August normally heralds the end of summer break for children, who are preparing to head back to school. Stores compete with sales on back-to-school supplies; pediatricians' offices are swamped with athletes needing sports physicals and neighborhoods get especially noisy as children try to cram the evenings with fun activities before they're crammed with homework.
As everyone's aware, this fall is historically different. The social planning and changes accompanying the pandemic have meant that more adults are working remotely, whether they want to or not. College classes are being held online and elementary and high school children are not sure how classes will be run.
The American Academy of Pediatrics (AAP) recommends children return to school, writing, "The importance of in-person learning is well-documented, and there is already evidence of the negative impacts on children because of school closures in the spring of 2020."1 Yet the guidelines the CDC wants to use are nothing short of institutionalized isolation.2
Children will wear cloth masks all day; everything is cleaned and disinfected daily and between uses; students are not allowed to share pens and pencils and desks are expected to be placed 6 feet apart. Children will hear announcements throughout the day as a reminder to wash their hands and practice social distancing.
This "new normal" has a significant impact on the mental health of adults and children, which experts expect will create a deluge of psychological issues and challenges in the months to come.
Yuval Neria of the New York State Psychiatric Institute runs the facility's PTSD program and told the American Heart Association that mental health professionals are in uncharted territory in predicting the effects of this pandemic:3
"I don't think the mental health consequences will be limited to PTSD only. In fact, I think we should expect other mental health problems, such as depression, anxiety, substance abuse and potentially increase in suicide. They are already there and kind of showing themselves.
Disasters are usually limited to space and time. And there is an onset of a disaster — which may take some time — but there is an end. But I think viruses have their own way to inflict adversities on us. The threat is ambiguous. (It) is everywhere and nowhere. It's ongoing. It may take a long time."
Children at High Risk From Largest Psychological Experiment
Despite research showing that children are not physically affected by COVID-19 nearly as badly as adults,4 the CDC and the AAP continue to recommend strict measures for children returning to school. As demonstrated in this short video, these recommendations are not without consequences.
Children may recover more quickly than adults, but they are expected to experience significant psychological trauma from the mandates that policy makers have imposed on the public.
With the social distancing and lockdown requirements across many countries, young people and children no longer have the interactions they need to develop a strong mental and emotional foundation.5 The lack of a structured routine likely means they are also less physically active. In one study from Shanghai, China, the same surveys were sent twice to the same group of 2,427 children and adolescents.6
The data revealed that the children were less active by 7.25 hours each week. More importantly, however, they increased the number of screen time hours by 28.83 per week when compared to their lifestyle pattern before the pandemic. This prolonged screen time can compound psychological challenges, including emotional stability and the ability to make friends.7
Long-Term Psychological Harm Injures at Least One Generation
Children who experience maltreatment and food insecurity during their childhood years have an increased risk of obesity, heart disease and dementia later in life.8 Unfortunately, more children are likely to experience these challenges during mandated social isolation. Additionally, child welfare services are stretched, which means there is less support in the community.9
With rising financial instability, experts expect there to be an increase in family violence, which contributes to nonaccidental injury and mental trauma. And, in fact, this prediction has been found to be accurate, as told by a physician from Texas.10
A report from the United Nations describes how more than 1.5 billion students were out of school across 191 countries due to government-enforced lockdowns.11 Many students rely on their schools' breakfast and lunch programs, so having to stay home means they're less likely to get enough to eat.
School closures also create stress on parents as they are called upon to suddenly take on the responsibilities of homeschooling while still trying to maintain their jobs or deal with the stress of what to expect financially because of the upheaval from stay-at-home orders. One physician in an Italian pediatric department said he has seen increasing rates of violence, self-injury and suicide attempts in young people.12
Children are highly vulnerable to traumatic and adverse events. Some of the most commonly reported symptoms are anxiety, reduced appetite, depression and impaired social interactions. The physiological effects of stress and trauma can also compromise a child's immune system.13
Forced to stay home, isolated and without interaction at school, children are at risk for psychological and emotional damage. During the COVID-19 epidemic, a collaborative working group of the European Pediatric Association and Union of National European Pediatric Societies and Associations, along with Chinese academic institutions released the results of a preliminary study conducted in the Shaanxi province.
It showed that children from 3 to 6 years old were more likely than older children to be clingy and to be afraid their family may get COVID-19. Children from 6 to 18 years were more likely to be inattentive or to ask persistent questions. In all age groups, children showed inattention and irritability. Other symptoms included nightmares, fatigue, poor appetite and sleeping disorders.
Psychological Damage From Quarantine
Evidence of the negative mental health effects due to forced quarantines and social distancing continues to mount. In one meta-analysis, researchers found that prolonged confinement was positively correlated with psychological damage and in some cases the injury lasted months after the quarantine was over.14
In another study, the researchers compared inflammatory markers of 103 patients to their mental status while they were hospitalized with mild symptoms of COVID-19.15 Researchers used an online survey to measure psychological symptoms such as depression and anxiety. Peripheral inflammatory markers were collected at baseline and within three days of completing the survey.
The researchers discovered that levels of C-reactive protein were positively associated with those who had symptoms of depression. In a separate study published in The Lancet, scientists reviewed 24 studies analyzing the effects of quarantine and found negative effects included "post-traumatic stress symptoms, confusion and anger."16
The bulk of the evidence points to the significant toll on the social and emotional well-being of adults and children who are suffering during the pandemic. While the world undergoes what has been described as the largest psychological experiment ever — without informed consent — it may be time to include one of the strategies the French used in the aftermath of terrorist attacks in the mid-1990s.17
In response to the crisis, the government set up a second triage in which people who were not physically injured were given immediate psychological help and checked for indications they may need further treatment.
In a piece written in World Economic Forum, Elke Van Hoof, health and primary care psychologist at Vrije Universiteit Brussel, laments the challenges and psychological crisis we are facing because of:18
"… not setting up the second tent for psychological help and we will pay the price within three to six months after the end of this unprecedented lockdown, at a time when we will need all able bodies to help the world economy recover."
Loneliness May Exacerbate Damage From Social Isolation
Some experts believe loneliness is exacerbating the effects of social isolation and quarantine during the pandemic. A reporter from The Guardian spoke with Cheryl Webster, an active, community-involved person who moved from California to Texas.19 For 2.5 years before the lockdown, Webster hosted a game night at her home. In the months since social distancing became the norm, she's heard from one person from the group.
She spoke with a reporter from The Guardian, saying, "I think that's the hardest part about loneliness. Is it my fault? Am I not a very nice person? Or is there something wrong with me?"20 There are so many people who report feeling the same way that governmental agencies have begun to consider how to work loneliness into the equation of all the rules they're creating.
Occasional bouts of the social blues are to be expected, especially after disruptive or sad events, but feeling lonely all the time carries with it a host of unsavory physical problems as well.
The Guardian also spoke with the husband and wife research team of John and Stephanie Cacioppo who, in 2014, reported on the dangers of isolation over extended periods of time. They noted that "feeling socially isolated can raise levels of the stress hormone cortisol, disrupt sleep, and also lead to long term health consequences, such as earlier morbidity."
There's a Pill for That
Although some public health policies have been written to incorporate social interventions to encourage lonely people to meet with others, many believe the solution is not in having regular interactions with people you don't know very well, but in developing long-lasting, healthy, meaningful relationships.
Others, like Stephanie Cacioppo, are taking a different approach: Since May 2017 she has been seeking an answer for loneliness using chemicals.
In other words, researchers are hoping to cure loneliness by giving you one more pill. And the pills come with a hefty price tag and a list of side effects. One drug — allopregnanolone — is a neurosteroid sold under the brand name Zulresso. The drug was released on the market in 2019 for the princely sum of $34,000 for just one prescription.
As well as having a royal-sized price tag, the medication is dispensed through a restricted program since the secondary effects are dangerous. Other researchers are testing the use of oxytocin, known as the "love" hormone. Rene Hurlemann from the University of Oldenburg in Germany knows oxytocin is central to social bonding and hypothesizes it may have an impact on treating loneliness.
To test this, they are working on an interventional study in which individuals are undergoing group psychotherapy with a focus on participation in social activities and talking about loneliness. Half are receiving oxytocin.
Hurlemann believes the drug should not be prescribed without psychotherapy, but rather that it could be used to speed the formation of a bond of trust between the therapist and the individual.
Medicalizing Loneliness May Increase Isolation
Not everyone is excited about using a pill for loneliness. Many of the psychologists and therapists the reporter from The Guardian spoke with expressed hesitancy about using a pharmaceutical solution for an emotional condition. Instead, they favored talk therapy.
Rachael Benjamin is a psychotherapist from New York who leads group therapy for individuals dealing with loneliness and believes medicalizing it may make people feel even more isolated. While she acknowledges that many medications can be lifesaving, she believes "Pills can't build intimacy."21
If you're experiencing depression, anxiety or feelings of loneliness, consider trying Emotional Freedom Techniques (EFT) to help dispel negative emotions and cope with the social isolation from this pandemic.
If you're unfamiliar with EFT, Julie Schiffman does an excellent job explaining the process in the video at the top of the page at "Basic Steps to Your Emotional Freedom." In the short video below Julie demonstrates how to use EFT specifically for the COVID-19 pandemic.
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