A former Little White House intern writes about his experience in isolation due to COVID exposure

by Eivind Hamarheim Johnsen

By the first 2-3 weeks of March this year, the sars-CoV-2 virus (coronavirus) developed into a pandemic and caused the majority of countries worldwide to a lockdown. The societal effects of the lockdown were enormous and will most likely affect the world economy long-term additionally to short-term, as already widely known.[1] The pandemic outbreak has additionally exposed and exacerbated weaknesses in the health care systems.[2] During the lockdown in many countries, populations around the world were told to stay home as much possible as a preventive intervention in order to reduce the risk of spreading the virus. In some countries that was brutally affected by the first wave of infection, like Italy, people were even fined for staying outdoors outside of certain hours. The pandemic stroke the globe approximately at the same time, which meant societies across all continents were shut down so as to get control over the spread of infection. What do we know about the effects it has had on individual level?

In the very beginning phase of the second wave of coronavirus, I was “self-isolating” at home for 6 days, from the 18^th of September to the 23^rd of September 2020. According to the Danish National Board of Health´s official website, sst.dk (Sundhedsstyrelsen), “self-isolation” includes the following:

You must stay home and not meet other people you do not live with.
You must avoid close contact with people you live with.
You must be especially aware of maintaining a high level of hygiene and cleaning.

People who are infected with coronavirus or are at risk of being infected has to self-isolate. For instance, a person who lives with a person who gets infected has to self-isolate, independently of her or his feeling of having symptoms or not. The 18^th of September, I received a message from a person I had been in contact with who had multiple symptoms for coronavirus. She had taken a test which was positive – there was no doubt she was infected, also because of her disease course. This meant I had to stay isolated until my roommate was free for symptoms for 48 hours and I had two negative tests. However, I never developed any of the symptoms related to coronavirus, which meant that I had to stay at home despite the fact that I felt completely healthy.

For some reason, being isolated was very different in September compared to how it felt in March. In March, isolation felt like participating in a social initiative directed by the government, where the whole Danish population was on board. The situation was new to all people in the world, which resulted in new trends and challenges on social media. Many people found alternative ways to exercise at home, pleasure in new activities such as baking and reading, and were creative with their parenting. In September, on the other hand, isolation resulted in a feeling of loneliness, boredom and frustration. I could not even imagine staying isolated more than a week. Why were there such remarkable differences in the perception of the isolation and the effects of it, comparing the two episodes? Furthermore, what do we know about the effects of being isolated from other people, taken into consideration that humans are social creatures by nature?

There exists a large body of research on how humans in addition to other species are influenced by isolation from their own. Several decades before the coronavirus outbreak, scientists have investigated the effects of social isolation. Just above 30 years ago, House, Landis, and Umberson (1988)[3] published a vastly cited article linking social relationships and health. Though they at the time concluded that processes and mechanisms linking social relationships to health needed further investigation in the future. They claimed, however, theory and data reviewed in their article met criteria for considering social relationships a cause or risk factor of mortality and probably morbidity, from a wide range of diseases. Just over two decades later, Cacioppo, Hawkley, Norman, and Berntson (2011)[4] published an article titled “Social Isolation”, building on evolutionary psychological, ethological and modern biopsychosocial theory and empirical findings. They concluded the following about social isolation in humans:

The effects of perceived isolation in humans share much in common with the effects of experimental manipulations of isolation in nonhuman social species: increased tonic sympathetic tonus and HPA activation, glucocorticoid resistance, decreased inflammatory control, immunity, sleep salubrity, and expression of genes regulating glucocorticoid responses. (2011, p. 5).

These neurobiological, hormonal, behavioral and genetic alterations linked to perceived social isolation culminates in an alertness to social threats, and a feeling of aversive pain that can motivate behavioral change. Moreover, these effects together are linked to higher rates of morbidity and mortality in older adults. This does not mean that older people who have to stay socially isolated for a week are at huge risk of dying due to the isolation itself. What it conveys in this context is that humans, like other species, could be affected by unfavorable changes that make us vulnerable to negative outcomes (e.g. physical illness, psychological disease).

The link between social isolation and psychological disease (e.g. depression, anxiety) is known to be of importance within psychological research. Per date, majority of psychological researchers would most likely agree that social support is an important protective factor to prevent vulnerability to developing psychological illness. Only two years ago, Taylor, Taylor, Nguyen, and Chatters (2018) studied the link between social isolation, depression and psychological distress in older adults. Some of their main findings was that older adults who reported subjective social isolation from both family and friends had higher levels of depressive symptoms, and subjective isolation from friends only was associated with both more depressive symptoms and higher levels of psychological distress.

Even though the link between social isolation and aversive outcomes has been demonstrated, there is still hope in case you will have to stay home in the nearest future. Due to the pandemic outbreak and high degree of isolation in the general population, researchers are investigating now investigating what effects it can have in this specific situation. If the findings are consistent with studies presented above, they will also most likely try to develop effective interventions with the aim of reducing potential harmful effects of being isolated for a day or 14. As a consequence of the rapid technological progress at the time of writing, we have a lot of opportunities to connect with people even though we have to stay at home. Personally, I tried to have a consistent wake-up time, connect with friends and family every day, eat healthy and limit my news exposure. Some of these strategies were excessively helpful, whereas others were harder to complete to a full extent. Therefore, I would encourage you to be mindful about your own approach (e.g., strategies or habits) in case you had to practice self-isolation. That might make it somewhat easier to get through the feeling of loneliness. Be scientific about it, think about what might work best for you!

[1] Fernandes, N. (2020). Economic effects of coronavirus outbreak (COVID-19) on the world economy. Available at SSRN 3557504.

[2] Blumenthal, D., Fowler, E. J., Abrams, M. & Collins, S. R. (2020). Covid-19—Implications for the Health Care System. I: Mass Medical Soc.

[3] House, J. S., Landis, K. R. & Umberson, D. (1988). Social relationships and health. Science, 241(4865), 540-545.

[4] Cacioppo, J. T., Hawkley, L. C., Norman, G. J. & Berntson, G. G. (2011). Social isolation.