Reflections on the New Zealand Experience in Managed Isolation and Quarantine during the SARS-CoV-2 Global Pandemic

Abstract

The SARS-CoV-2 pandemic led to worldwide stay-at-home orders and social isolation. Social isolation—a lack of social interaction within groups and communities [16], has prevailed during quarantine and social distancing orders. Additionally, perceived isolation (i.e., loneliness)—the subjective feeling of being isolated while not physically alone, can co-occur with social isolation. The perception and physical isolation during this pandemic have affected many demographics. For example, seniors in nursing homes may be at greater risk for isolation. As most nursing homes have canceled group activities, confinement to their rooms and the lack of digital literacy among elders has exacerbated the feeling of isolation within nursing homes and other elders living alone [17]. Additionally, groups with a lack of technological connectivity can also feel increased loneliness during lockdowns [14]. Despite the lack of research exploring the potential influence of loneliness and isolation on the severity of SARS-CoV-2, studies have shown that loneliness and isolation contribute to factors directly attributing to aggravating the severity of SARS-CoV-2 [1, 2, 4, 6-9, 12, 13, 15, 19, 21]. These studies have demonstrated an association between isolation, lowered immune response, higher inflammation markers, cardiovascular disease, and risk for diabetes [1, 2, 4, 6-9, 12, 13, 15, 19, 21]. Although several factors contribute to severe illness from SARSCoV- 2, taking measures to reduce the feeling of isolation may serve as a viable prevention measure. This review evaluates current literature examining the association between loneliness and severe SARS-CoV-2 illness. It aims to provide an alternative perspective to isolation measures in place by public health highlighting the importance of mitigating isolation. This review examined both basic science, clinical literature, and databases, including PubMed/MEDLINE, EMBASE, and Google Scholar. No time, setting, or language restrictions were imposed on the search strategy. Primary research articles, including case studies, and non-primary studies centered around human and animal isolation studies and their health effects, were also included. Studies concerning meta-analysis were excluded from this review. Studies focused on the feeling of loneliness and health effects, determined if their subjects were lonely using the UCLA Loneliness Scale [8]. While studies focusing on isolation placed the test animals in physical isolation [2].