'Mass quarantine is not sustainable over a long period'

Deutsche Welle: Hundreds of millions of people are locked in their homes right now. What should we expect to happen to them?

Sir Simon Wessely: Prolonged quarantine is very difficult. The message is: If we have to do this for a long period of time, I think it will be very, very hard for large numbers of people. And I don't really think it's sustainable over a long period of time on a population basis.

Why?

I think it's not sustainable for many people. It's physically difficult, it's psychologically difficult, because social isolation is not how we, as human beings, work. And the whole business of life becomes more difficult and frustrating. The evidence is that people do start to, you know — they get careless.

And then they finally get cooped up. And then they finally just need some real form of human contact. I think we'll find that it will be awkward for many people. There'll be some who'll be fine, but particularly, confinement — if you aren't like us and have a reasonably large, comfortable property — I think it will become, as the weeks go by, less and less endurable.

What will change in the people who self-isolate in the weeks ahead?

First of all, in the short term, we have proven to be adaptable as a species, very quickly, to new realities. Our government has been quite careful to signal in advance nearly all the changes that have been made. So, everyone has been waiting for this that and the other — working from home, the restaurant ban, then the complete ban.

So they've been giving us a little bit of time to prepare, which I think has been very helpful. But then, after a while, people start to either get blasé about it, complacent, and not bother, or they'll just say: "I don't care, I've just had enough, I'm just going to have to go outside and see people or do something."

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What exactly will they feel, on a day-to-day basis?

You don't need to be a psychiatrist to know the emotions are boredom, frustration, anger, irritability, as well as a strain on relationships. And remember, many people now are already having to deal with their children, who should be at school, but now aren't — in a very, well, controversial decision, really. This happened all around Europe and the world. Shutting schools has added to the pressures.

And I think everyone will say, well, that's blindingly obvious, isn't it? And they would be quite right — it is blindingly obvious. There's also confusion, if they don't get sufficient information. In previous episodes [of epidemics] that's proved very difficult. We've seen from some of the cruise ships that we've had, and some of the accounts from other people who've been stuck in other countries with really inadequate information, they find that probably most disturbing of all.

Finally, that human longing for genuine face-to-face social interactions or variety: People will start to take liberties, not because they don't want to comply, but they'll just find it exacting and difficult. When that will happen is going to vary from person to person, and of course huge numbers of people will manage. But others won't.

And in the long term?

Psychologically, there are long-term side effects for some people. It is not without risks.

What are they? 

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Some people will develop psychiatric conditions, mental health conditions. There will be a rise in depression. For some people, there will be specific stressors — the anxiety of either believing that you might be infecting the people you've been quarantined with — or been infected yourself.

Some people develop, particularly health professionals who've been quarantined in hospitals during the SARS epidemic, an increase in the rate of post-traumatic stress disorder. So, there will be an increase in psychiatric disorders. It certainly won't be a zero-sum game. 

There's also the issue of people avoiding those who they think have the virus.

Yes! We've never been in this situation before, but we've had situations where small numbers of people are quarantined, and others aren't. Those who've been in quarantine are exposed to stigma, and social distancing, and isolation, even though they are now recovered and well. And that's been recorded around the globe and goes back hundreds, thousands of years.

How does altruism factor into this? The idea that I'm helping others through self-quarantining?

I think that's probably the single most important question. We know that those who've been coerced into quarantine do worse than those who have voluntarily quarantined themselves.

And those who see it, or are seen, as having acted altruistically and quarantined themselves to protect others — maybe their sister-in-law's new baby, or their elderly parents— will do better in both the short and long term.

So altruism, and the appeal to altruism, and making people feel they are doing something slightly heroic, slightly for the benefits of others, is the single most important thing that local authorities, police, governments can do. 

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How do you view the images from spring break celebrations, "corona parties," people breaking quarantine and putting others at risk? Should we judge them harshly, or should we try to understand it's a part of human nature?

I can understand that — an outbreak of hedonism. I think it is irresponsible, if you want me to say it as a citizen, but as a psychiatrist I would say it's understandable.

The reaction, of course, is inevitable. And I think there's another thing that's happening as well. Quite a few people, and I have to say myself included, almost wish to get [infected with COVID-19] and get it over with. So my wife is lucky. She has been tested, and she has now had the virus, and she is now immune — or at least, immune for the near future — and she will go back to work as a doctor, doing a good job. And many, many people will say, "Let's get it over with. Then I can go back, altruistically, to contributing to society. Or at least I've been through it."

How did your wife contract the virus?

She went to New York, came back, and contracted it — and was quite ill for two days. For a couple days it was bloody awful. But she recovered almost as quickly as she got ill. And now she's back to her normal self, if one can ever describe Clare as normal...

Sir Simon Wessely is the president of the Royal Society of Medicine and the co-author of a review on the psychological impact of quarantine. He spoke to DW under imposed quarantine after his wife contracted COVID-19. Wessely is a clinical psychiatrist whose academic discipline is epidemiology, or the study of big populations. His expertise is in issues like military health, terrorism, how people respond to emergencies and disasters, and big surveys and studies. He previously presided over the Royal College of Psychiatrists.

This interview — in abridged form — was broadcast on DW's weekly science podcast, Spectrum, on March 24, 2020.