The Psychological Impacts of Quarantine

Quarantine is the separation and restriction of movement of people who have potentially been exposed to a contagious disease to ascertain if they become unwell so reducing the risk of them infecting others.

This definition differs from isolation which is the separation of people who have been diagnosed with a contagious disease. The word “quarantine” was first used in Venice, Italy in 1127 with the outbreak of leprosy, UK 300 years later began to impose quarantine in response to plague. Most recently quarantine has been used in the COVID-19 outbreak.

Stressors during quarantine :

1. Duration: Longer durations of quarantine were associated with poorer mental health specifically post- traumatic stress symptoms, avoidance behaviours and anger.

2. Fears of infection: Persons in quarantine fears about their own health, fears infecting others and family members. They worry if they experience any physical symptom related to the infection, concerns occur more in pregnant women and those having young children.

3. Frustation and boredom: Confinement, loss of usual routine, reduced social and physical contact with others creates boredom, frustration and a sense of isolation from the rest of the world.

4. Inadequate supplies: Inadequate basic supplies eg food, water, clothes or accommodation is a source of frustration associated with anxiety and anger.

5. Inadequate information: Poor information from public health authorities, insufficient clear guidelines about actions to take and confusion about the purpose of quarantine are significant stressors.Lack of clarity about the different levels of risk leads to fearing the worst. Lack of transparency from health and government officials about the severity of the pandemic can be stressful also.

Stressors postquarantine:

1. Finances: Financial loss can be a problem during quarantine with people unable to work and having to interrupt their professional activities with no advanced planning. This creates great socioeconomic distress and a risk factor for the development of psychological disorders later on.

2. Stigma: Stigmatisation and rejection from people in their neighbourhood is a common phenomenon. In most cases they are treated differently, avoided, social invitations are withdrawn, treating them with fear and suspicion and making critical comments are also commonly exhibited behaviour patterns. General education about the disease and the rationale for quarantine and public health information provided to the general public can be beneficial to reduce stigmatization whereas more detailed information in educational institutions and workplace might also be useful.

How Can We Mitigate the Negative Impacts of Quarantine?

1. Keep it as short as possible:
Restricting the length of quarantine to what is scientifically reasonable given the known duration of incubation periods and not adopting an overly precautionary approach would minimise the negative effects on people. Even short extensions are likely to exacerbate frustration and demoralisation.

2. Give people as much information as possible: Ensuring those under quarantine have a good understanding of the disease in question and the reasons for quarantine should be a priority.

3. Provide adequate supplies:
Quarantined households should have enough supplies for their basic needs and these must be provided as rapidly as possible.

4. Reduce boredome and improve communication : People who are quarantined should be advised as to what they should do to stave off boredom and be advised on coping and stress management techniques. The ability to communicate with family and friends is also essential.

Thus it can be concluded that the psychological impact of quarantine is wide ranging, substantial and can be long lasting. If a quarantine experience is negative then there can be long term consequences that affect not just the people quarantined but also the health care system that administered the quarantine and the politicians and public health officials who mandated it.