The psychological toll of living in quarantine or isolation

This story is from The Pulse, a weekly health and science podcast.

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Writer Michele Lent Hirsch has been thinking about all the people being quarantined right now. She’s been through something similar, though under different circumstances.

When she was 25, she had thyroid cancer. The treatment is to swallow a tablet of radioactive iodine.

“You actually become radioactive, it’s pretty wild and not fun,” she said. “The day before it was to happen, I actually considered telling them, ‘Never mind, I don’t want this part of the treatment,’ because the idea of being radioactive and knowing that I could endanger other people as well was really scary.”

But she knew she had to do it.

So Hirsch went into a room with the radioactive warning logo, people came in, wearing gowns and masks, and she swallowed the radioactive pill. And that’s when the isolation started, for three days in a safe room with no windows, in a hospital in Manhattan.

“And so I was stuck in this room where I wasn’t supposed to go near other human beings, I had such a feeling of isolation, almost no intellectual stimulation, and really very little communication with other people.”

She could have visitors — in a way.

“On the second day of my quarantine, my mother visited the hospital, but I saw just the tip of her nose in the doorway because they would not let her within something like 15 feet of me to protect her from what was in my body,” Hirsch said. “And so she visited, but I just heard her voice from far away, I saw her nose, I saw maybe like a tiny bit of her shoulder.”

“It was really upsetting for my mom because … she wanted to hug me and comfort me, I’m her kid, and the doctor said ‘no.’”

“In some ways, honestly, that was worse than if someone I loved had not visited me.”

Nurses and medical staff would take care of Hirsch, wearing devices to log how much radiation they were exposed to.

“It felt like I was in this dystopian film or something where people around me were basically logging how much exposure they were getting to the bad thing that was inside my body.”

“It’s a really surreal feeling, and it’s a really bad feeling to know … just by being around these people I’m potentially harming them,” Hirsch said. “I totally felt like a freak.”

Once, she sneezed while a nurse was in the room. The nurse scuttled away in a hurry. Hirsch said she had maybe four minutes of human contact a day, so medical staff could take her blood pressure and do other procedures.

“It is an extremely psychologically isolating thing to be physically isolated, and being in a room that’s meant for isolation I think adds to it.”

Hirsch has been reflecting on the experience now that more people are living under quarantine or isolation. She said it would be ideal if those people could talk to therapists or social workers, someone who understands that being cut off from the rest of the world is painful.

There is not a lot of research on the psychological toll of being quarantined. One of the few studies came from the SARS outbreak in the early 2000s, from several authors, including Laura Hawryluck, an intensive care doctor at Toronto Western Hospital and an associate professor of critical care medicine at the University of Toronto.

She worked on the front lines during the SARS outbreak, and some of her friends and colleagues had to be quarantined. That got her and some other doctors wondering what the experience does to someone.

“One of the things that was most striking was the anxiety that people were experiencing and sort of the confusion of messages that were happening at the time,” she said.

Hawryluck and her co-authors found symptoms of post-traumatic stress disorder and depression in almost a third of the people they surveyed, with more symptoms the longer someone was quarantined.

As an ICU doctor herself, Hawryluck had to wear full protective gear every day, including an N95 mask and something akin to a hazmat suit. So she’s also thought about how challenging it is for medical staff to care for isolated patients.

“Patients can only see your eyes, and so that very human contact of forming a really strong therapeutic relationship is much more difficult when you can’t see somebody’s face,” she said. “It’s much more difficult to reassure somebody or to treat them to have them understand that you understand their anxiety and provide what all of us would consider the best care that we can.”

Above all else, Hawryluck said, what matters is that patients have a consistent source of reliable information, and know who they can turn to for help.

“People … in quarantine aren’t people that we’re isolating off from society,” she said. “They’re people that we owe a duty to care for, and that duty needs to be spelled out loud and clear so that people do feel cared for and not abandoned.”

She said quarantine and isolation are fraught measures to contain outbreaks, but there will be more emerging diseases, so we should think about how to do it well.

One of the first people to be quarantined in the United States during this coronavirus outbreak pointed to it as a good example.

Yulin Yin lives in Minnesota, but he went to Wuhan in January to visit his family for Chinese New Year. The outbreak had already begun in China when he arrived, and after several days Yin was evacuated back to the U.S. with all the other Americans. They were quarantined at a Marine base in San Diego.

For 14 days, he stayed in a suite that was like a hotel room, with a living room, a coffee maker, a bedroom, and a shower.

Staff would check his temperature regularly. He’d have boxed meals. People from the Centers for Disease Control and Prevention and the U.S. Public Health Service would be there every afternoon to hold a town hall meeting and answer questions.

“The CDC really did a really good job … [to] calm us down, to assure us it is OK to just try to relax and have a good stay.”

Since the evacuees didn’t have symptoms and were monitored regularly, they were allowed to mingle, and some even made friends with one another.

“We asked for a soccer ball, so we would be kicking the soccer ball,” Yin said. “Some people would be dancing in the courtyard. Later, we have a lady who teaches … modeling, so she was actually teaching many of us how to walk the runway.”

Yin learned the runway walk.

Yin said the internet there was actually faster than what he had back home in Minnesota. And he said he is grateful for the staff, contractors, and people who worked hard to keep them comfortable.

At the end of two weeks, Yin got a certificate showing that he had been quarantined, did not have the virus, and was safe to go back into society.

“When we were leaving, it’s more like graduation because we made so many friends,” Yin said. “I think it’s one of the best things that can happen in a very unusual situation.”