“Quarantine between necessity and associated risks.”

Analysis of a review

Prof. Roberto Brugnoli

The outbreak of the Covid-19 pandemic has forced the implementation of infection containment measures across the planet. Many of the most affected countries have therefore had to resort to mass quarantine measures, so-called “lockdowns.” This state of emergency, almost unprecedented in Europe, has opened a wide debate on the effects of this lockdown, which involves so many aspects of our lives, starting with the psychological. In an effort to present a timely summary of studies that have analyzed the psychological impact of previous quarantine measures, an important contribution in the Lancet by a research team from the Department of Psychological Medicine at King’s College London (S.K. Brooks et al.) came out at the end of February.

[ Download full article | The Lancet review 2020 | PDF ]

The World Health Organization itself had, moreover, from the very beginning advocated research along these lines, in order to be able to help the states affected by the virus in developing measures to contain the contagion. In this article we will therefore present the results of this research, which still appear to be very useful in order to be able to understand the situation in which we have been involved in recent months. First of all, it appears useful to differentiate quarantine from isolation: while the former is preventive and involves anyone who has been potentially exposed to infection, the latter concerns people who have been diagnosed with a contagious disease. The two terms are often used interchangeably, but the difference is instead substantial. Quarantine has been used several times in the past two decades, as was the case, for example, in 2003 in China and Canada for severe acute respiratory syndrome (SARS) or in West Africa in 2014 because of Ebola. This allowed the creation of a scientific literature on the topic of psychological effects of epidemic containment measures, from which the King’s College team then selected 24 research papers to analyze in their synthesis contribution. Of these, those comparative and/or longer-term studies that allow psychological dynamics to be investigated with a broader scope play a particularly prominent role. The main element highlighted by the research is the existence of negative mental health effects associated with quarantine measures. As we shall see, the factors that play a role on these effects are both inherent in the quarantine itself and dependent on the manner and efficiency of its management. Indeed, it is clear from the research that the choice to implement a mass quarantine should be deeply weighed, carefully weighing the psychological risks and benefits to the community. Research has shown that the negative symptoms of quarantine can be emotional disturbances, depression, stress, irritability, insomnia, post-traumatic stress symptoms, anger and exhaustion. The various researches have pointed to a number of factors, both social and individual, that can negatively affect the psychological management of quarantine. One of the main stressors is the lack of clear information about the duration, manner, and purpose of quarantine. Among the studies conducted, it appears that unclear information about the disease, how it is spread, and symptoms also triggers a sense of fear that one may become ill or infect loved ones. Job and financial insecurity often causes not only stress, but also generates a sense of frustration if one is forced to rely financially on one’s families. Various studies have also shown that the fear of having difficulty in being able to obtain basic necessities and to have free access to medical care is a strong psychological stressor to be taken into account. Another element of concern is the possibility that the stigma to which quarantined individuals may be subjected may exacerbate pre-existing cultural, ethnic and religious disagreements. The review suggests that being in quarantine is a predictor of post-traumatic stress symptoms, even years later.

An attempt has been made to identify possible anticipatory elements to understand whether there are risk categories and demographic and social factors that may particularly affect them. At present, the scientific literature does not allow for unambiguous answers, although there is some consensus on certain categories. Among those at risk seem to be, for example, those with a history of prior psychiatric illness who, according to some studies, often show feelings of anxiety and anger in the 4-6 months following quarantine.
Among the studies reviewed in the research there also seems to be a need to pay special attention to health care workers, who appear to be particularly vulnerable given their position vis-à-vis the disease. As the news has also shown, this proximity to the disease can exacerbate episodes of social stigma, due to the fear of a section of the population that they may be vectors of contagion. Several studies have shown how for homebound health care workers the inability to help colleagues is severely difficult to cope with psychologically. Indeed, on the one hand there is the sense of guilt of not being able to help, and thus of creating harm to one’s colleagues, and on the other hand there is the strong sense of isolation given by being away from one’s work group.Therefore, hospital management should envision a support plan for health workers facing quarantine, decreasing the sense of isolation from one’s team and the stress caused by this forced condition. In fact, some studies have compared the psychological state among health care workers who have been forced into quarantine with those who have not, and found that the former are likely to experience a higher chance of psychological disorders such as exhaustion, anxiety, irritability, indecision, and worsening work performance, which in some cases even lead to consideration of resignation. Research suggests that the negative effects of quarantine can be at least partially mitigated by a number of factors, to which institutions must therefore pay attention. In order to be able to alleviate this as much as possible, one should, for example, try to counteract the sense of boredom and isolation and provide adequate and practical instructions to combat these moods. A psychological support network should also be ensured, and online or telephone support should be activated for those who want more information about the disease and how to behave appropriately with the people with whom they share the home. It was then pointed out that among the key elements to positively manage quarantine is to have a working cell phone and good wi-fi coverage in order to be able to keep one’s network of contacts active, but also to be able to reassure loved ones about one’s health status. Also in order to stay active individually and socially, some studies highlight the positive function of smartworking, even at the cost of lowering productivity.

One very interesting aspect that emerges from the article is that in order to help people live more peacefully through quarantine, one must have the understanding that one is also doing so for the good of the community and to protect and help the most vulnerable.
In conclusion, the research suggests that the consequences of quarantine can be long-term, not only for the individuals who find themselves experiencing it, but also for the health care system and public administration at all levels. It therefore seems of paramount importance, should quarantine be necessary, to consider the psychological effects and put in place a public response that works to mitigate them as best as possible.