Managing COVID 19 Quarantine Stress: A Guide to Social Work Response

Social workers should have been the front runners in this battle against Corona, but remain an underutilized force, partly due to their own hesitation and tardy approach and partly due to the lack of vision of our policymakers. While in most of the western countries, they form an integral part of the teams of the COVID Warriors and their services are being utilized for their specialized skills in these critical times, no such scenario is visible in India.

Uncertainty and confusion are two defining features of COVID-19, leading to much fear. As prevention is the only way to prevent the spread of the diseases, ‘social distancing’ and ‘quarantine’ have become the new buzz words. While quarantine may be the best available mechanism to control the spread of corona, it has its own share of challenges. Those in quarantine, particularly institutional quarantine, are more vulnerable to stress, as this period of confinement away from the sanctity and comfort of one’s home can be very traumatic. 

Mental health can become an important concern for those facing quarantine stress and timely help and intervention can go a long way in mitigating its short term and long term ill-effects. Here social work professionals could help to improve the quality of life of people and communities, besides helping to promote systemic change in society. Just as in any profession that involves helping people—such as medicine, nursing —social work profession, too, helps people through some of the toughest times in their lives. Human beings have certain inner strengths to overcome their problems. A social worker’s endeavour is, to identify and mobilize those strengths and, use available community resources to cope with the crisis.

What is Quarantine? 

Quarantine is an old term but came in vogue as a bedrock for preventing the spread of the highly contagious COVID 19. The word quarantine originates from ‘quarantina’, the Venetian language of Italy, meaning 40 days. The concept of quarantine has been known since biblical times and in history, quarantine has been observed for epidemics like the plague, flu, smallpox, tuberculosis etc. In the Middle Age, Italians adopted that word to describe a 40-day period that boats had to wait before docking, to ensure the passengers weren’t sick with the plague before they were allowed to join the population on land. It’s from this use that we eventually got the term that’s all over the news today (Merriam-Webster Editor, Peter Sokolowski). 

Though the terms quarantine and isolation are used interchangeably, they convey two different meanings and are two different mechanisms in public health practice. Quarantine is imposed to separate and restrict the movement of persons who may have been exposed to infectious disease, but not yet known to be ill, but isolation is a complete separation from others, of a person known or reasonably believed to be infected with a communicable disease. The word typically describes the confinement of people who appear healthy but could have the disease.

Quarantine could be mandatory or voluntary depending on the situation. Current COVID-19 crisis has put the people into de facto quarantine, with its closure of shops, offices, academic institutions and postponement of public examinations. In India disobedience to quarantine rule has been made a punishable offence with fines, imprisonment or both under sec. 269, 270, 271 of The Indian Penal Code (IPC) 1860.

Understanding the Dimensions of Quarantine Stress

However, dimensions and intensity of stress may vary in institutional and home quarantine, but the fear of being found positive may haunt in both cases. Institutional quarantine is usually dreaded and the fear of being locked up in an unfamiliar centre is often a cause of great stress, along with the attending perceived risk of getting the infection if one is not already infected. The fears are sometimes not misplaced, as evident from reports that trickle in about the poorly maintained, overcrowded, centres that lack hygiene and basic facilities. It is undisputed that this kind of confinement over a prolonged period is likely to have an adverse impact on the -social, emotional, physical, financial, and mental health of a person. Studies suggest that stress is responsible for as much as 90% of all illnesses and diseases, including cancer and heart disease. Prolonged stress adversely affects our immune system, and makes us more vulnerable to infections and disease. 

As millions of people throughout the world are in some kind of lockdown, we are witnessing arguably the largest socio-psychological experiment ever. This time, it is not a village or town or region that is quarantined, but nearly a third of the global population is dealing with these intense stressors.

However, people who are quarantined due to exposure to someone who tested positive report a wide range of negative psychological effects including fear, confusion, nervousness, anger, grief, numbness, sadness, guilt, and difficulty in sleeping due to anxiety. The risk of infection, or of losing loved ones, as well as the prospect of financial hardship are some key stressors. While these insights are not new, as epidemics have happened in the past, but the sheer magnitude and scale of the present lockdown are mind-boggling. Following are the dimensions of quarantine stress: 

• Duration of confinement. One study has shown that quarantine for more than 10 days will have more stress symptoms as against less than 10 days. Hence longer the duration, higher the stress
• Fear for one’s own health, fear of being infected and infecting others adds up to the mental stress. Elderly, pregnant and those with young children may be under greater stress may need greater support during these times.
• It is well established that low level of immunity and co-morbidity is significant in increasing the mortality in COVID-19 infections, hence making those having diabetes, blood pressure, more vulnerable to stress.
• Frustration and boredom are a natural outcome of quarantine restrictions.
• The constant bombardment of Corona news, inadequate, confusing information, and fake news instil fear and aggravate stress
• The uncertainty of origin, symptoms and treatment of COVID-19 plays an important part in causing stress during the quarantine
• Severe restrictions imposed on movement, difficulty in getting essential supplies, further enhance the stress levels
• Homesickness, absence of one’s family, feeling of helplessness and of being at the mercy of others can be highly distressing.
• Feeling of being trapped with no escape route, and that there is a safe place to hide and seek refuge, as the tentacles of the pandemic are spread everywhere.
• Numbness, insomnia, confusion, anger, are behavioural manifestations of the underlying stress

Post-traumatic stress disorder (PTSD-) an anxiety disorder can be the result of quarantine. A study of the 2003 SARS outbreak of the psychological effects of quarantining found that a substantial portion of those quarantined displayed symptoms of PTSD  and depression. Increased length of time spent in quarantine increased symptoms of PTSD and quarantine itself, was perceived as a personalized trauma. Public health officials, psychologists and Social workers should be aware of this disorder and how to deal with it.  

Post Quarantine triggers of stress could be as follows:

• Loss of income, financial insecurity and uncertainty of the future can further complicate matters.
• Stigma and feeling of being condemned for no-fault, indifference, bordering on hostility in one’s social spaces once out of quarantine can be a major trigger of stress

Social, psychological and economic factors can increase one’s probability of suffering distress during and after quarantine. Factors such as poverty, unemployment, health, personality characteristics, social isolation, lack of network ties and social support from one’s kin and absence of adequate coping strategies can increase individual’s susceptibility to stress, as isolated individuals with weak support systems are likely to be more vulnerable. Elderly, women and children also tend to be especially vulnerable because they are dependent on adult caregivers for their survival and recovery in disasters.

Social work Response

Social work, as a profession, has always played an important role in disaster management, by virtue it’s knowledge, skill and experience. Social workers possess the basic skills necessary for the development of individual, family, and community response plans in disaster. India’s demography, geopolitical compulsions and responses, rural-urban dichotomy, religious underpinnings, illiteracy and poverty, inadequate medical infrastructure and resources, a huge population of migrant workers make disaster management a daunting task.

Reports of misbehaviour in quarantine centres against caregivers, resistance to quarantine rules, and forcible breaking out of quarantine centres have become a routine affair. Such alarming behaviours inadvertently increase the dangers of the spread of the virus on one hand and cause stress on the other. Such behavioural responses can be attributed to the fear and stress that the affected persons face during quarantine which warrants intervention and skilful handing by a team of behavioural experts led by trained social workers. Work done in emergencies and disasters is an essential aspect of social work interventions aimed at the reduction of severity of the effects of disasters, through prevention and mitigation, as well as improved emergency response, through preparation and planning.

Social work interventions are most needed at the individual and family levels to deal with the stressful impact of quarantine.

Individual-level Interventions 

• A risk analysis, in which the vulnerability, threat and capacity assessment of the individual is done which can help identify the causes of stress and their possible impact on the individual and the family well-being. Vulnerability is a set of prevailing conditions, that adversely affects one’s ability to respond or mitigate any challenge or crisis and varies from person to person.  Such an assessment can help understand the level and intensity of stress, as also the individuals’ coping capacity. With the understanding of the circumstances surrounding the case, the social worker can be better equipped for specific interventions for reducing the stress as per the requirements of each case. Analysis of past history of any behaviour malfunction/disorders can also be helpful.
• Encouraging the individual to share the trauma narrative, so that some of the effects are discharged. Communicating and sharing is a pressing need as it provides an outlet for the pent up emotions during the period of confinement.
• Helping the affected to stay connected with the social and family networks via technology such as video conferencing and contactless video call on What’s App etc.
• Assisting to deal with boredom and frustration by encouraging to talk with spouse and children, listen to music, creating an opportunity for innovation, developing hobbies such as reading, writing etc.
• Motivating to exercise regularly. Yoga and meditation have been found to be particularly helpful for their multiple benefits, such as improving immunity, general health, and mental relaxation.
• Encouraging to maintain their daily routines as much as possible
• Restricting and limiting media exposure and providing practical, credible information at specific times
• Counselling and emotional support

Family Level Interventions 

Whether one is quarantined at home or in an institution, it is a traumatic period for the family, when it may suddenly find itself ostracised and stigmatized as potential carriers of the virus. Even the neighbours and friends may cut ties and distance themselves during this trying period when they are needed the most. Some measures given here can help the family to deal with the negative psychological effects:

• The role of a social worker becomes very crucial in giving the family the much-needed support and care, whether by way of emotional support or empathy or by way of reassurance that they are not alone in this hour of crisis.
• Intuitive understanding of their predicament, unconditional acceptance and helping them stay connected with the member who is quarantined, can go a long way in mitigating the negative impact of stress.
• Helping with services such as the essential supplies like groceries and medicines, obtaining financial and other assistance as required and available from the state machinery can go a long way in helping the family to cope with the financial challenges. Quarantined persons with a lower income may require additional levels of support.
• Counselling to the family to accept the situation and come to terms with the psychological impact through reassurance and making them understand that a psychological reaction in such situations is normal.
• Creating positive moments and building capacity for self-care, especially in the case of elderly and children in the family

Scope for Research  

Social workers take into account peoples’ inner struggles as well as the influence of their environment-physical, social, psychological, economic- to extricate them from stress and anxieties which affect their social functioning. The social work perspective is needed for coping with stress during and after a disaster or traumatic event. The present calamity presents social work professionals with an opportunity for developing interventions, research, and empirical evidence to guide our disaster-related response.

Besides, the pandemic also presents an excellent opportunity to study the impact of a calamity of this magnitude and intensity and the accompanying lockdown on the human psyche, relationships and social behaviour patterns, along with different variables. How does it impact men and women, old and young, rich and poor differently, and what are the coping patterns of different individuals can be areas of investigation? Evidence-based responses at the micro and macro level can give greater conceptual clarity for our interventions with the affected.

Conclusion and Agenda for Discussion

Social workers should have been the front runners in this battle against Corona, but remain an underutilized force, partly due to their own hesitation and tardy approach and partly due to the lack of vision of our policymakers. While in most of the western countries, they form an integral part of the teams of the COVID Warriors and their services are being utilized for their specialized skills in these critical times, no such scenario is visible in India. Medical and Psychiatric social work is a specialised field of social work practice, well advanced in western countries, from where social work’s professional model has been transplanted and transported to the Indian soil, but it is still struggling for recognition in India, as it is still not mandatory to appoint social workers in hospitals and health care centres.

Social workers have the wherewithal to analyse how a pandemic impacts individuals and families and how to address these issues. With the increasing number of people being quarantined, social workers, along with health care staff, can play a key role to combat quarantine stress. Social Workers can understand the language of trauma and respond effectively as they are equipped with the necessary skills and knowledge during their training for this field of practice. They need to define the factors that influence the success of quarantine and must be prepared to offer additional support to persons who are at increased risk for the adverse psychological and social consequences of quarantine. It’s high time for social work academicians, professionals, practitioners and aspirants to make the world recognize their contribution in the ensuing COVID 19 pandemic.

NOTE: Dr. Mrs. Ranjana Sehgal is Professor at Indore School of Social Work, Indore, India.  

(Disclaimer: The opinions expressed are the personal views of the author. The facts and opinions appearing in the article do not reflect the views of Devdiscourse and Devdiscourse does not claim any responsibility for the same.)