The coronavirus pandemic: quarantine, shutdowns and all that stress

The word quarantine first came around to use in Italy's Venice in 1127. It was used in response to Leprosy and was later heavily used during the Black Death. It took another 300 years until the UK properly began to impose quarantine measures in response to plague.

The word is back in use again. Countries around the world have imposed quarantine measures in varying degrees to combat the spread of novel Coronavirus (Covid-19). The illness is caused by the new coronavirus SARS-CoV-2 and was declared a pandemic early last March.

There is precedent for such measures. Citywide quarantines were imposed in areas of China and Canada during the outbreak of severe acute respiratory syndrome (SARS) in 2003, and entire villages in many west African countries were quarantined during the Ebola outbreak in 2014.

Pandemics are far from being a medical phenomena though. They disrupt personal and professional lives severely and affect people and societies on several levels. The key strategies promoted for containment of pandemics are isolation and physical distancing – both can have significant impacts on daily lives and interpersonal relationships. These sudden outbreaks of public health events also pose huge challenges to the mental health service system.

Quarantine can easily deplete our energy levels, affecting our ability to concentrate and increase stress. In fact, many experts believe more than seventy percent of the diseases are related to stress and diagnosing chronic stress can be a way to address chronic illness. Psychosocial stress increases the risk for both somatic and psychiatric diseases and worsens their prognosis.

The biochemistry of stress is complicated. But here is an easy breakdown of the matter: Cortisol, a hormone that works as a key player in the body's stress response, is often measured in research as an indicator of stress. The human body has two adrenal glands located on top of the kidneys, and these glands produce hormones in response to stress. In case of apparent threat, the hypothalamus--an area in the brain--sends direct signals to the adrenal glands, causing them to release a catecholamine and epinephrine (same as adrenaline). It leads to an immediate action by stimulating faster breathing and heart rates. The adrenal medulla also secretes another catecholamine, norephinephrine, which works to stimulate liver cells in releasing glucose making more fuel available for cellular respiration.

These hormones have short-term effects as the nerve impulses are sent from the hypothalamus. Hormones secreted by the adrenal cortex provide a slower, longer-acting (chronic) response to the stress. While cortisol is an important and helpful part of the body's response to stress, it is important that the body's relaxation response be activated so the body's functions can return to normal following a stressful event.

Unfortunately, in the current high-stress pandemic situation, the body's stress response is activated so often that the body doesn't always have a chance to return to normal, resulting in a state of chronic stress.

People are biologically wired to react differently to stress. One person may secrete higher levels of cortisol than another in the same situation. Studies have also shown that people who secrete higher levels of cortisol in response to stress also tend to eat more food and food that is higher in carbohydrates than people who secrete less cortisol.

If you're more sensitive to stress, it's especially important for you to learn stress management techniques and maintain a low-stress lifestyle in these circumstances. This is an easy way to get cortisol secretion under control and maintain a healthy lifestyle at the same time.

How affected one is by a period of social isolation, or just reduced interactions, is also influenced by their personality. 

"If you're a massive extrovert who thrives on social contact" the experience is going to hit harder "than if you're an introvert who's very comfortable curling up on a couch with a book," according to psychologist Dr Sherry Benton, Professor Emeritus of the University of Florida.

But science shows us that anxiety and isolation exact a physical toll on the brain's circuitry. They increase the vulnerability to disease—by triggering higher blood pressure and heart rates, stress hormones and inflammation—among people who might otherwise not get sick.

Prolonged loneliness can even increase mortality rates. In 2015, Julianne Holt-Lunstad, a neuroscientist and psychologist at Brigham Young University, published an analysis of seventy studies, involving 3.4 million people, examining the impact of social isolation, loneliness, and living alone. The results are especially notable in light of today's pandemic. The review found that loneliness increased the rate of early death by twenty-six per cent; social isolation led to an increased rate of mortality of twenty-nine per cent, and living alone by thirty-two per cent—no matter the subject's age, gender, location, or culture.

Due to the uncertainty and lack of knowledge surrounding Covid-19, its lightning-fast transmission and infectious nature and serious threat to life as we know it is pushing everyone at an edge.

The emotional response caused by stress is mainly a series of accompanying emotional experiences putting people in a negative emotional state such as depression, anxiety, panic, disappointment or fear. The main behavioral changes caused by stress are restlessness, inattention, reduced ability to solve problems, slow action, frequent anger, crying easily, smoking and alcohol abuse.

In a recently published article in the journal of Psychology, Health and Medicine, the authors studied  the public psychological states and its related factors during the outbreak of coronavirus disease 2019 (Covid-19) in some regions of China. It showed that during the outbreak, 93.67 percent did not have any symptoms of anxiety and 6.33 percent felt anxious. Which gives us reason to hope. Nearly 82.83 percent people had no symptoms of depression and 17.17 percent were found to have been showing symptoms of depression.

In another journal-- The Lancet--published March 14, 2020 Samantha K Brooks and a group of authors wrote a review article titled "The psychological impact of quarantine and how to reduce it: rapid review of the evidence".

The authors tried to understand stressors during the quarantine. Which include: a) duration of quarantine b) fears of infection c)frustration and boredom d) inadequate supplies e) Inadequate information, etc. and the stressors of post quarantine are as follows: a) finances b) stigma.

Boredom and isolation will cause distress; people who are quarantined should be advised about what they can do to stave off boredom and provided with practical advice on coping and stress management techniques. Having a working mobile phone is now a necessity, not a luxury.

Activating your social network, albeit remotely, is not just a key priority, but an inability to do so is associated with immediate anxiety, and long- term distress.

Stay home, but try to stay connected.

 

Dr HU Shekhar, Ph.D, is a professor at the Department of Biochemistry and Molecular Biology at Dhaka University.