As the COVID-19 outbreak intensifies, we're seeing mass isolation in virus epicentres, with about 500 million people in China "under varying degrees of quarantine", and all of Italy in lockdown.
In Australia, self-isolation is being advised for those who have been in close contact with a confirmed coronavirus case, or have travelled from a country with a large number of cases.
People under isolation, which is different from social distancing, must avoid public places, gatherings and visitors, and wear a surgical mask if leaving their home. For many, this means being confined at home except for essential trips for supplies and appointments.
But what are the psychological impacts, and consequent social impacts, of this? Reports from China suggest isolation has led to neglect of vulnerable people, babies being abandoned, and increased domestic violence, fear and anxiety.
In a recent review of literature, published in the Lancet in light of the COVID-19 outbreak, authors reported that being required to isolate often resulted in symptoms of traumatic stress, confusion and anger. These effects are worse among people who are isolated for a long time, fearful of infection, have limited supplies, receive inadequate information, or are experiencing financial loss or stigma.
Many in isolation experience a sense of "cabin fever". This often involves feeling dissatisfied, restless, irritable and bored when confined.
For people who are feeling well, being isolated may initially provide a novel respite from daily responsibilities. However, this can quickly become stressful and anxiety-provoking.
As COVID-19 spreads in Australia, we can expect to see more people requiring isolation.
Images from Wuhan, China, are providing a snapshot of the social disharmony that can emerge from forced isolation.
One retired police officer, Wan Fei, allegedly told Sixth Tone domestic violence reports had nearly doubled since China's cities went into lockdown. He claimed as of late February, the police station in Jingzhou's Jianli County had received 162 reports of domestic violence for that month, more than triple the number reported in February last year.
One of this article's authors (Patrick), has had correspondence with colleagues in Hubei, who have also reported increased household tension among isolated families. Anecdotally, idle time has led to more alcohol consumption, and domestic and family violence has become more prevalent.
Simultaneously, many Chinese social services, including community centres and social work agencies, closed when quarantine restrictions were imposed. Many social workers and helping professions have since started offering services online.
Past research suggests stress during times of disaster leads to increased rates of domestic violence. In interviews with 30 women following the 2009 Black Saturday bushfires, more than half reported experiencing violence after the disaster. Of these women, most had not experienced any form of violence prior to the disaster.
Stress can also place people, particularly those who are disadvantaged, at risk of mental illness and addictions.
As the crisis deepens in Australia, we may have to face similar challenges. One viral video of aggressive shoppers, seemingly fighting over toilet paper, has already highlighted the psychosocial impacts of the coronavirus.
Attention to personal and community hygiene may exacerbate people's existing anxieties, potentially heightening phobias and clinical conditions such as obsessive compulsive disorder, and fuelling racist behaviour.
People approaching retirement may become unsure of their prospects for safety and prosperity. And casual employees may face sudden income insecurity. Workplace closures, like those seen in Australia during the 2009 H1N1 (swine flu) outbreak, could also adversely affect household functioning and finances.
Emotionally, people may experience stress due to the uncertainty of where the virus may spread, and the welfare of family members.
Individually, we can all take action to avoid or reduce the potential emotional, psychological and social impacts of COVID-19. Workplace contingency management plans should factor in psychological support for staff, allowing employees to work from home if possible.
Access to accurate and realistic information about the pandemic could help avoid fearmongering and hysteria. Our fears, doubts, frustrations and disappointments will likely be shared by others, so we should relay reputable information to family, friends and colleagues.
Online sites such as Skype and Facebook can help us stay connected. Many are using these tools to make light of an otherwise difficult situation, including people in China tuning into online dance raves via TikTok.
Politically, we need to invest in social support services such as online counselling and telephone support lines. These could assist isolated people and help build community cohesion and resilience. Recently in China, and during the 2014-2016 spread of Ebola in Senegal, psychological support hotlines were established for such purposes.
Australia's federal government has begun to evaluate and respond to financial costs borne by households. As the crisis unfolds, there will a need to compensate people for income losses associated with isolation.
When quarantine is necessary, it should be for the minimal amount of time and no longer than 14 days, given the likelihood that symptoms will show in this time. People quarantined should be provided with clear information about why they are being isolated and what they should do moving forward.
All of us, regardless of national borders or political worldviews, are facing the incursion of COVID-19. Instead of allowing the virus to bring out the worst in us, let's try to build a sense of solidarity across our communities.
Learning from experiences in other countries, and similar past events, could help alleviate potential negative psychological and social impacts.
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