When China placed a series of cities under lockdown in January to blunt the spread of COVID-19, experts warned that other countries may not be able to implement the same policies. But over the past few weeks, cities, states, and countries around the world have similarly restricted people’s movement in order to stop the virus’s spread.
Some people, who’ve been exposed to the virus, have to stay away from others for two weeks in a formal quarantine. Other communities are full of people who don’t have documented exposure to the virus, but have still been told to stay at home to help slow the pandemic.
Previous research shows that those decrees, whether at an individual or community level, can take an emotional toll. None of that research, which focused on the psychological impact of quarantine during outbreaks of diseases like SARS and Ebola, quite matches the current global situation, says Neil Greenberg, professor at King’s College London and president of the United Kingdom Psychological Trauma Society. But it offers good guidance for what experts expect to see during this pandemic. Greenberg reviewed the existing evidence in a paper published in The Lancet.
“The key message that came through was that if you do quarantine or extended isolation badly, that rather than just being distressing, it can have some long-lasting psychological impacts,” he says. “There’s evidence of depression and some symptoms of post traumatic stress disorder.”
During a pandemic like this one, quarantining some people and asking the rest to stay at home is necessary for public health. But officials can structure isolation in ways that minimize the psychological impact of those policies — for example, by not promising that a quarantine period will be for one length of time and then extend it for longer.
The Verge spoke to Greenberg about the best way to manage a shut down.
This interview has been lightly edited for clarity.
What does a badly done quarantine look like?
A bad quarantine means people don’t get good information about what they’re doing and don’t have a good rationale for why it’s needed. They don’t have access to basic supplies or health care and don’t have good communication. If people suffer financial losses and feel like they can’t afford to carry on with their lives, that can have a bad impact. And if at the last minute, someone alters the length of time you’re quarantined and says it has to be longer. That’s a recipe not just for ineffective isolation, but for poor mental health.
How well are officials and governments doing to make sure these quarantines aren’t done badly?
It varies quite a lot. Some countries have draconian policies in place, and some are lax. The key thing about isolation around the world is that people want to see a good rationale for why it’s being done. In Italy, with the death rates what they are, there is a good rationale for why the government needs to impose a restrictive regime. That helps.
In a situation where we’re very worried about lots of deaths, but the number of deaths is currently low, people might begin to question the rationale. At that point, there’s concern that people aren’t isolating who should be. There’s confusion: why is this happening, why aren’t people sticking to it?
But public health experts say that restrictive measures work best if they go into place before there are lots of deaths — how do we get people to see that as enough rationale?
Like we do in all aspects of life. We try and draw on previous experience of when that’s been important. Certainly among the scientific community, there’s been discussion of the Spanish flu of 1918. The danger, then, is people say that we didn’t have the health care that we have now. The stronger the similarities are, the better.
One assumes that when this crisis is over, the next time, people will be far more understanding than they have been previously. It’s difficult enough for governments to get their own heads around what needs to happen now. In this case, even clear science stories and information are hard for people to understand.
Is there a difference, psychologically, between being quarantined as an individual versus being quarantined — or told to shelter in place — as a city or state?
When you look at war or terrorism, which impact whole cities, we see that if we’re in it together, it makes things easier. Generally, at-risk people or people who have been quarantined can be stigmatized. They’re seen as dirty or infected. If everyone has been in it together, you don’t see that. People are less likely to be singled out as different or strange — which, if it happened, could cause mental health problems.
If you asked people in Europe in 1938 how they would cope with being bombed for years, everyone would say it’s impossible. But once you get into a new sense of what is normal as a community, people adapt and cope.
After this is over, what should governments and individuals do to help people recover from the emotional challenges of sheltering in place?
It absolutely should be part of the recovery process. But it’s not inevitable people will have long-term psychological difficulties. Some people will thrive: in a bizarre way, especially health care workers, who are facing extraordinary challenges. They may rise to the occasion and have what we call post traumatic growth. I’m not trying to be too positive, but it’s not all doom and gloom.
The challenge is how do you get a population, a family, a team to carry on while also detecting the small percentage of people who will suffer mental health problems? How do we get them help accessing care? Accessing care can be hard at the best of times, and there’s no reason to think it will be any easier. We need to think in our recovery plan about how to identify and help those people.
If we’re trying to look for the benefits, it might be that we are learning how to better communicate with our loved ones when we’re locked down. We might end up, when we get back to normal socialization, in a community with a better capacity for links than before.