{"id":47413,"date":"2020-05-05T11:11:03","date_gmt":"2020-05-05T10:11:03","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=47413"},"modified":"2020-05-06T08:17:49","modified_gmt":"2020-05-06T07:17:49","slug":"peter-brindley-covid-19-has-shown-us-the-difference-between-solitude-and-loneliness","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2020\/05\/05\/peter-brindley-covid-19-has-shown-us-the-difference-between-solitude-and-loneliness\/","title":{"rendered":"Peter Brindley: Covid-19 has shown us the difference between solitude and loneliness"},"content":{"rendered":"

When it comes to covid-19, numerous column inches have repeated the mantra: \u201cstay apart and flatten the curve.\u201d Recently, a new hymn has emerged: \u201cenough already; open things up\u201d. Like you, I am unsure what to advise and what to expect. For now, most of us strive for monkish separation while praying that this won\u2019t last. I simply want to inform this debate by outlining the literal and figurative costs associated with \u201csplendid isolation.” If not for healthcare professionals, then consider our patients. This is because, through the fog of my visor, some look scared and alone.\u00a0\u00a0<\/span><\/p>\n

Pre-covid studies showed that patients on isolation precautions (IPS) were more likely to experience adverse events, report lower satisfaction, and pen more formal complaints. Despite everybody\u2019s efforts, isolated patients probably get less attention<\/a> from nurses: approximately 50% less room entries, 50% less time spent in their rooms, and 50% less physical contact. Before doctors get too pious, we fare equally badly when it comes to laying on (literal) hands. In short, good-intentions can compound social isolation with literal isolation. Sometimes, Safety (with a big S) can be dangerous.\u00a0<\/span><\/p>\n

Isolation precautions might also increase the patient\u2019s psychological vulnerability when they crave reassurance and human touch. Isolation might even make patients feel they are \u201cunclean\u201d or even \u201cundeserving of attention.\u201d Isolated patients appear to have higher rates of depression and delirium, plus greater use of antipsychotics and physical restraints. The threat of quarantine could deter patients from seeking help, as outlined in medicine\u2019s euphemistic new term: \u201cnon covid, covid-related deaths.\u201d These are the patients who stay away from the hospital until, for example, their stroke or heart attack is past the point of no return. Are we surprised?\u00a0<\/span><\/p>\n

We expend finite resources whenever we screen and isolate, and let\u2019s face it, we weren\u2019t resource-flush before all this began. We also burn through precious masks that may already be in nail-bitingly limited supply. There is also what is known in admin-speak as \u201clabour-time\u201d. This is time spent donning and doffing protective gear, which could be invested elsewhere. There is the cost of employing infection control practitioners. There are the cost of follow-up and the cost of testing and testing and testing. There is also the costs from the inability to co-locate isolated and non-isolated patients. There are costs because of delayed discharge and preventable ICU-days. And on, and on\u2026<\/span><\/p>\n

Recent clinical shifts have taught me that, when it comes to covid-19, no \u201cisolate\/don\u2019t isolate algorithm\u201d is a match for the realpolitik of frontline care. I know I am not supposed to put my head in my hands, but I can\u2019t help it because somebody somewhere seems to find a reason to isolate each and every patient. Once \u201con precautions\u201d they are rarely removed for at least a day, and sometimes not even when the test comes back negative: let me further explain.\u00a0<\/span><\/p>\n

Even in the absence of <\/span>signs<\/span><\/i> (those things that healthcare workers measure i.e. fever, x-ray changes) or <\/span>symptoms<\/span><\/i> (those things that patients report i.e. shortness of breath or cough) you are likely to hear the following well-intentioned refrain: \u201cbut you can\u2019t always trust the test: isolate him.\u201d In those not yet tested, I also hear \u201cbut he could be an asymptomatic spreader: isolate him.\u201d There\u2019s also \u201cI can\u2019t trust his answers because he\u2019s confused\/intoxicated\/unreliable: isolate him,\u201d and even \u201cit\u2019s in the community: isolate him.\u201d To some this will sound fine: you can\u2019t be too careful, after all. But like everything in medicine, there are pros and there are cons. Just like everything in life, complexity can rarely be distilled into an unsinkable one-page algorithm.\u00a0\u00a0<\/span><\/p>\n

A wonderful caring colleague reminded me that Anne Frank managed 761 days of isolation. This was as he despaired that his fellow citizens have already returned to the pavements, paths, and bike lanes. Secretly, I have found myself channeling the 1800\u2019s Scottish Philosopher Thomas Carlyle who argued that \u201cisolation is the sum total of wretchedness\u201d. Regardless, my guess is that self-imposed isolation has been tough on everyone. I bet we now all understand why solitary confinement is the worst thing you can do to a prisoner.\u00a0<\/span><\/p>\n

Covid-19 is teaching us that human connection is like oxygen. We now understand the difference between solitude (aka one week of blissful Netflix) and loneliness (aka one month of nothing but Netflix). If so then we should understand that, for inpatients, there is a huge difference between a broken bone that lays you in bed for a day, and a virus that imprisons you for weeks. Just take a moment and imagine what it\u2019s like to be sick, starved of visitors, and unable to recognize masked healthcare workers as fellow humans eager to help.<\/span><\/p>\n

Perhaps you can identify when I say that I relish a firm handshake, delight in seeing the sparkle in another\u2019s eyes, and love a rib-busting hug. Moreover, after 20 years working as an ICU doctor, the science is often workaday but the thrill of connection remains. The term \u201csplendid isolation\u201d originated in the 1900s with politicians warning about the risks of getting too close. The analogy seems on point for covid, but so does the eventual historical lesson. In other words, for better or worse, \u201csplendid isolation\u201d did not last. Those in power eventually accepted what the public always knew: being close is what makes life splendid, or at least a little less wretched. As we struggle with this mighty question, let me reassure you of one thing: your doctors and nurses care deeply, even if you can\u2019t see that in our faces because of all this clunky gear.<\/span><\/p>\n

Peter Brindley<\/i><\/b>, Professor of Critical Care Medicine, Medical Ethics, Anesthesiology at University of Alberta, Canada. <\/span><\/i>
\n<\/span><\/i>Twitter:<\/i><\/b> @docpgb<\/span><\/i><\/a>
\nCompeting interests<\/i><\/b>: <\/span><\/i>None declared<\/span>.<\/span><\/i><\/p>\n","protected":false},"excerpt":{"rendered":"

When it comes to covid-19, numerous column inches have repeated the mantra: \u201cstay apart and flatten the curve.\u201d Recently, a new hymn has emerged: \u201cenough already; open things up\u201d. Like […]<\/p>\n

More…<\/a><\/p>\n","protected":false},"author":1,"featured_media":47061,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[18895],"tags":[],"class_list":["post-47413","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-peter-brindley"],"yoast_head":"\nPeter Brindley: Covid-19 has shown us the difference between solitude and loneliness - The BMJ<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmj\/2020\/05\/05\/peter-brindley-covid-19-has-shown-us-the-difference-between-solitude-and-loneliness\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Peter Brindley: Covid-19 has shown us the difference between solitude and loneliness - The BMJ\" \/>\n<meta property=\"og:description\" content=\"When it comes to covid-19, numerous column inches have repeated the mantra: \u201cstay apart and flatten the curve.\u201d Recently, a new hymn has emerged: \u201cenough already; open things up\u201d. 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