as hugging, handholding and other forms of affection and support attained through physical contact (Pandika, 2020).
It has been suggested that while social distancing is a necessary procedure to flatten the coronavirus pandemic curve, it could also cause a 'social recession', through a collapse in social contact, which will be particularly hard on those already vulnerable to isolation and loneliness. This group may include the elderly and those with pre-existing health conditions (Klein, 2020). Killam (2020) argues that, while isolation is the right response to the pandemic, something must be done to combat any potential ill-effects from the sense of loneliness that it might cause. He suggests that if social media is used sporadically and carefully, it can work to beneficially counter-act times of loneliness caused by isolation. This viewpoint is supported by a recent study of the use of social media in a controlled manner, which showed that how social media is used is more relevant to good mental health than how often it is used (Bekalu, et al., 2019).
The Negative and Positive Arguments for Panic Buying
In addition to issues around quarantine and social distancing, the outbreak of the novel coronavirus COVID-19 has resulted in spates of panic buying in several countries (Wray, 2020). Households stockpiling certain goods, such as toilet paper, hand sanitiser and canned foods has been particularly noticeable, although those products are not yet in short supply (Jankowicz, 2020). This side-effect of the pandemic has been associated with a psychological need to take control of an otherwise chaotic and potentially unmanageable situation. A sense of autonomy and competence is gained by individuals, who feel that they are doing the smart thing by stockpiling goods (Taylor, 2020). It has been suggested that stockpiling in the event of crisis, is not panic buying, but a rational and understandable response with the aim of self-protection. Because the virus has a 14-day incubation period, it can be considered reasonable and sensible to stockpile food and other essentials, for at least that period of time. However, human beings tend to err on the side of caution, so buying more than may be necessary is a typical response related to panic buying (Savage and Torgler, 2020).
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This research paper has described and examined some of the psychological and mental health consequences of quarantine, isolation, social distancing and panic buying, in relation to the current novel coronavirus COVID-19 pandemic. On an individual and small group level, quarantine and self-isolation are being used to remove individuals from society temporarily in order to protect them and others by reducing the spread of the virus. Social distancing measures are also being implemented on a small and large scale. In some countries, these include closing schools and colleges, banning mass gatherings, advising businesses to conduct meetings remotely and encouraging staff to work from home where possible. While all of these measures are generally considered reasonable and necessary, it has been shown that there are potentially negative psychological and mental health consequences arising from them. It is suggested that health experts should increase public awareness of the negative consequences of quarantine, self -isolation and social distancing and offer workable countermeasures and solutions, where possible.
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