More people are being exposed to infection as the number of COVID-19 cases continue to grow, resulting in an increased need for quarantines. The fear, stress and stigma associated with being quarantined can be damaging to one’s mental health.

The differences between isolation, quarantine and social distancing

The U.S. Centers for Disease Control and Prevention (CDC) defines medical isolation, quarantine and social distancing as follows:

Isolation – The separation of a person or group of people confirmed or suspected to be infected with COVID-19, and potentially infectious, from those who are not infected. This can prevent spread of the virus. Isolation for public health purposes may be voluntary or compelled by federal, state, or local public health order.

Quarantine – The separation of individuals who have had close contact with a COVID-19 case, but are not showing symptoms, to determine whether they develop symptoms of the disease. This keeps the person from potentially spreading the virus in the community. Quarantine for COVID-19 should last for a period of 14 days in a room with a door. If symptoms develop during the 14-day period, the individual should be placed under isolation and evaluated for COVID-19.

Social Distancing – The act of remaining out of congregate settings, avoiding mass gatherings and maintaining distance (approximately 6 feet, or 2 meters) from others when possible. Social distancing strategies can be applied on an individual level (e.g., avoiding physical contact), a group level (e.g., canceling group activities where individuals will be in close contact), and an operational level (e.g., rearranging desks in an office to increase distance between workers).

 Emotional impact of quarantine

The simple act of being quarantined can be distressing. When people are quarantined, they:

• Can be completely separated from loved ones
• Lose their freedom of movement
• Don’t know if they will show symptoms or not
• Don’t know how the disease may affect them
• Have no understanding of how long they will be separated
• Experience boredom and have too much time to worry about the situation

People who have been quarantined have reported or shown a high prevalence of symptoms of psychological distress and disorder. Symptoms reported include emotional disturbance, confusion, depression, stress, irritability, insomnia and post-traumatic stress symptoms. In addition, the stigma surrounding those in quarantine can lead people to feel rejected and/or avoid seeking help.

How to reduce the negative effects on mental health

• Seek trusted information sources. COVID-19 information and news is everywhere, and it’s hard to know what’s true. Follow news from the World Health Organization, the CDC and your state health department. Stay away from suspect information that well-intentioned people may share on social media. If you have specific questions about your situation, call your doctor.
• Make sure you have adequate supplies. Make your experience as tolerable as possible. Make sure you have basic supplies such as food, water and medicine for the duration of the quarantine period. Many communities have stores or services that will deliver essential items to your door, so keep a list in case you need anything.
• Make the most of your downtime. As noted above, isolation, boredom and stigma negatively impact mental health. Call old friends you haven’t talked to. Catch up on your reading, do crossword puzzles or play electronic games. Listen to music. Organize those piles of paper you haven’t gotten to. If you can, work remotely.
• Keep a journal, blog or vlog about your experience. Writing down your feelings and experiences, or talking about them, can be cathartic for some people. And if you are comfortable sharing it, your journal can be helpful for other people in the same situation.
• Don’t be afraid to reach out. Talk to a neighbor or two and let them know of your situation so they can help. Find others who are going through the same thing or have been in your shoes before. Talking to someone who knows what you’re going through can help you feel less alone.
• Focus on how you are helping. Remind yourself that your isolation, while difficult to bear, is truly helping contain the spread of disease and potentially saving lives.

If you find yourself feeling overly sad, angry or anxious, contact a behavioral health professional. They can conduct appointments over the phone and provide helpful advice.

After the quarantine

You’ve stayed away from everyone for 14 days, and you’re still healthy. When you are released from quarantine, remember that social distancing may still be in force.

You might have some residual stress from being alone for so long, or you might be angry that you had to stay separated from loved ones when you weren’t contagious. It’s OK to have those feelings. If they don’t subside after a few months, talk to a behavioral health provider.

For more information and tips, visit www.MagellanHealthcare.com/COVID-19.

Humans are social beings, and the social distancing that is necessary to flatten the coronavirus curve is hard on everyone. The forced change in social behavior and the resulting isolation can affect people’s mental health in many ways. Whether you are home alone, with a sick family member or with kids out of school, isolation can increase stress and anxiety.

Depending on your situation, isolation can impact you in different ways. From loneliness to feeling cramped, dealing with these feelings on top of worrying about the COVID-19 outbreak can be overwhelming.

General tips
• Keep in touch with your social support groups virtually through social media, FaceTime, Skype, online games and other digital platforms.
• If the weather is nice, go outside and get some fresh air. Maintain a 6-foot distance from others.
• Stay busy. Read, play games or work on a project.
• Decrease the time you spend watching or listening to upsetting media coverage.
• Draw on skills that you have used during difficult times in the past to manage your emotions. That may include deep breathing, meditation, positive self-talk, etc.
• Maintain a healthy lifestyle. Stay hydrated, eat nutritious meals, exercise and get enough sleep.
• Avoid using tobacco, alcohol or other drugs to cope with your emotions.
• Access information that can help you cope with stress, worry and confusion during the pandemic. Visit Magellan Healthcare’s COVID-19 response website for information and links to self-assessments, videos and other resources.
• Get the facts about your risk and how to take precautions. Use trusted national and international resources including the World Health Organization, Centers for Disease Control & Prevention and State Departments of Health.

For people living with children
• Remember that during times of stress, it is common for children to seek more attachment and be more demanding on parents.
• Be honest when discussing COVID-19, but do so in an age-appropriate way. If your children have concerns, help them ease their anxiety.
• Make sure you model good behavior. Children will observe adults for cues on how to manage their own emotions during difficult times.
• Help children find positive ways to express their fears about the situation. Every child has their own way to express emotions. Sometimes engaging in a creative activity such as drawing can help this process.
• Maintain a safe and supportive environment and practice familiar routines in daily life as much as possible, especially if children are confined to home.
• Provide children with engaging activities

For caretakers of older adults
• Provide practical and emotional support by sharing simple facts about what is going on.
• Give clear information about how to reduce risk of infection in words older people with/without cognitive impairment can understand. Repeat the information whenever necessary.
• Engage their family and other support networks in providing information and helping them practice prevention measures (handwashing, proper sneezing and coughing techniques, etc.).
• Be aware that older adults in isolation and/or those with cognitive decline/dementia may become more anxious, angry, stressed, agitated or withdrawn during this time.
• Encourage older adults with experience and special skills to help others by providing virtual peer support, reading to children over the phone, and the like.

To learn more about what Magellan Healthcare is doing to support clients during the  COVID-19 pandemic, visit  MagellanHealthcare.com/COVID-19.

To learn more about Magellan Health’s corporate response to the COVID-19 pandemic and to view Magellan’s available resources click here: https://www.magellanhealth.com/news/covid-19/

Adapted from Miller, H. (2020, March 10). WHO gives advice on handling mental health toll from the coronavirus. Retrieved from https://www.cnbc.com/2020/03/10/who-gives-advice-on-handling-mental-health-toll-caused-by-coronavirus.html. March 13, 2020.

It is midnight and I’m feeling anxious. I am hearing my daughter cough—she and I returned from New York City four days ago. I’m highly aware of what is known about the incubation and symptom development of the coronavirus. What if she, I, and all the others flying home from NYC last week became the latest vectors of this disease? I have a feeling of dread that I can’t shake, and it’s fueled by the fact that I can’t protect her from any illness, let alone coronavirus.

Anxiety is natural. It’s to be expected in times like these. The news cycle keeps us up to date on every change in the number of infected persons, or the number likely to die. There is a sense of foreboding about whether oneself will get sick, or whether our children or parents will fall ill. We rightly worry about what will happen to the economy and our financial well-being. And, it’s not as if anything else goes away—there is still work, financial obligations, an impending presidential election, countries at unease, and climate change. It is easy to reach the point of feeling on edge, irritable, anxious, or overwhelmed. I would be lying if I said I didn’t feel some of those feelings tonight.

Turning the Anxiety Around

Here are some helpful tips to consider as you grapple with the uneasy feelings associated with the coronavirus:

1. Accept It – It’s important to accept that this is happening; it’s real. Don’t pretend that it’s not. Look for the middle ground here—avoid the Armageddon predictions, as well as the pundits who say this will be over in a week. Accept that your partner, your children, your friends, your parents likely have some level of anxiety—some more than others. Be willing to share those feelings—sharing does not mean that one is weak. That honesty may make one feel less isolated in learning that others feel the same way. Talk to your kids to understand their feelings. My daughter asked me why I was buying extra groceries when I had told her that I wasn’t scared. Her question opened up a wonderful conversation; I am so glad she asked.
2.  Be Informed – Keep yourself informed, but, don’t fall for the endless news cycle and the counting of the numbers of people who have become infected, or what the politicians are saying. Use legitimate sources such as the World Health Organization or the Centers for Disease Control websites. Listen to the science. Know what your public health authorities are saying so that closures don’t come as a surprise, and you are aware of mitigation efforts.
3. Recognize our Burdened System – Try to understand that the healthcare system is under strain right now. The coronavirus is additive—none of the other needs for healthcare have gone away. This means that triaging is critically important and because for the vast majority of cases—those with mild and moderate symptoms—the care is symptomatic, there is no cure. Demanding to be seen because of cold or flu symptoms doesn’t serve anyone. Those with documented fevers, and with shortness of breath or labored breathing, need to be prioritized and seen first.
4. Take Advantage of the Time – If you are now working at home, embrace some of the time you’ve saved in not commuting. Use this time to go for an outdoor walk, or to do yoga in the house. Start journaling. Engage in self-care, and care for those who live with you. Read your child an extra story, cook a hot breakfast, watch something that will make you laugh. All of this will support your ability to focus while you are at working from home. And if you are still needed in the office, use this time to focus on the task at hand. Remember to engage in handwashing, and social distancing. Use your commute to focus on something other than the coronavirus. Listen to a book or find new music. While at work, think about starting a desk exercise routine.
5. Recognize the Challenges – Realize that working from home and social distancing can be hard, especially in our tech-enabled world. If you are someone who travels a great deal for work, and those travels have been placed on hold, understand that you might become antsy at being grounded for weeks on end. Your routine, and the routine of your family has been upset. Talk about it. Understand that while it may be hard for you to stay home, it may be hard for your family to change their usual routine that takes place in your absence. It will take time to adjust and that’s okay. That’s the reality.
6. Maintain a Routine – Do your best to keep your usual schedule, and keep your kids on their schedule, too. This isn’t a holiday. It’s a time to be productive at home during the usual work and school hours. It’s a time to get a full night’s sleep. Print worksheets for your kids. Read. Keep screen time limited to educational activities. If going outdoors is an option, stay active outside. If it’s not, access an exercise program online. Checkout online books from your local library. Play a game. Do a puzzle. Watch television or stream some of the content you’ve been wanting to watch—but not for endless hours. I have ordered a PSAT prep book, and downloaded DuoLingo for my daughter. While she’s not so happy about that, those unpopular choices are the right thing to do.
7. Seek Help – Finally, if the anxiety is affecting your ability to carry out your roles, seek counseling. While face-to-face visits may not be possible, look for telemedicine or tele-behavioral health providers. If these are not an option, seek support through app-based services. Apps that focus on cognitive behavioral therapy or problem-focused therapy may be helpful. Look for apps that support relaxation, medication, and techniques to deal with insomnia.

As our country engages in mitigation, and promotes self-isolation and quarantine, realize that none of this is easy. But it is necessary. You aren’t in it alone—the whole community, even most of the world’s population is adjusting to this new state of life. By participating in what is best for the community, you are taking control of the anxiety by doing something to fight the spread of coronavirus. It’s important to recognize the critical role you are playing in this fight. Thank you.

To learn more about what Magellan Healthcare is doing to support clients during the  COVID-19 pandemic, visit  MagellanHealthcare.com/COVID-19.

To learn more about Magellan Health’s corporate response to the COVID-19 pandemic and to view Magellan’s available resources click here: https://www.magellanhealth.com/news/covid-19/

When I was a child visiting my grandparent’s Iowa farm, I would often hear stories of how my mom and her eight brothers and sisters lived during the war efforts of the 1940’s. My grandma described a common purpose—that sense of pride that the family rationed and repurposed. Their singular focus was that the good of the individual was less important than the whole of the country, even the world.

Watching the coronavirus make its way across the world and rapidly grow in the United States, I can’t help but think of those stories. As the shelves of Costco and Sam’s Club stores emptied this weekend, and school closures were announced community by community, it made me realize that our time to step up is now. Our singular, collective focus needs to be mitigation and in order to be successful, mitigation efforts need to be embraced and enacted on by us as individuals.

What is Mitigation?

Mitigation is a strategy to reduce the seriousness or impact of a natural disaster, such as a pandemic. The goals of mitigation include minimizing morbidity and associated mortality, avoiding an epidemic peak that overwhelms healthcare services, keeping the effects on the economy within manageable levels, flattening the epidemic curve to wait for vaccine development and manufacturing to reach populations, and actively pursuing the development of antiviral drug therapies. Practically, mitigation relies on social distancing—measures that are taken to restrict when and where people can gather to stop or slow the spread of infectious diseases such as the coronavirus.  Social distancing measures include limiting large group gatherings, closing buildings and canceling events. However, for mitigation to be successful, individuals, even those who are asymptomatic, must be willing to self-isolate.

Self-Isolation Challenges

In a society as mobile as ours, and where high degrees of social contact is the norm, self-isolation is challenging. For instance, if one has become accustomed to eating meals outside the home, the transition to grocery buying and cooking may seem formidable. If one is used to getting together with friends to play cards, go running, have a beer after work, the loss of those types of activities will create holes in one’s social network.

We are fortunate to have an infrastructure in which many people can work from home and education can be delivered virtually. Workers who cannot isolate because the nature of their work cannot be done virtually, must take precautions. While in the workplace, distancing at least six feet, maintaining high levels of handwashing and the use of hand sanitizers is a must.   When returning home, it is best to avoid being in the presence of those most vulnerable to coronavirus—elders and persons with underlying comorbidities. It is also important to acknowledge that one may feel anxious and may not have all the answers that our members or clients are seeking. Maintain lines of communication with co-workers and supervisors. For those who are new to work at home, talk to coworkers for whom this has been the norm to get some advice on structuring the workplace and the day. And don’t forget that you can use technology to connect with friends. Facetime, Skype and other video conference capabilities are a great way foster your relationships during social isolation.

Mitigation is a critically important strategy to quell the spread of the virus. It has been beneficial in China as new cases are now falling. In areas where community spread is mild, targeted isolation of high-risk people, or those who may have come in contact with the virus, can be implemented. Even inside households, those with symptoms should keep distance from the healthy. And, even if you are asymptomatic, but have been in a high-risk area or where there is growing or wide community spread, it is important to maintain social distancing and self-isolation.

Social distancing and isolation are not easy—but I am trying to look at them as the Victory Gardens of my mother’s childhood. I hope that 50 years from now, my grandchildren will hear stories of how the United States and the world beat back the coronavirus, and I hope that my children who are on this journey with me now will reflect and recognize the importance of a global community, productively working together for the common good.