Surviving isolation: Families under siege during coronavirus

Contrary to first impressions, being under quarantine can be hard work, especially if a member of the household is suspected of being exposed to the coronavirus.

Grandparents 'Zoom' the Seder with their family (photo credit: JOSEFA SILMAN)
Grandparents 'Zoom' the Seder with their family
(photo credit: JOSEFA SILMAN)
Resemblance in the following account to anyone’s life is entirely coincidental.
Contrary to first impressions, being under quarantine can be hard work, especially if a member of the household is suspected of being exposed to the coronavirus. If a family member comes down with a mild form of the disease, or if they came in contact with a sick person, they need to self-quarantine in a separate room and avoid all contact with the others. Their food is delivered to their door and if possible, they use a separate bathroom.
The psychic pain for the isolated person is quite severe.
Imagine being in this situation. How many Netflix movies can you watch? How much time can you spend on social media? Eventually it becomes stale.  The stigma of sickness, especially in a social environment that seeks to assign blame, is reinforced by being isolated from other people. On top of that, there is worry and guilt about the possibility that you might have infected others, maybe even a family member.
If you can work or attend classes from your isolated room, you are in a much better place. At least you have a purpose; you feel productive, and you are moving forward. If you are a breadwinner and are able to continue your work from home, at least you don’t have to worry about the financial aspect of staying home. If your livelihood is dependent on leaving the house, or worse, if you got laid off, your worry and misery are compounded.
As day follows night, the distraction afforded by the internet wears thin. Maybe at first it was fun, catching up on all the TV series and movies that you missed because you were busy making a living. You’ve been contacting all your family, friends, acquaintances, neighbors and commiserating about the cursed coronavirus. A few days pass, then a week of the same experience in the same environment. Now you start panicking.
You feel like you can’t go through another week. In the meantime, the rest of your family has the “luxury” of moving freely throughout the rest of the apartment or the house. They can go to the kitchen; they can prepare food; they can even take a walk outside. But they are worried sick about you. They talk to you through the door (or staying 2 meters away), asking frequently how you are doing and about your temperature.
They also worry that they may be infected, or that they might have infected other people in the family, especially the elderly. Family members start keeping distance. They stay away from each other, which is not so easy, unless you live in a very large home. They meet each other in the corridor and get startled. They turn away so as not to come in close contact.
Afraid to go shopping, they order food delivery. But this is not reliable and not always available. They try to go shopping for food, but the supermarkets aren’t really safe. How do you keep a 2-meter distance in the narrow aisles of the supermarket? Despite gloves and masks – when available – your family members can never be sure that they didn’t catch the virus.
Hand sanitizer starts to run low (if you were lucky enough to have gotten some before the shelves were empty), because everyone is constantly using it. If someone sneezes or coughs, a moment of dread descends on the household. What if the person is sick? What if that person did not sneeze into his sleeve?
The news sound grim. You can get out of your isolated room after the fourteen days period, but you don’t know when you can resume your old life, because every day the news becomes grimmer and grimmer. Is this pandemic going to be over in a month? Or, will it be two?  Some predictions are even worse.
Social isolation has proven to be the most important factor in controlling the spread of coronavirus. The Chinese regime imposed draconian measures to keep people inside their homes and avoid human interaction. It seems to have worked. Chinese authorities reported in the middle of March that the number of new people infected with COVID-19 has started to decline. Italy has confirmed recently that social distancing seems to be working and they are seeing a decline in new cases.

But social isolation and particularly quarantine, carry a heavy psychological price (on top of the other consequences to health and finances.) The unexpected and unprecedented changing circumstances of life in the age of coronavirus create tremendous stress, which is exacerbated by the uncertainty and inability to predict when the pandemic will be end.
A recent rapid review of the psychological consequences of quarantine, published in the Lancet last month, reported that most studies of quarantined subjects observed effects such as confusion, anger, and post-traumatic stress symptoms, sometimes lasting even three years after the end of the quarantine.
While the effects of quarantine will be felt by most people, those with pre-existing psychological disorders are particularly vulnerable. They can tolerate the enforced isolation even less than others.
People who suffer from GAD (Generalized Anxiety Disorder) experience a constant free-floating anxiety which is ready to attach to any cause, real or imagined. Coronavirus, however, is very real. And being in quarantine reinforces the reality even more. For such a person, the worry over infectiousness, coupled with a sense of helplessness and lack of control can turn into an anxiety attack.
Quarantine also involves physical containment, usually in a small space. Sometimes it is a room in a house or an apartment where infected people need to isolate from their family to protect them. But worse yet is when they are forced into quarantine in a separate location, away from family and away from their familiar things.
You may recall the protests of the Israeli citizens caught on board of the Diamond Princess cruise ship at the beginning of the outbreak. They exhibited mounting anxiety, not only because of the possibility of getting infected but also because of being ensconced in small spaces, away from their home and family; and in the middle of the ocean.
For people suffering from anxiety or from claustrophobia, this can cause unimaginable psychic pain.
People suffering from depression, are at increased risk too. Being placed in quarantine can exacerbate their symptoms. Depressed people tend to isolate even during normal times, and the uncertainty and worries brought about by the pandemic may only increase their sense of helplessness and hopelessness. They need to be supported and embraced by their family, their community and their therapists. They need to be encouraged, monitored closely, and continue their treatment.
The elderly are particularly vulnerable, both physically and psychologically. Their chances of dying as a result of complications of the coronavirus are high. And they get infected more often, especially in some nursing homes, where there seems to be a failure in containing the infection. They are terrified. 
Many had lost much of their previous freedom because of physical frailty. They may live at home but are often dependent on others to help them get around. Even if they have a loving family, who visit often, they experience some loneliness even during normal times. Others live in facilities, where they have little control over their daily lives, their food and their outings. They also are dependent on contact with family and friends for their well being. Putting the elderly in quarantine, while certainly necessary to protect them, can have dire psychological consequences. People can die from coronavirus; they can also lose the will to live. Every effort should be made to support the elderly psychologically and allow them contact with their family, while using the highest level of protection.
As the social isolation,(and in some cases- a lockdown reinforced by the government) keeps extending, the psychological consequences can only worsen, even for more resilient people. We don’t know how long we are going to be stuck at home. The extended time in close proximity can prove too much for some families, leading to  friction between family members. Consider the couple who planned to separate before the outbreak and now they find themselves forced to live under the same roof. Or the bored siblings, who have gotten their fill of movies, social media and games and now are getting on each other’s nerves. Families blessed with many children, without access to media, must find ways to occupy children of different ages, often in a small space. And we haven’t even started to talk about financial anxieties and basic survival.
In times like these, solidarity and compassion are more important than ever. While governments struggle to find ways to contain the coronavirus and find solutions to the economic consequences of the pandemic, it is up to us as communities to come together and find ways to support our members physically and psychologically, while also prioritizing safety. Each one of us needs to take a step back from our own duress and identify those who are more vulnerable than ourselves.
We need to reach out to people in our family and in our community and, if we can, to the larger community and help them endure and survive these difficult times. 
Mark Banschick, MD is a child and adult psychiatrist in Katonah, New York. Gabriel Banschick is a third-year medical student at the Sackler School of Medicine, American Program, Tel Aviv University