Is COVID-19 Isolation Causing PTSD?

Once upon a time (1962) and far, far away (France), a 23-year old geologist named Michel Siffre set out to spend 63 days in a glacial cave. No doubt he ended up learning a lot about ice, but he also came to understand something about the psychological effects of isolation. Fifty-eight years later, his experience in that adventure and at least one later expedition provides clues as to why insomnia, exhaustion, unproductive thoughts, anxiety, anger, aggression, depression, nightmares, and other emotions and symptoms classically associated with post-traumatic stress disorder (PTSD) are plaguing so many of us during the COVID-19 pandemic.

On July 9 of that year, Siffre settled into a dark cave 130 meters underground. The cave’s temperature was below freezing. Small chunks of ice fell on him as he slept. He didn’t have a watch because he wanted to learn whether his no-natural-light experience would reveal circadian rhythms.

But he had brought batteries and an electric light by which to read Plato. He also had a telephone of sorts with which he reported to a team stationed outside the glacier. Every morning when he called them, he counted off 120 seconds aloud to show evidence of mental clarity. Usually, counting off what he believed were two minutes took about five.

Eventually, September 17 arrived. The outside team told Siffre to climb back to the surface. He balked at the very idea. By his count, he still had 34 days to spend underground.

Cut off from natural light and most human contact, Siffre had lost track of time in a very big way. Over the course of his 63 days of isolation, psychological time had proceeded at roughly half the pace of real time.

Now we know that isolation can come with a far heavier cost than a time warp. During a second (and much longer) cave foray, Siffre noted in his journal that he could “barely string thoughts together.” Studies since — with astronauts and prisoners, for example — have linked prolonged isolation that’s far less draconian than what Siffre endured with general cognitive decline and with symptoms similar to those seen in people with PTSD.

Today, as COVID-19 sweeps across the world, many people are being told by governments, doctors, and employers to isolate themselves for a set period of time. Meanwhile, millions are either voluntarily isolating or social distancing long-term. This means that this pandemic is in some way an enormous experiment in the psychological and cognitive effects of being alone.

What’s so bad about fear, angst, and staying home?

A glance at recent headlines makes it clear that COVID-19-related isolation can cause troubling emotional changes. “This is Not a Normal Mental-Health Disaster” is a story from July 7 in The Atlantic. On July 14 Fortune ran “How Tech Giants Are Handling the Unprecedented Mental Health Crisis in the Workplace.” “Mental Health Toll of the Coronavirus Epidemic Is Becoming Clear” was a New Scientist story on July 16.

Earlier in this century, the coronaviruses causing SARS and MERS wreaked mental health havoc, as did some of the public health responses to them.

In 2002  to 2004, severe acute respiratory syndrome (SARS), had a fatality rate of 11 percent. The Middle East respiratory syndrome (MERS) epidemics of 2012 – 2019 were far more lethal, killing over 34 percent of the people infected. SARS was ultimately controlled by a combination of mandated isolation and contact tracing. Because people infected with the MERS virus sometimes showed no symptoms, mandated isolation was not very effective against it, though it was tried.

During SARS, 129 people who were newly released from isolation responded to a web-based survey developed by researchers working under the direction of the University of Toronto physician and bioethicist Laura Hawryluck. About 31 percent of them reported symptoms of depression. General symptoms of PTSD were reported by about 29 percent. (The overall prevalence of depression in Canadian adults is thought to be about 5.4 percent. The prevalence of full-on PTSD is about 2.4 percent.)

This dark picture is reinforced by one drawn from a second SARS epidemic study. Led by infectious disease and public health specialist Donna Reynolds of the University of Toronto, researchers surveyed more than 1,000 formerly isolated people. Working with this much larger study population, they found PTSD in only about half as many respondents as Hawryluck’s study had. Even so, the prevalence was six or seven times the Canadian norm.

Data from the MERS epidemic also showed symptoms of PTSD in once-isolated people. A team led by Seoul public health specialist Hyunsuk Jeong of Catholic University of Korea surveyed about 1,700 people who, though ordered to isolate, were ultimately not diagnosed with MERS. Survey data showed that two weeks of mandated isolation produced significant levels of anxiety, aggression, and anger that persisted, though at lower levels, months after release. Jeong’s report includes a suggestion that, in future epidemics, emotional support systems and interventions be put in place lest isolated people develop long-term PTSD.

Send in the therapists

As was true with MERS, many COVID-19-contagious people have no symptoms; for this reason, mandated isolation and contact tracing are not enough to stop the pandemic. Guidelines suggesting that everyone stay at home and, when outside the home, stay six feet away from other people have been the public health alternatives. Voluntary isolation may be less upsetting than mandatory isolation. But with no date in sight by which the need to stay separate will lift, self-isolating may be leaving more than a few deeply afraid people without distraction or physical reassurance.

Over the next months and years, solid data about whether COVID-19 is accelerating PTSD rates will probably become available. Key to the PTSD diagnosis is the fact that its symptoms don’t spring from a person’s inherent weakness. PTSD is a mental health problem visited upon a person by outside, calamitous forces. And, as Vietnam-era studies demonstrated, almost anyone who experiences strong feelings of helplessness from an overwhelming danger can develop the anxiety, depression, nightmares, insomnia, and other symptoms typical of PTSD.

Meanwhile, people are dying, and not just from physical COVID-19 symptoms but from the disease’s killing emotional costs.

• In Lockport, Illinois a 54-year-old man reacted poorly to his 59-year-old girlfriend’s breathing problems. Afraid that she had COVID-19 and that he’d been infected, he shot them both to death. They’d had COVID-19 tests, but he’d been too anxious to wait for results. Autopsies showed that neither was infected.
• Fearing they had COVID-19, an elderly Indian couple drank poison together. Again, autopsies showed that neither was infected.
• In India a 50-year-old father of three had a viral illness that his physician suspected was COVID-19. The man became obsessed with videos from China showing ill people collapsing in the streets and other people being forced into hospitals against their will. He isolated himself and threw stones at his family and friends to keep them away. Then he hung himself.
• In New York, a 49-year-old emergency room doctor became exhausted by the death and suffering she’d seen. On a visit to her family in Charlottesville, she died of self-inflicted wounds.
• In Italy, a patient jumped out of the hospital window while he was waiting to see if he was infected with COVID-19. He had bronchial pneumonia.
• A 36-year-old Bangladeshi man had a fever and cold symptoms, and he’d lost weight. His neighbors became convinced he had COVID-19. People began avoiding him. He hung himself. His COVID-19 test was negative.
• The New York Post reported that a Bronx man who had tested positive for COVID-19 attempted “suicide by cop.” He called 911 and reported himself as a gunman in the lobby of his own building. As he waited for the police, he brandished an antique revolver and a 12-inch knife coated with ketchup. The police shot him seven times in his lower body. He survived the gunshots but died five days later in the hospital of COVID-19.
• In the beginning of July, a program coordinator for County Suicide Prevention Network in El Dorado County, California said that suicide rates between March and July were double what they were at the same time last year.
• In mid-April The Denver Post reported that calls, texts, and chats to the Colorado Crisis Services hotline, including Colorado calls to the National Suicide Prevention Lifeline, saw a 47% increase over the numbers reported for March 2019.
• Opioid drug overdoses are spiking in cities and counties across the country. As reported on July 1 by The Washington Post, data from ambulance teams, hospitals, and police show that “suspected overdoses nationally jumped 18 percent in March, 29 percent in April and 42 percent in May.”

How social isolation affects the brain.

Studies of the brains of people who, for whatever reason, are chronically socially isolated may shed some light on the sort of cognitive damage that long-term COVID-19-related isolation could bring.

The studies show that, with social isolation, some areas of the brain become smaller.

• For example, many isolated people have a smaller prefrontal cortex than normal. Sited at the very front of the brain, it handles working memory and also plays an important role in decision-making and behavior.
• The hippocampus, located centrally inside the temporal lobes, helps other parts of the brain process memories. It is often smaller in socially isolated people, and it sometimes also has lower concentrations of a protein called brain-derived neurotrophic factor (BDNF). Both small hippocampi and diminished BDNF are associated with diminished learning and memory.
• The amygdala are smaller in many socially isolated people. Each one of the two almond-shaped areas of gray matter is centrally located inside a temporal lobe. Interpreting images and sounds, the amygdala are vital to decision-making and to memory processing, and they also seem to play a significant role in emotional intelligence.

An admittedly alarmist idea is that, with imaging research linking chronic isolation to structural and chemical changes in the brain, very long-term social isolation of the sort that may ultimately be required to stop COVID-19 could conceivably create an epidemic of subtle cognitive decline.

The takeaway of all of this for people who over the past five or six months have come to feel slowed, confused, anxious, depressed, exhausted, or sleepless may be that this new frame of mind is not necessarily what you brought to the party. Of course, some disturbances of brain function could be the result of the disease itself. But they could also be the mental health costs of the COVID-19 calamity, in which case you are probably far from alone in feeling the way that you do.

No one yet has solid, rich data about the effects of COVID-19 on mental health or cognition; the pandemic is still too young, though efforts are ongoing. Members of Rebecca Saxe’s lab at the McGovern Institute for Brain Research at MIT are surveying primarily MIT students, postdocs, and staff to see how COVID-19-related isolation is affecting various aspects of mental health. Emergency Medicine specialist Jin Han of The Critical Illness, Brain Dysfunction and Survivorship Center at Vanderbilt University Medical Center is studying whether patients hospitalized for COVID-19 develop cognitive impairment, depression, or post-traumatic stress disorder. Epidemiologist Daisy Fancourt and colleagues at the University College London have enrolled 90,000 people in a study of the social and psychological consequences of the pandemic. In Australia, researchers at Deakin’s Centre for Social and Early Emotional Development are enrolling 2,000 participants in a survey of parent and child mental health well-being. And so on.

Meanwhile, as the COVID-19 epidemic races on with no end in sight, so does time, at least in the perception of some. Five minutes can feel like two, and 63 days can feel like 29. Is it a re-hash of Michel Siffre’s time warp experience? Or is it, as Yogi Berra once quipped, “Deja vu all over again?”