Past quarantine lessons: what have they taught us to apply today

In 2003, the outbreak of the SARS epidemic caused hundreds of workers in Beijing hospitals to be exposed to the virus, some of whom had to spend a period in quarantine. Three years later, a group of psychologists analyzed his mental state. Although a long time had passed, around 10% of them still suffered from post-traumatic stress, a percentage that reached triple among inmates.

In 2007, Australia was rocked by an equine flu epidemic like never seen before. Most of the inmates were farmers or people belonging to the horse industry sector, whose income depended on their health. More than a third suffered psychological problems that required external intervention, and 14% of the total of those consulted suffered a condition that could fit some of the DSM-IV descriptions, the quintessential psychological guide.

In 2009, influenza A became one of the last major precoronavirus pandemics, forcing families in many different corners of the planet to isolate themselves, from Canada to South Korea. Research published four years later would find that confined children scored four times higher on post-traumatic stress tests than they had been able to leave home. Too it happened with adults: 28% could be a candidate to suffer a mental problem compared to 6% overall.

The experience in South Korea, Canada, China, Liberia or the USA is very similar: we react badly, through stress, confusion and anger

These are three of the nearly 3,166 studies that, according to a group of researchers from King’s College London, exist on the psychological influence of quarantines. Of them, they have selected 24 most understanding to draw a global map of past quarantines that has just been published in ‘The Lancet’. From Canada to Taiwan, passing through South Korea, Sierra Leone, China, Liberia, USA or SwedenWhether it's SARS, influenza A, Ebola, or Middle East respiratory syndrome, we are all just as human everywhere. Which means, in Roman paladin, that negative psychological feelings were reported in all parts of the world. As usual, post traumatic stress, confusion and anger.

"Quarantine is often an unpleasant experience for those who have to live it," recall the authors, with Samantha K. Brooks to the head. "Separation from loved ones, loss of freedom, uncertainty about the disease state and boredom can sometimes have dramatic effects."

It is not only about the psychological consequences mentioned above, but also a potential increase in suicides – a study published in 'Disaster Medicine and Public Health Preparedness' cited two cases at the beginning of the SARS epidemic, in one of which was managed to avoid in time that a hospital patient jump out the window– or in legal disputes.

Is what happened with Kaci Hickox, who sued the Governor of New Jersey Chris Cristie after he was forced to "quarantine" Ebola against his will "unconstitutionally." ORother times, even if it was just five years ago.

Lesson 1: watch out for aggravating factors

General psychological symptoms, emotional disturbances, depression, stress, low spirits, irritability, insomnia, symptoms of post-traumatic stress, anger and emotional exhaustion. Especially, low spirits and irritability. Also among those who had been in contact with some of those infected by SARS they showed fear (more than 20%), nervousness and sadness (18%) and guilt (10%). In some cases, there were also hopeful responses. Even if it was less than 5%, there were also feelings of relief and happiness.

One of the most common complaints during the SARS epidemic was that the authorities had provided food, but only at the beginning

There are several types of stressors. On the one hand, those that were already at stake when the quarantine entered, such as a hypothetical inmate depression. On the other, the duration —as was the case in the Toronto study that we are talking about here—, the symptoms of post-traumatic stress soared between day 10 and the first two weeks of isolation; fear of infection (starting to feel symptoms triggered discomfort, especially among pregnant women or young children) or frustration (when participating in daily activities) and boredom.

Two other factors influencing bad quarantine were not having access to basic goods, such as food, clothing or medicine. One of the most common complaints during the confinement of the SARS in Toronto was that although the authorities had provided the inmates during the first stages of the seclusion, this support had been reduced as time passed. The final key is information:

"Following the Toronto SARS epidemic, participants perceived confusion emanating from differences in style, approach, and content of various public health messages due to poor coordination between the different jurisdictions and levels of government involved," they explain. the authors. "The lack of clarity about the different levels of risk, in particular, led to the participants fear the worst"

Lesson 2: that the money is not late

Once the quarantine was over, the participants' greatest concern was their financial stability: the economic consequences are among the most durable. Going back to the equine flu epidemic, those Australians whose jobs depended on the horse industry were twice as likely to experience mental problems as those who had been confined but worked in another sector. After all, what was dying was His way of life.

Those who lived with income of less than 25,000 euros per year (in exchange) showed more symptoms of stress

Very late Y very littlewas the response that some of the aid recipients during the Ebola crisis in Senegal gave when asked if they had received enough. Even in wealthy countries, such as Toronto, where income was slow to come, for those without sufficient financial cushion, the quarantine period had been particularly painful. Those who lived on incomes of less than 25,000 euros per year (in exchange) showed more symptoms of stress.

In this case, it is perhaps much less likely that any kind of stigmatization, since we are all confined. In the past, it was one of the most pressing problems. Being confined by being a doctor or a nurse generated a certain discomfort among the family, who thought that perhaps your work was too dangerous, and generally, generated a certain social rejection. The most dangerous effect, that many of those who began to feel symptoms of respiratory diseases they preferred not to communicate it.

Lesson 3: the danger of not seeing the future

Although most societies have understood the need to impose self-confinement in the harshest way, the work, which began to be written when the coronavirus was an epidemic that had barely left Wuhan, reflects the duality that any quarantine entails. "The potential benefits of a mass quarantine need to be carefully weighed against possible psychological costs”, Recommend the authors.

"The successful use of quarantine as a public health measure requires us to reduce, as far as possible, the negative effects associated with it." It is possible, therefore, that the authors' recommendations today may seem naive. For example, when they remember that one of the measures to mitigate these effects is "shorten it as much as possible" "Restrict the length of the quarantine to what is scientifically reasonable given the known duration of the incubation periods and not taking an openly preventive approach it would minimize the effect on people. "

The authors specifically cite the example of Wuhan and advise against dealing with indefinite terms. "Our evidence also emphasizes the importance of authorities adhering to their own quarantine length, and not extending it," they propose. "For people already in quarantine, an extension, no matter how small, is likely to exacerbate any sense of frustration or demoralization. Imposing a police cordon indefinitely in entire cities without a clear time limit (as seen in Wuhan, China) can be more damaging than quarantine procedures limited to the incubation period. ”

Letting people know that you are helping others helps mitigate the negative effects

As the alternative, remember, it is usually worse, it is necessary to adopt certain measures so that “the experience is tolerable for the people" Namely: explain what is happening, why, tell them how long it will continue, provide “meaningful” activities for them to carry out during quarantine, clearly communicate, guarantee basic supplies (such as food, water or medicines) and reinforce the sense of altruism that people, in their right, should feel.

That is one of the keys to the study: altruism.

Lesson 4: do the right thing to feel good

Although there are no concrete studies on the differences between forced and voluntary quarantines, the authors do remember that the feeling of doing something altruistic, for the benefit of others, will most likely improve mental health once the confinement is over. "In other contexts, feeling that others will benefit from such a situation probably makes that the situation be easier to carry, and that probably applies to quarantine, "recall the authors.

"Reinforce that quarantine is helping to keep others safe, including the most vulnerable (such as newborns, the elderly, or those with pre-existing medical problems), and that the health authorities are truly grateful, can help to mitigate the effect on the mental health of the isolates ”, they add.

This is what happened in China, after SARS, where the doctors who had worked in the midst of the epidemic suffered more if they were single or felt at risk of contagion, and their only mitigating factor was the feeling of having accepted this responsibility. Without expecting anything in return. This was corroborated by other research, which recalled that the mental impact of the quarantine was mediated by the perceptions of the inmates, so perceiving that others are being saved is a mitigating factor.

Good news: in a study that accompanied the inmates months after their release, anxiety and fury were more than halved

The collected studies rarely give good news, with one exception, which we can hold on to as if it were a moral nail. This is the one performed in South Korea among MERS (Middle East respiratory syndrome) patients during 2015. Once again, the picture is well known –anxiety in 7.6%, fury in 16.6%-, but both percentages fell significantly between four and six months after the end of confinement to more than half (3.6% and 6.4%, respectively).

The hope is that it is the only one of the collected studies that had tracked patients' mental health after the survey, and the results had varied enormously in a very short time. We may have a hard time today, but for most, they will end up coming better times.