What are the side effects of social and physical distancing?

By Dr. Ananya Mandal, MDApr 12 2020

Researchers Sandro Galea from the Boston University School of Public Health, Boston, Raina M. Merchant, from the Perelman School of Medicine, Philadelphia, and Nicole Lurie, from the Coalition for Epidemic Preparedness Innovations. Oslo, Norway, published an opinion paper in the JAMA Internal Medicine titled, “The Mental Health Consequences of COVID-19 and Physical Distancing The Need for Prevention and Early Intervention”.  They call for urgent attention to be paid to the effects of social and physical distancing on the mental health of the population during the COVID-19 pandemic.

The Mental Health Consequences of COVID-19 and Physical Distancing The Need for Prevention and Early Intervention. Image Credit: Fizkes / Shutterstock

Situation now

COVID-19 disease caused by the novel coronavirus, SARS-CoV-2, has infected over 1.8 million people in 185 countries and territories. Worldwide physical distancing measures are now in place worldwide. These measures, isolation, home quarantine, lockdowns, and the closure of all places where people congregate, are aimed at preventing the virus from spreading from one person to another. However, social distancing, as this form of physical distancing, is now commonly known as may have other consequences. The team writes, “While these steps may be critical to mitigating the spread of this disease, they will undoubtedly have consequences for mental health and well-being in both the short and long term.”

The team says that these consequences cannot be underestimated and need to be assessed, and interventions need to be in place to mitigate the impact of the pandemic on individuals as well as population mental health.

What does existing literature say?

There is little evidence of what impact this form of extreme measure can have on the human psyche during and after the incident. The researchers wrote that large disasters could provide a clue as to what could happen after this is over. The examples they cite include traumatic ones such as World Trade Centre attacks or school and mass shootings and its long term impact on the psyche. They also cite the impact of natural disasters such as Tsunamis and hurricanes and the effects of environmental disasters such as major oil spills etc.

These traumatic events could lead to “depression, posttraumatic stress disorder (PTSD), substance use disorder, a broad range of other mental and behavioral disorders, domestic violence, and child abuse,” write the researchers. They also explain that these mental health problems may persist long after the event is over.

During and after COVID-19

The team of researchers explains that this COVID-19 pandemic itself may lead to an increase in the number of cases of depressive disorders and anxiety disorders along with loneliness, social isolation, substance abuse, and a rise in domestic violence. They also warn that with the schools closed, there is a risk of a sharp rise in the number of cases of child abuse across the nations.

What needs to be done?

The United Kingdom, they wrote, has issued first aid guidance from the Mental Health UK to deal with the altered situation. The team says that there is no clear scientific literature yet that reveals how to prevent mental health problems at the population level. But they suggest that three steps can be taken to prepare for the “inevitable increase in mental health conditions and associated sequelae,” that are to arise once the pandemic abates.

First step

Step one of the plan is to develop outlines to deal with loneliness and its long term effects on the populations that are being forced to socially isolate at home during the pandemic. Also, to develop ways that could intervene and help people after this is over. The researchers point out that digital technologies could help people connect socially while remaining physically distant.

People generally congregate at places of worship, parks, gyms, etc. Since these have been closed down, the activities could be done online on a schedule, write the researchers. This will not only provide a social connection without physical proximity but also promote a feeling of togetherness, which could be good for mental health.

Workplaces could also be made virtual so that employees can work virtually together and not feel lonely. Social contact and outreach could be ensured. Outreach and voice calls and video calls can also assist marginalized or isolated populations including “elderly, undocumented immigrants, homeless persons and those with mental illness,” they wrote.

Social media groups also help people come together and share information and feelings. People can also reach out for resources and help when they need it.

The researchers explain that time schedules and connections are vital for children, especially. However, online resources may not be possible for all children due to a lack of access to technology and the internet. They write, “Needed are approaches for ensuring structure, continuity of learning, and socialization to mitigate the effect of short- and long-term sheltering in place.”

Second step

The researchers point out that now more than ever, robust surveillance is needed, reporting and intervention mechanisms to deal with domestic violence and child abuse. All persons who are at risk of such abuse may be restricted from seeking help, and this can stem from staying indoors and not being able to leave homes where such abuse is meted out.

The authors write, “Systems will need to balance the need for social distancing with the availability of safe places to be for people who are at risk.”

Third step

The most crucial step is to prepare for the effects of the pandemic would be stepped care write the researchers. This could begin with the care that requires fewer resources followed by the care, which may require more resources as the situation of the pandemic eases. The authors explain that it would require screening for mental illness and training of the non-traditional help groups and caregivers to provide “psychological first aid” to those in need. Laypersons could be taught how to reach out and help those in need during the early stages of social isolation. This could also be followed up with telemedicine, communication, and support using technology platforms, they wrote.

The authors conclude, “The worldwide COVID-19 pandemic, and efforts to contain it, represent a unique threat, and we must recognize the pandemic that will quickly follow