SOCIAL DISTANCING, QUARANTINE and ISOLATION, in COVID-19 TIMES. A Rapid Review- Fijian focus.

Introduction.The response to pandemic COVID-19 has seen the mobilization of various social isolation strategies to provide containment from an invisible, new warrior.Whilst global healthcare systems struggle to contain spread, these restrictive public health measures are themselves creating additional stress and distress to individuals and society generally. Undoubtedly isolation benefits containment effort and reduces spread of the virus but we face a catch-22 situation. Medical complications to social distancing, self-isolation, enforced quarantine measures, and locked-downs add important variables to psychological and health stressors, to an increasing number of individuals and communities, globally and are largely unaddressed (1,2).

This paper outlines important health issues related to pandemic isolation strategies currently in play. These health issues are reported as wide ranging, substantial and long lasting (3). The health impact is not only confined to the physical but mental, emotional and spiritual well being of those impacted by these measures of social distancing, self or mandatory quarantines. We discuss salient health, social and gender connotations as it impacts on society in the short- and long-term vulnerable groups inclusive of children, women, aged and the disabled.

The socially Interactive Humanity.Most humans by nature are socially interactive and this remains vital to their health and well being. Enforced social isolation under pandemic circumstances has its down side and the ensuring signs and symptoms of loneliness are under-appreciated public health risks(4).  With SARS 2-Corona Virus 2019, the COVID19 pandemic has created a state of uncertainty, confusion and great pain at all levels of the global communities. There are many variables unaccounted for and the science is in catch up phase.

The Health impacts of Social distancing, quarantines and isolation measures: Without question, poorly structured planning and without adequate free flow of information in isolation and quarantines the circumstances can be problematic for both the enforcers and the quarantined. Such was the case when a kissing couple on the Suva foreshore were charged for failure to distance socially. Without clear guidelines on procedures and processes, individuals are prone to negative feelings, emotional unrest, lost routines and financial concerns and in the above-mentioned case legal action. Resulting anxiety manifests as confusion, anger, low mood, irritability, insomnia and if prolonged leads to depression with potentials of self-harm as documented in the Ebola pandemics in the recent past (2). In the longer term, such individuals exhibit avoidance behaviors in large crowds and paranoia to hand washing and difficult socialization skills.Some positive measures in the isolation phase can assist in reducing these potentially lethal longer-term behavior changes.

Establishing a new pattern to daily existence.

·      Essentials of daily routines must be encouraged, avoiding emotional despair, boredom and personal frustration.

·      Time spent on daily exercise routines such as walks and body conditioning is mandatory. A sense of physical health impacts on the sequel of emotional, spiritual and mental well being. The “happy hormones” from the brain creates positivity in the self. Meditation and Breathing exercise carry great weight in the lives of individuals whether of religious or non-denomination origins are good examples of such.

·      Revisiting old hobbies (music, arts, gardening) can be reviewed as the learning curve to these remain relatively flat. Acquiring new skills in this computerized, digital world can be challenges learnt for procuring entertainment, knowledge and study. Online exposure does require some skills up-building but it’s never late to learn with discounted rates on offer. Some online study keeps the mind active and pushes dementia further away.

·      How about some learning some cooking skills or taking up backyard gardening? That does not need computers and internet or WIFI access.

Social Issues – Vulnerable Children The vulnerability of children in this period is poorly researched. Structured daily routines are paramount especially on young minds lying idle without the formal school environment of being taught, learning and interacting with their peers and friends in the classroom and sporting areas.

The commendable efforts of Fiji parents and the Ministry of Education (MOE) is acknowledged to maintain sanity in the home environment. Structured “Home Schooling” is important on a daily basis akin to the school patterns with intermittent breaks. Some monitoring of teaching and learning skills by both children and their new found home-school teachers is almost mandatory to acknowledge lessons learnt are in fact meaningfully achieved. The prompt assistance by the MOE in on-lining programs and subsequently getting the schools to draw up their teaching and learning schedules, surely is worthy of rosy achievement.

Intermittently allowing children, play time and organized family oriented physical activities strengthens some of those currently loosening bonds Experiences from the 20th Century of rearing our millennial's than by the baby boomers became problematic with the focus on materialism. This will now pan out on the millennial parents if they do not take heed. The pandemic is well positioned to make amends. Those strong familial bonds are the strengths in society which matter: pandemic or no pandemic. Cherish and grow them with love and empathy. The social and gender issues inter phase in the area of how society cherishes the girl child and womankind.

Women and the Pandemic.There has been an accelerated application for divorce proceedings in China after the COVID19 outbreak – lock downs. Women have been the target of domestic violence in most States but we in the Pacific resolve our stress and tension in physical ways. Domestic Violence is on increase in COVID 19 times. Fijian data is very disturbing. No longer just an increase in reporting but the degree and increase of violence is stunning and shameful (4). Husbands / partners no longer financially stable resort to domestic violence when confronted for their inappropriate coping strategies such as drinking grog and not sustaining the financial pressures of daily living. Perpetrators can use the existing restrictive measures to express gender inequality through increased violence against women and girls. Emerging global data reveal that with the emergence of the COVID-19 pandemic, the violence against women and girls (VAWG) and particularly domestic violence has intensified (5). The female has the difficult task of managing the children, the household and manage the restricted food budget and even work outside the domestic confines. Voicing her concerns, she ends up as a punching bag for her distraught male companion or husband. Post pandemic the societal issues could worsen with high divorce rates, single parenthood and fragmentation of family units.

 COVID19 – impact on the Aged. Social measures to contain COVID-19 additionally impacts by worsening the loneliness of the aged, globally. Compounded with immune-challenged medical conditions of non-communicable disease (Hypertension, Heart diseases, diabetes, respiratory illnesses and cancer.) Their morbidity and mortality remain high in many state jurisdictions, take UK as an example for that matter. Compounded with low socio-economic ranking, minority races and ethnicity, one cannot help noticing the social inequities the 20th Century with its fiscal dominated agenda leading millions prone and susceptible to the new microscopic warrior. Even in the most developed countries look at USA, Colored and Hispanics are greatly affected compared to white Americans. What will transpire in the develop world is in a conjectural stage.

The Disabled/Challenged face greater Health Threats. Poor communication ability of the disabled/ challenged or with miscommunication the abled-body fails to comprehend the needs and wants of their disabled brethren would result in compounding stress to this significant component in society. That voice of the disabled has not been heard so far.  Is it muffled, lost in bureaucracy? The special and specific health needs during this pandemic of disabled/challenged needs to be identified, tabled and the onus would be to interweave their specific needs into the mainstream, akin to normal times. Much work needs to start in this area soon globally and in the sovereign states of the affected world. There has been very little research in this area so far and one needs to address the needs of all parties in the community and ideally not leave the disabled behind.

Reality Check. As we possibly exist from the first wave of the COVID 19 there are some important pointers on our moral compass, guiding us into the future.

1.    There have been many pandemics in the last 250 years and all have invariably been followed by devastating second and third waves with greater human calamity. The improved documentation since the Spanish influenza (102 years ago), we are experiencing the 8th pandemic and that each has had a second wave, with high mortality and mortality on all counts, worse than the first. We don’t need Nostradamus to spell that out.

2.    The question of masks and gloves remain and the fashion changes. For what its worth stays within the established guidelines. Oop, recent research suggests aerosol droplets travel up to 3 metres and that should be the distancing separation? Oh!

3.    In different jurisdictions different population groups are affected: We note the disproportionately high rates in the aged in UK retirement homes. The socially disadvantaged, people of color and minorities in USA. The millennial having stroke events post COVID19 in USA and now more recently “Kawasaki Syndrome” in American children. The jigsaw puzzle remains to unfold its true picture.

4.    The talk of the pandemic going “endemic” is also being raised.  With the seasons changing we may seem to be doomed with no vaccine in sight. That will be another matter as the virus family can mutate and how humanity learns to mitigate is another unanswered question. Will vaccines be available in the developing world and at what cost are difficult questions to answer just yet.

In the current Country specific Exit Strategy. The public health issues remain paramount today although economic restructuring needs planning invariably. “Go slow” is the mantra. Phased and structured re-opening based on “need not wants” is essential. Serious thoughts to keep focused in addressing public health needs cannot be given second place to resurrecting the economy. Porous borders do not help long term. Freight flights continue to bring in human cargo who have outlived their visitor status abroad and help sustain revenue to our national airlines. A moot point indeed. Pre-planned measures inclusive of distancing, quarantining and isolation strategy must be thought out planned and executed efficiently for the next wave: COVID 20. Reducing the quarantine phase “stress” in isolation which can be emotionally substantial and long term must be given greater thought. Where are our counselors and psychiatrists? The Fijian general practitioners are good listeners but not engaged in our healthcare rapid review of the evidence, unfortunately.

On a brighter note, give some thoughts to how humanity will choose to travel in future. This is still conjectural theory. I had hoped for a Sea Cruise someday but have some second thoughts now. Hopefully the Environmental man made disaster “Climate change, global pollution may demonstrate reversals as humanity pauses, takes on new directions from its previous materialistic course. Thank you:  SARS 2-Corona Virus for leading the path, as much as it pains. A new world order will evolve. Will the world see another hegemon?

References.

1.     Brooks S et al. The psychological impact of quarantine and how to reduce it: Lancet 912-202020: https://doi.org/10.1016/S0140-6736(20)30460-8

2.     Louise C. Hawkley1 and John P. Capitanio. Perceived social isolation, evolutionary fitness and health outcomes: a lifespan approach. Philosophical Transactions of the Royal Society B; 2015: 370 (1669).

3.     Nursbaumer-Streit B et al: Quarantine alone or in combination with other public health measures to control COVID-19: a rapid review; Cochrane Database of Systemic Reviews: 2020; Issue 4. Art. No.: CD013574.

4.     Fiji Women’s Right Movement 2020. Women’s human rights groups: Risk of rise in domestic violence cases during COVID 19 Pandemic www.fwrm.org.fj/news/media-releases

5.     COVID -19 and ending violence against women and girls. 2020/04. www.unwomen.org

 Author Details.

1.Dr. Neil Sharma.

2.Dr. Josefa Koroivueta.