The virus doesn’t know tribes, it doesn’t know boundaries, it just doesn’t know….And that, in some ways, is a dramatic reminder of how connected we are - Robert Waldinger
image by: Karen Grace Inal
When the full story of Covid-19 is written, it will likely emphasize the physiology of the disease. We will understand the scientific nature of the virus, its tenacious binding to the lung and brain, and the cascade of symptoms and immunologic reactions that determine its run through the body.
More subtle and complicated, however, has been its disproportionate psychological impact on the lives of aging individuals who avoided the disease itself by largely staying at home and isolating themselves. If we didn’t know it or believe it before the pandemic, the hard reality is now unavoidable: Social isolation cripples and it kills.
As a doctor I knew the science of social isolation before the pandemic. But the pandemic has opened our eyes to the tragic consequences of loneliness in a way that was impossible before. Now, as life slowly returns to normal, let’s not close our eyes to what we’ve learned. Let’s acknowledge that despite our best efforts and technology, there is a missing element to living life by text, phone and video chat that must be illuminated and studied. And let’s make sure to take the lessons of the past year and apply them to our post-pandemic world.
Consider one of my patients, who is a sad reminder of what I’ve seen both in my practice and in my community. From the very first waves of coronavirus that hit Miami Beach, she was fastidious about staying at home and dutifully avoiding all the previously enjoyable rhythms of life, including her beauty salon, weekly card game and favorite lunch spot. At age 90, she was among the most vulnerable of the population, and only after her second vaccine did she begin to tentatively venture out.
But she is not the same person I knew at the outset. She is more hesitant and skittish about leaving her home, more irritable at her adult children’s admonitions, and more depressed by the losses of friends and social opportunities.
Of course, the dangers of social isolation and loneliness were hardly unknown before Covid-19. A major report released in 2020 concluded that prior to the pandemic an estimated 25% of older adults were socially isolated and 43% were lonely. We know that a lack of contact with others—whether family, friends or acquaintances—leads to a lack of attention to personal needs and other problems, and blocks access to care, education and services that could ameliorate those problems.
The result is not surprising but it is stunning in its effects, with social isolation possibly having a greater impact on mortality than smoking, obesity and physical inactivity, according to the report. Despite these well-established findings, social isolation and loneliness somehow routinely escape the attention of our doctors, and the rest of us, when assessing the usual elements seen as critical to both our general health and the quality of our lives.
I offer the example of another of my patients who resolved to find ways to blunt the pernicious effects of the pandemic’s restrictions. He took a long walk every day. He joined Zoom classes and social groups. He would video-chat with his daughter and her family on a regular basis.
All of these efforts were meaningful to him, but they lacked the personal presence and touch he was used to. He missed the camaraderie of his colleagues, staff and patients at the doctor’s office where he used to work before the pandemic pushed him into early retirement. He missed hugging his daughter and grandsons. Zoom classes were stimulating, but he couldn’t make friends with other participants at the end of each class before the virtual room snapped shut.
As his experience makes painfully clear, smiles, touches, greetings, social pleasantries and face-to-face talks, with all of their sensory elements, are the currency of a healthy mind and body. The physicality of these interactions taps into the most primal centers in our brains that serve to reassure and soothe us. They relax muscles, lower blood pressure and stress hormones, and increase endorphins.
In short, they help us to maintain the homeostasis so vital to good health. We eat and sleep better when we eat and sleep with others. This is, in part, why people who are married or in long-term relationships live longer than those who are single people. We are filled with more purpose and joy when we pray, sing and congregate together.
Sadly, it seems we needed a pandemic to remind us of that fundamental truth.
None of this is to say that social isolation can’t have its silver linings. For some people, isolation can be a blessing, giving us time to reflect, pray, study and find oneself amid the storms and strife of both everyday life and a pandemic. It can also prompt us to find ways to cope, help others, and express our wisdom and creativity through new endeavors. Indeed, many aging individuals have finally learned to master the technology of their smartphones and computers. They have started new relationships, enrolled in new classes, re-engaged with religious congregations and other communities, and become activists for a variety of causes from the comforts and confines of their homes and neighborhoods.
But it would be foolish to think that social isolation is something to be fostered. And if there is anything this pandemic has taught us, if there is anything we have learned from this yearlong natural experiment forced upon us, it’s that we need to address the high cost of isolation and loneliness in our post-pandemic world.
These lessons are as profound as they are simple:
• Technology is not a replacement for human contact. Our health depends on the physical presence of other people. Optimal social connections are sensory experiences that enable our bodies and brains to feel safe and comfortable, and to explore authentic relationships. If we confine healthcare, education, business endeavors and family meetings to video chats only, we will be missing a critical, ineffable part of the human experience that is vital to our well-being.
• Loneliness must be taken seriously. A routine part of medical care and social services should be assessing the roles and quality of social contacts and detecting the presence and degree of loneliness, then building a social-contact remediation plan into overall treatment. It is preventive medicine at it best. What’s more, such social interactions must be factored into future planning for pandemics and other natural disasters that require isolation or breaking of social bonds.
• Technology can help, but it needs to be better designed for the elderly. Most hardware and software in the internet age has been designed by and for young people with sharp eyes, nimble fingers and short attention spans. Video chats get the job done but are designed with fast on- and offramps that may obfuscate rather than emulate normal social interactions. Telehealth is still clunky and limited to the metrics that can be collected by imperfect sensors and eyeballs. Just a few ideas include bigger and more easily engaged visual and auditory fields; less abrupt starting and stopping to encourage interactions around the corners of meetings; and novel interactive features to make sessions more active and less passive experiences.
During the pandemic, we have all missed a vital part of ourselves that is woven into our neural wiring and cannot thrive without real social connections. As the pandemic slowly ebbs and we try our best to resume the social lives we once took for granted, we must take these lessons to heart and apply them to our daily lives. We must understand that the sharp pain of social isolation that so many felt over the past year is a constant fact of life for so many of our loved ones, our acquaintances, our neighbors.
We’ve seen the damage it does. Now it is time to deal with it.
Source: Marc Agronin, What Covid-19 Taught Us About the High Cost of Isolation, The Wall Street Journal, April 10, 2021.