The struggle to balance literal survival with all the things that make surviving worthwhile has never been so clear, with the COVID-19 pandemic forcing many to sacrifice social connections – and therefore quality of life – for life itself. And yet, as I wrote in a recent Health Affairs policy brief, Social Isolation and Health (released June 22, 2020), being socially connected in meaningful ways is actually key to human health and survival.
The COVID-19 pandemic and the need to slow the virus’ spread have highlighted the pervasiveness of social contact within, and social relevance of, nearly every sector of our lives, including employment, education, entertainment, travel, transportation, and recreation. The pandemic has also highlighted the underlying weaknesses of our current social “support systems” for older adults, students, families, workers, and at-risk populations. As such, COVID-19 has underscored the necessity of strengthening local and federal systems to rebuild and sustain the social and emotional needs of the population – a task that will be critical to the nation’s public health recovery from the pandemic.
In this post, I explain why concerns about social isolation are heightened during the pandemic; discuss why policy responses must consider the impact of reduced or changed social connection across all sectors; highlight possible unintended consequences of improved digital connection; and, emphasize the importance of prioritizing social needs in recovery efforts.
Population-Wide Social Isolation Due To COVID-19
While social isolation and loneliness were prevalent in the population prior to COVID-19, efforts to reduce the virus’ spread via stay-at-home orders, quarantine, and social distancing recommendations have exacerbated an already serious problem. With the exception of “essential workers,” the pandemic has meant limiting physical proximity to those with whom one lives. For the 28 percent of Americans who live alone, this has meant little to no human contact for months. Regardless of living situation, interactions with anyone outside the home have been severely limited for everyone. Preliminary surveys suggest that within the first month of COVID-19, loneliness increased by 20 to 30 percent, and emotional distress tripled. While several surveys are still ongoing to capture the full extent of the problem, current evidence suggests the pre-existing public health crisis of social isolation and loneliness may be far more widespread than previously estimated. (...)
Social Contact Is A Key Component Of Every Sector
The pandemic has shown the world how fundamental social contact is in our lives, as almost every aspect of life has changed to create social distance. These social distancing efforts have led to remote working; remote or online education; cancellation of sporting, entertainment, and professional events; and, closures of museums, parks, churches and much more. Going forward, we are likely to see sustained changes to the way we live, work, and play, and even in the way we age. In fact, we have already seen calls for permanent changes in social norms, policies and physical environments– all of which are social determinants of health. The Centers for Disease Control define the social determinants of health as “the conditions in which people are born, grow, live, work and age, as well as the complex, interrelated social structures and economic systems that shape these conditions.” The substantial changes in our social behavior as a result of this pandemic are clearly far-reaching, but we do not yet know what lingering longer-term public health effects the pandemic may foreshadow. If the prevalence rates of social isolation and loneliness remain elevated or increase, such changes are likely to lead to a greater public health burden in the longer term. (...)
The COVID-19 pandemic and the need to slow the virus’ spread have highlighted the pervasiveness of social contact within, and social relevance of, nearly every sector of our lives, including employment, education, entertainment, travel, transportation, and recreation. The pandemic has also highlighted the underlying weaknesses of our current social “support systems” for older adults, students, families, workers, and at-risk populations. As such, COVID-19 has underscored the necessity of strengthening local and federal systems to rebuild and sustain the social and emotional needs of the population – a task that will be critical to the nation’s public health recovery from the pandemic.In this post, I explain why concerns about social isolation are heightened during the pandemic; discuss why policy responses must consider the impact of reduced or changed social connection across all sectors; highlight possible unintended consequences of improved digital connection; and, emphasize the importance of prioritizing social needs in recovery efforts.
Population-Wide Social Isolation Due To COVID-19
While social isolation and loneliness were prevalent in the population prior to COVID-19, efforts to reduce the virus’ spread via stay-at-home orders, quarantine, and social distancing recommendations have exacerbated an already serious problem. With the exception of “essential workers,” the pandemic has meant limiting physical proximity to those with whom one lives. For the 28 percent of Americans who live alone, this has meant little to no human contact for months. Regardless of living situation, interactions with anyone outside the home have been severely limited for everyone. Preliminary surveys suggest that within the first month of COVID-19, loneliness increased by 20 to 30 percent, and emotional distress tripled. While several surveys are still ongoing to capture the full extent of the problem, current evidence suggests the pre-existing public health crisis of social isolation and loneliness may be far more widespread than previously estimated. (...)
Social Isolation Carries Long-Term And Immediate Risks To Survival
With a highly infectious and deadly novel virus, why should we care about social isolation and loneliness? As described in my brief, robust evidence links social isolation to increased risk of death from all causes and increased morbidity across a variety of physical health outcomes. These well-established risks are a result of chronic effects over time. Thus, understandably, restrictions associated with the immediate risks of the coronavirus were prioritized for public health. Nonetheless social isolation and loneliness do have immediate effects that are health-relevant that should not be ignored.
The increase in distress due to social distancing that many Americans are experiencing is a normal response. Given that humans are a social species, this is our biology signaling a need to reconnect socially, just like hunger signals us to eat, and thirst signals us to drink water. Proximity to others, particularly trusted others, signals safety. When we lack proximity to trusted others our brain and body may respond with a state of heightened alert. This can result in increases in blood pressure, stress hormones, and inflammatory responses—which if experienced on an ongoing basis can put us at increased risk for a variety of chronic illnesses. Among those with pre-existing health conditions, these changes in physiology could potentially exacerbate the condition, precipitate the onset of an acute event, or hasten disease progression.
Immediate effects of social isolation related to the pandemic have already been observed, with surges in mental health concerns, substance abuse, and domestic violence. Early observation suggests problematic health behaviors, including substance use, poorer sleep, and emotional or overeating, may increase. Further, more than two million Americans purchased guns during the month of March (the second highest monthly total in the decades since such records have been kept), raising concerns for increased risk for suicide. Both short-term and long-term public health concerns will emerge if steps are not taken to mitigate these effects.
With a highly infectious and deadly novel virus, why should we care about social isolation and loneliness? As described in my brief, robust evidence links social isolation to increased risk of death from all causes and increased morbidity across a variety of physical health outcomes. These well-established risks are a result of chronic effects over time. Thus, understandably, restrictions associated with the immediate risks of the coronavirus were prioritized for public health. Nonetheless social isolation and loneliness do have immediate effects that are health-relevant that should not be ignored.
The increase in distress due to social distancing that many Americans are experiencing is a normal response. Given that humans are a social species, this is our biology signaling a need to reconnect socially, just like hunger signals us to eat, and thirst signals us to drink water. Proximity to others, particularly trusted others, signals safety. When we lack proximity to trusted others our brain and body may respond with a state of heightened alert. This can result in increases in blood pressure, stress hormones, and inflammatory responses—which if experienced on an ongoing basis can put us at increased risk for a variety of chronic illnesses. Among those with pre-existing health conditions, these changes in physiology could potentially exacerbate the condition, precipitate the onset of an acute event, or hasten disease progression.
Immediate effects of social isolation related to the pandemic have already been observed, with surges in mental health concerns, substance abuse, and domestic violence. Early observation suggests problematic health behaviors, including substance use, poorer sleep, and emotional or overeating, may increase. Further, more than two million Americans purchased guns during the month of March (the second highest monthly total in the decades since such records have been kept), raising concerns for increased risk for suicide. Both short-term and long-term public health concerns will emerge if steps are not taken to mitigate these effects.
Social Contact Is A Key Component Of Every Sector
The pandemic has shown the world how fundamental social contact is in our lives, as almost every aspect of life has changed to create social distance. These social distancing efforts have led to remote working; remote or online education; cancellation of sporting, entertainment, and professional events; and, closures of museums, parks, churches and much more. Going forward, we are likely to see sustained changes to the way we live, work, and play, and even in the way we age. In fact, we have already seen calls for permanent changes in social norms, policies and physical environments– all of which are social determinants of health. The Centers for Disease Control define the social determinants of health as “the conditions in which people are born, grow, live, work and age, as well as the complex, interrelated social structures and economic systems that shape these conditions.” The substantial changes in our social behavior as a result of this pandemic are clearly far-reaching, but we do not yet know what lingering longer-term public health effects the pandemic may foreshadow. If the prevalence rates of social isolation and loneliness remain elevated or increase, such changes are likely to lead to a greater public health burden in the longer term. (...)
Addressing The Digital And Social Divides
Maintaining connections to others outside the home during the quarantine has increased our reliance upon phones and digital technologies. Of course, reliance on technology was rapidly increasing prior to the pandemic, but with increasing demand for telehealth, telework, and online education, issues of connectivity and the digital divide have been catapulted to the forefront of many policy discussions. Access to the internet is more crucial than ever, but we must pause to ask the bigger question: what is the full scope of consequences that may result from scaling digital capabilities and solutions?
While digital tools have clear benefits, including the capability to provide access to information and resources and bridge distances, there are potential tradeoffs. It is unclear to what extent digital tools approximate the human experience of in-person contact, or whether our biological needs for human connection can be satisfied through such tools. There is some evidence of a “loneliness paradox” wherein tech and social media that should make us more socially connected actually increase loneliness. In addition, the pandemic has highlighted limitations of video conferencing tools that go beyond Zoom Fatigue. For example, anyone who has attended a virtual funeral or wedding, or even just a virtual happy hour, realizes that it may be better than nothing but feels drastically inadequate. According to one survey, these virtual social gatherings failed to reduce loneliness among 48 percent, and actually increased loneliness among 10 percent of respondents. Permanent scaling of digital solutions may create a different kind of digital divide, such that human contact becomes a luxury exacerbating economic disparities. (...)
Maintaining connections to others outside the home during the quarantine has increased our reliance upon phones and digital technologies. Of course, reliance on technology was rapidly increasing prior to the pandemic, but with increasing demand for telehealth, telework, and online education, issues of connectivity and the digital divide have been catapulted to the forefront of many policy discussions. Access to the internet is more crucial than ever, but we must pause to ask the bigger question: what is the full scope of consequences that may result from scaling digital capabilities and solutions?
While digital tools have clear benefits, including the capability to provide access to information and resources and bridge distances, there are potential tradeoffs. It is unclear to what extent digital tools approximate the human experience of in-person contact, or whether our biological needs for human connection can be satisfied through such tools. There is some evidence of a “loneliness paradox” wherein tech and social media that should make us more socially connected actually increase loneliness. In addition, the pandemic has highlighted limitations of video conferencing tools that go beyond Zoom Fatigue. For example, anyone who has attended a virtual funeral or wedding, or even just a virtual happy hour, realizes that it may be better than nothing but feels drastically inadequate. According to one survey, these virtual social gatherings failed to reduce loneliness among 48 percent, and actually increased loneliness among 10 percent of respondents. Permanent scaling of digital solutions may create a different kind of digital divide, such that human contact becomes a luxury exacerbating economic disparities. (...)
Social Needs Must Be Prioritized In Pandemic And Recovery Policy
Concerns about the secondary ramifications of the pandemic have focused nearly exclusively on a global economic recession. There should be similar concerns of a social recession. Similar to an economic recession that can have lasting effects even after the economy begins to grow, the social restrictions put in place during the pandemic may have profound long-term consequences, even after restrictions are lifted.
by Julianne Holt-Lunstad, Health Affairs | Read more:
Image: uncredited
[ed. See also: the following post.]
Concerns about the secondary ramifications of the pandemic have focused nearly exclusively on a global economic recession. There should be similar concerns of a social recession. Similar to an economic recession that can have lasting effects even after the economy begins to grow, the social restrictions put in place during the pandemic may have profound long-term consequences, even after restrictions are lifted.
by Julianne Holt-Lunstad, Health Affairs | Read more:
Image: uncredited
[ed. See also: the following post.]
