The ease with which we now use words such as quarantine and isolation is remarkable. Quarantine has an ancient ring to it.
First used in Venice, Italy in 1127 in the context of leprosy, quarantine gained widespread use in response to the Black Death. Now Covid-19 has ensured quarantine's place in our modern lexicon.
Quarantine is the separation and restriction of movement of people who have potentially been exposed to a contagious disease to ascertain if they become unwell, so reducing the risk of them infecting others.
It differs from isolation, which is the separation of people who have been diagnosed with a contagious disease from people who are not sick. However, as we have seen in recent weeks, the two terms are often used interchangeably.
In a review recently published in The Lancet, doctors at Kings College, London take a close look at the psychological effect of quarantine and how to reduce it. Most of the research points to negative psychological effects including post-traumatic stress symptoms, confusion, and anger.
They found that people quarantined because of being in close contact with those who potentially had Sars reported various negative feelings during the quarantine period: over a fifth reported fear, 18 per cent reported nervousness and sadness, and one in 10 reported guilt. On the flip side, some respondents reported positive feelings with five per cent saying they felt happy and four per cent feeling relief.
One study compared psychological outcomes during quarantine with later outcomes and found that during quarantine, seven per cent showed anxiety symptoms and 17 per cent showed feelings of anger, whereas 4-6 months after quarantine these symptoms had reduced to three per cent(anxiety) and six per cent (anger).
For some, avoidance behaviours continued after the period of quarantine had ended. Among healthcare workers, being quarantined was significantly associated with avoidance behaviours, such as minimising direct contact with patients and not reporting for work.
Does the length of time in quarantine make a difference?
“Three studies showed that longer durations of quarantine were associated with poorer mental health – specifically, post-traumatic stress symptoms avoidance behaviours, and anger,” the Lancet paper states. And one study found that those quarantined for more than 10 days showed significantly higher post-traumatic stress symptoms than those quarantined for less than 10 days.
The sense of stigma was a major theme throughout the literature, often continuing for some time after quarantine, the authors found. Quarantined healthcare workers were significantly more likely to report stigmatization and rejection from people in their local neighbourhoods.
Is there anything we can do to mitigate the psychological consequences of quarantine?
Unsurprisingly, keeping it as short as possible helps.
“Restricting the length of quarantine to what is scientifically reasonable given the known duration of incubation periods, and not adopting an overly precautionary approach to this, would minimise the effect on people,” the Kings College experts advise. For people already in quarantine, an extension, no matter how small, is likely to exacerbate frustration and demoralisation.
Providing a clear rationale for quarantine and information about protocols to those about to be isolated helps. Ensuring they have sufficient supplies is also important. And appeals to altruism by reminding the public about the benefits of quarantine to wider society may reduce stigmatization.
There are several strategies that can help all of us cope with the stresses associated with the Covid-19 pandemic. Even if the situation seems increasingly dire and our anxiety is mounting, it’s important to tell ourselves the outbreak will inevitably pass and there are simple ways to mitigate our risk. If you are not physically unwell, do not self-isolate. Try to maintain contact with people online or by phone.
We should ration our consumption of news. There is a natural tendency to over-consume media when we’re faced with threats like coronavirus – we crave answers and reassurance.
“This too shall pass” may be a useful phrase du jour.