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Quarantine: Managing the Ups and Downs

After only just jumping out of one lockdown and straight into the next, the impact on Melbourne and Melbournians is starting to show. This is a situation that is brand new for so many people. It almost feels like there is an invisible war that is being fought around the state of Victoria, and the importance of staying home and isolating has become the only way to win the battle.

Quarantine is the separation and restriction of movement of people who have potentially been exposed to a contagious disease (CDC et al., 2003). It is designed to ascertain whether an individual is likely to become unwell and if so, reduce the risk of them infecting others. This is different from isolation. Isolation is the separation of those who are not infected from those diagnosed with the contagious disease (Manuell & Cukor, 2011). This word was first distinguished in Venice (Italy) when the ‘Black Death’ started to pass through Europe (Newman, 2012). This happened almost 900 years ago and whilst there have been pandemic outbreaks previously, no pandemic has been felt as globally as the current coronavirus outbreak.

Everyone in Victoria will find themself on one of the following categories across the state: 

(1) They may/may not have COVID-19 and have been instructed to quarantine for 14 days; 

(2) They have been in contact with someone who has been diagnosed and need to isolate in order to prevent the spread; or 

(3) They have to practice social isolation to prevent the spread. 

This process is not a pleasant experience and nobody has lived through a time like this before. Everyone is feeling the loss of freedom; uncertainty over their disease status and even boredom, which can all have mental and physical effects.

Studies have shown that those who have been quarantined experienced emotional disturbance (Yoon et al., 2016), depression (Hawryluck et al., 2004), stress (DiGiovanni et al., 2004), low mood (Lee et al., 2005), irritability (Lee et al., 2005), insomnia, anger (Marjanovic, Greenglass & Coffey, 2007) and emotional exhaustion (Maunder et al., 2003). It is worth mentioning that low mood and irritability stand out having high prevalence amongst these studies (Lee et al., 2005). All these studies and participants were conducted during previous pandemics such as the SARS outbreak and other notable outbreaks.

So what can you do to get through this process? The first thing to understand is the potential stressors that can be generated through the current lockdown.

  1. Duration of quarantine

The length of quarantine can have significant impact on mental health and behaviours with studies showing that those quarantined for longer than 10 days showed significantly higher post traumatic stress (Hawryluck et al., 2004).

  1. Fears of infection

Not only is it the fear of getting infected but passing the virus onto other is a source of anxiety and fear.

  1. Frustration and boredom

The loss of a usual routine, reduced social and physical contact with others and the inability to take part in day-to-day activities can cause distress for individuals.

  1. Inadequate supplies

Basic essentials such as food, water or clothes is a source of frustration amongst citizens. There is evidence that there can be associated anxiety and anger 4-6 months after quarantine release (Jeong et al., 2016)

  1. Inadequate information 

Previous research during the SARS epidemic showed that insufficient clear guidelines about actions to take and confusion about the purpose of quarantine can disconnect the community and can lead to misinformation, lack of concern and increased risks of spread within the community.

So how can you look after yourself and others during this time. The WHO have put out some useful information and advice to help during this time.

  • Keep informed
    • Keep up to date with the latest information and guidelines from attributable sources (Government, WHO etc)
  • Maintain a stable routine
    • Get up and go to bed at similar times
    • Maintain personal hygiene
    • Eat healthy meals 
    • Exercise regularly 
    • Allocate time for work and time for resting
    • Make time for doing things you enjoy
  • Minimise your newsfeeds and limit your screen time 
    • Try and reduce the time you are looking at screens, maintain regular breaks from on-screen activities
    • Be mindful of how much you watch or listen to news.
  • Social contact is important
    • Stay connected with your friends and family. Video calls on free software such as Skype, Zoom or Facetime are extremely beneficial during this time 
  • Alcohol and drug use
    • Avoid using alcohol and drugs as a way of dealing with fear, anxiety and social isolation
  • Help others 
    • If you are able, support people in your community who may need it

The last piece of advice is particularly important, perhaps even more so in this time. It is important to not discriminate. Fear is a normal reaction when things are uncertain and it can sometimes be expressed in ways that are hurtful to others.

Don’t discriminate against people who you may think have coronavirus.

Don’t discriminate against people from specific groups across the world or from lockdown suburbs.

An important part of getting through this tricky time is to be aware that everyone is going through this experience. Understanding your emotions and reactions will be beneficial in getting through this difficult time.

Be kind to one another. 

Stay safe and stay strong.

For more information please visit the WHO page https://www.who.int/campaigns/connecting-the-world-to-combat-coronavirus/healthyathome/healthyathome—mental-health?gclid=EAIaIQobChMIxJu_sMnT6gIVjjgrCh1NVAu9EAAYASAAEgLyLvD_BwE

For anyone looking for advice or information for anxiety or depression please visit the Beyond Blue website and seek support

https://www.beyondblue.org.au

References

Brooks, S. K., Webster, R. K., Smith, L. E., Woodland, L., Wessely, S., Greenberg, N., & Rubin, G. J. (2020). The psychological impact of quarantine and how to reduce it: rapid review of the evidence. The Lancet.

Center for Disease Control, Rothstein, M. A., Alcalde, M. G., Elster, N. R., Majumder, M. A., Palmer, L. I., … & Hoffman, R. E. (2003). Quarantine and isolation: Lessons learned from SARS. University of Louisville School of Medicine, Institute for Bioethics, Health Policy and Law.

DiGiovanni, C., Conley, J., Chiu, D., & Zaborski, J. (2004). Factors influencing compliance with quarantine in Toronto during the 2003 SARS outbreak. Biosecurity and bioterrorism: biodefense strategy, practice, and science, 2(4), 265-272.

Hawryluck, L., Gold, W. L., Robinson, S., Pogorski, S., Galea, S., & Styra, R. (2004). SARS control and psychological effects of quarantine, Toronto, Canada. Emerging infectious diseases, 10(7), 1206.

Jeong, H., Yim, H. W., Song, Y. J., Ki, M., Min, J. A., Cho, J., & Chae, J. H. (2016). Mental health status of people isolated due to Middle East Respiratory Syndrome. Epidemiology and health, 38.

Lee, S., Chan, L. Y., Chau, A. M., Kwok, K. P., & Kleinman, A. (2005). The experience of SARS-related stigma at Amoy Gardens. Social science & medicine, 61(9), 2038-2046.

Manuell, M. E., & Cukor, J. (2011). Mother Nature versus human nature: public compliance with evacuation and quarantine. Disasters, 35(2), 417-442.

Maunder, R., Hunter, J., Vincent, L., Bennett, J., Peladeau, N., Leszcz, M., … & Mazzulli, T. (2003). The immediate psychological and occupational impact of the 2003 SARS outbreak in a teaching hospital. Cmaj, 168(10), 1245-1251.

Marjanovic, Z., Greenglass, E. R., & Coffey, S. (2007). The relevance of psychosocial variables and working conditions in predicting nurses’ coping strategies during the SARS crisis: an online questionnaire survey. International journal of nursing studies, 44(6), 991-998.

Newman, K. L. (2012). Shutt up: bubonic plague and quarantine in early modern England. Journal of social history, 45(3), 809-834.

Yoon, M. K., Kim, S. Y., Ko, H. S., & Lee, M. S. (2016). System effectiveness of detection, brief intervention and refer to treatment for the people with post-traumatic emotional distress by MERS: a case report of community-based proactive intervention in South Korea. International journal of mental health systems, 10(1), 51.

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