Updated: May 13, 2020
In the past few months coronavirus disease 2019 (COVID-19) has received global attention due to its high fatality rates and lack of effective treatments and vaccines. The mass quarantine measures have led to common mental health problems, such as fear, anxiety, depression, and sleep problems, in patients with COVID-19 infections, close contacts, the public, and even health care professionals. There is a pressing need to establish appropriate mental health services to address the risk of psychiatric morbidities.
The crucial method in breaking the chain of infection is effective separation of infected individuals and suspected or actual carriers from the unaffected populations. This break of physical contact can be achieved through isolation, quarantine and social distancing.
Faced with sudden isolation and quarantine, individuals and small groups can react with fear anxiety which can give way to depression and despair or anger and acting out. Depending on the circumstances, the issue of isolation or quarantine may represent a precipitating traumatic event for the individuals involved. Patients who are placed in isolation are particularly vulnerable to neuropsychiatric complications because they are confined to limited space, their movement is limited and everyone is rushing to complete their task at hand and get out of the isolation room. Patients in isolation tend to receive less face-to-face time and are particularly susceptible to sensory deprivation and isolation from social contacts.
When the fabric of social support is ripped by isolation, it should be patched as soon as possible with available technological means, including phones, tablets, and social media. When preexisting social support cannot be reassembled due to stigma, then it is up to healthcare providers and other volunteers to step up and fill this void.
Handling anxiety during isolation and quarantine requires a multipronged approach that rests on support, reassurance, providing useful information, and solving practical issues for patients. If family members and friends are unable to visit patients in isolation, then it is incumbent upon healthcare personnel to provide the much-needed social contact, reorientation, and support, even at times when patients appear cognitively impaired and unable to communicate coherently. Providing contact with family members via telecommunication should be used judiciously, when having such communication is expected to have a beneficial effect on the patient and patient’s loved ones.
Young children may not be kept in isolation or quarantine without caregivers for any extended period of time. Children of all ages and adolescents benefit from structured time activities and routine. Routine may be designed to resemble the pre-isolation routine or it may be an entirely new routine. If isolated or quarantined children are missing school, they should be allowed to attend classes virtually. Other than assigning children homework and other tasks, the use of books, media, board, or electronic games can make the isolation less daunting. The use of the internet should be allowed and tolerated.
Empowering individuals to make decisions and by helping them restore or establish routines during the isolation, as well as directing them to utilize healthy defenses, including humor, may go a long way in maintaining mental health equilibrium.
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