‘A sad soul can kill you quicker than a germ’
John Steinbeck in Travels with Charley: In search of America, 1962
Isolating individuals from society is done for several reasons. For example, criminals are isolated from the rest of society in prisons for some time. Their crime against society was too great to keep them among us. Patients with severe psychiatric disorders that endanger others and themselves can also be isolated in an isolation cell in a hospital or facility. Patients with infectious infectious disease are isolated from people who do not have the infectious disease. In the latter case, attempts are made to prevent healthy people from becoming ill. The latter was done with patients with certain COVID-19 or with strong suspicion.
Quarantine is a form of separation and an imposed restriction on the freedom of people who are not ill, but who want to be prevented from becoming ill due to an infectious disease. It is also called reverse insulation. Sick people can also be nursed and treated in reverse isolation. For example, patients with a strongly reduced resistance, for example due to leukemia, are isolated in reverse. They want to prevent pathogenic microorganisms from reaching them and making them (er) sick. Also, people who are more susceptible to infection due to age and / or chronic physical condition and become sicker when infected than are sent to quarantine and are at risk of dying from the infection. The latter has been done in the Netherlands in the past two months with elderly people in nursing and care homes. Old people appeared to be much more susceptible to the coronavirus due to the state of their defenses and if they received COVID-19 mortality was high among them. Where young people coughed for a few days and had a fever after infection, old people died quickly and people with underlying diseases in the intensive care unit were given ventilation.
Social isolation and quarantine are generally seen as a great asset, because after all, the two major enemies, disease and death, are cut off. Because all elderly people in the homes, without exception, are isolated, it seems that it can be assumed that old people consider quantity in years to be more important than quality of social interaction. Death seems to be an always combatable enemy. In recent weeks, this has not been taken for granted by heartbreaking stories of dying elderly people who were no longer allowed to see their (grand) children and other loved ones at all. Physical contact was completely out of the question. There was a famine in the houses, not a need for food, but for physical skin contact and attention. It was, to me, an incomprehensible creed to poor elderly people. Isolation without consent. Quarantine without self-determination or your own choice. Old people who have built up our country after World War II are immeasurably socially isolated from everything that remains in their lives.
It has long been known that quarantine and enforced isolation is always a negative experience for those who must undergo it. The loss of freedom, autonomy, the forced separation of loved ones, the lack of physical touch, boredom and uncertainty about the duration of isolation can really have a dramatic effect on people’s mental health.
For example, the duration of the quarantine is important. During a SARS outbreak, it was found that people who were forcibly quarantined for more than ten days had a significantly higher risk of long-term stress-related disorders than those who were quarantined for less than ten days (Hawryluck et al. SARS control and psychological effects of quarantine. in: Emerging Infectious Diseases 2004; 10: 1206-1212). In many cases, old people have been quarantined in Dutch nursing and care homes for almost two months.
Old people with cognitive impairments, such as dementia, are now isolated from their neighbors. Many are seriously confused. They do not understand that their loved ones no longer visit them. Relatives are desperate under this. Research has shown that socially isolated people with cognitive and psychiatric illness during an MERS outbreak are still anxious and displeased 4-6 months after quarantine relief (Jeong et al. Mental health status of people isolated due to Middle East respiratory syndrome, Published in Epidemiology and Health 2016; 38: e2016048).
Many studies have found and described the negative psychological effects of isolation and quarantine (recently summarized by Samantha Brooks et al. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet 2020; 395: 912-920) . They describe that the hopelessness of the isolates during quarantine is self-evident (“unsurprising”), but that it is really very worrying that the negative psychological effects can still manifest themselves months to years later.
When I read in their review that: ‘Longer quarantine is associated with poorer psychological outcomes’ and that the authors advise keeping the isolation as short as possible (maximum 10 days), I feel the shivers down my spine knowing that most have been isolated from their loved ones for almost two months. Today it became clear that “as a test” in a care home, relatives with mouth masks can visit one hour a week. One hour a week !! My God!
Not only are negative psychological effects obvious, social isolation also has a negative effect. Matthew Pantell and colleagues described in their article ‘Social isolation: a predictor of mortality comparable to traditional clinical risk factors’ (American Journal of Public Health 2013; 103: 2056-2062) that people in social isolation are much more likely to die than comparable people who are not isolated. This was previously described by Julianne Holt and colleagues in PLosMedicine (2010; 7: e1000316) (Social relationships and mortality risk: a meta-analytic review). They reviewed 146 scientific studies and found a 50% higher risk of death in socially isolated people. They later also examined the effect of loneliness on mortality (Loneliness and social isolation as risk factors for mortality: a meta-analytic review. Published in Perspectives on Psychological science 2015; 10: 227-237).
When men were regularly visited by loved ones, the risk of myocardial infarction decreased by nearly 30% (Eng et al. Social ties and changes in social ties in relation to subsequent total and cause-specific mortality and coronary heart disease incidence in men. American journal of epidemiology 2002; 155; 700-709).
In the corona crisis, quarantine and social isolation aim to prevent people from becoming infected with the virus and becoming ill. It is generally assumed that the resistance of the insulated remains the same by the measure. However, this appears not to be visible at all. Sheldon Cohen and colleagues examined whether social connections with family, friends, work, and society were associated with an increased chance of becoming sick from infection with two different rhinoviruses, viruses that cause colds. They test this in 276 healthy volunteers. They found that the more social and emotional connections the subjects had, the more resistant they were to the virus. They published their findings in the leading journal JAMA (Social Ties and Susceptibility to the Common Cold, JAMA 1997; 277: 1940-1944).
I have not been able to find any scientific studies that state that quarantine and social isolation have no or minimal negative effect on mental and physical health. All (!) Describe drastic negative effects.
The aim is to prevent the elderly and vulnerable from becoming ill and dying by means of forced quarantine and social isolation. Reading all the scientific studies on this, it seems much more like isolation and quarantine to be deadly to them. There is excess mortality in nursing and care homes that is not directly related to COVID-19.
This makes me sad and I doubt whether we can look back on this in a neutral way.