Social isolation, with or without loneliness, can have as large effect on mortality risk as smoking, obesity, sedentary lifestyle and high blood pressure“

Clifford Singer, MD

The causal relation between isolation, depression, stress and diseases falls into the “settled science” category, there may only be a debate on how much is too much. On the quantitative matter, the agreement seems to be that we’re all different, to a point. So for this article I’m just going to investigate some reputable sources on this topic, with minimal inputs from myself.

Health effects of social isolation, loneliness

“Research has linked social isolation and loneliness to higher risks for a variety of physical and mental conditions: high blood pressure, heart disease, obesity, a weakened immune system, anxiety, depression, cognitive decline, Alzheimer’s disease, and even death”, reports the US Governement on the National Institute on Aging website.

“Conversely, people who engage in meaningful, productive activities with others tend to live longer, boost their mood, and have a sense of purpose. These activities seem to help maintain their well-being and may improve their cognitive function, studies show”, the report follows.
The article deals mainly with long term and chronic isolation and loneliness, but that’s not “as opposed to a short term quarantine”, it’s just a subjective quantitative difference. And if the situation is pre-existent, quarantining everyone seriously exacerbates it. Isolation in any quantity can trigger or aggravate a bad situation for a set of people, especially if there are other factors to promote it, such as uncertainty or fear. Everyone knows someone who goes crazy over a single day of loneliness, as well as “anti-social” people who can hardly be pulled out from self-isolation. There’s a full spectrum of personalities and a full spectrum of threats for them from mass-quarantines.
Remember: isolation is worse when everyone around is in isolation too.

Human beings are social creatures. Our connection to others enables us to survive and thrive. Yet, as we age, many of us are alone more often than when we were younger, leaving us vulnerable to social isolation and loneliness—and related health problems such as cognitive decline, depression, and heart disease. Fortunately, there are ways to counteract these negative effects.

US Government-supported research

Isolation is one of the factors that predisposes the elders to harm from viruses, instead of protecting them

Older adults are reporting social isolation or loneliness show poorer cognitive function 4 years later, claims a recent British study. “Interventions to foster social connections may be particularly beneficial for individuals with low levels of education.”
Which is precisely why the US National Institute on Aging is so concerned about it too.

“Efforts to address social isolation in older adults, including those relying on remote technologies, are likely to be cost-effective for health care systems, and are, at the very least, humane approaches to a very common form of distress in older adults.” notes Clifford Singer, MD, University of Maine Chief and reputed Geriatric specialist.

The elders are also the age category where loneliness was the most wide-spread before quarantines. About 28 percent of older adults — that’s 14 million people,  in the United States live alone, according to a report by the U.S. Department of Health and Human Services, (HHS). While many of them are not lonely or socially isolated — some seniors feel isolate despite living among family and friends.

Loneliness May Warp Our Genes, And Our Immune Systems

If anyone likes to make distinctions between loneliness, social isolation and forced social isolation, I’m just going to say that quarantine (even voluntary self-isolation) ads a great deal to all of those.
“The assumption is that social disconnectedness without perceived isolation (i.e. isolation without loneliness) would be more “ego syntonic” and less stressful than states of loneliness and depression, therefore having less impact on health. Research has not always supported this assumption (Cornwell & Waite, 2009). Social isolation, with or without loneliness, can have as large effect on mortality risk as smoking, obesity, sedentary lifestyle and high blood pressure“, notes reputed geriatrics specialist Clifford Singer, MD

Therefore a huge amount of scientific literature about loneliness becomes relevant to quarantine times.

NPR reports:
“Loneliness has been linked to everything from heart disease to Alzheimer’s disease. Depression is common among the lonely. Cancers tear through their bodies more rapidly, and viruses hit them harder and more frequently. In the short term, it feels like the loneliness will kill you. A study suggests that’s because the pain of loneliness activates the immune pattern of a primordial response commonly known as fight or flight.
For decades, researchers have been seeing signs that the immune systems of lonely people are working differently. Lonely people’s white blood cells seem to be more active in a way that increases inflammation, a natural immune response to wounding and bacterial infection. On top of that, they seem to have lower levels of antiviral compounds known as interferons.”

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Understanding the biology of loneliness

Losing a sense of connection and community changes a person’s perception of the world. Someone experiencing chronic loneliness feels threatened and mistrustful of others, which activates a biological defense mechanism, according to Steve Cole, Ph.D., director of the Social Genomics Core Laboratory at the University of California, Los Angeles. His NIA-funded research focuses on understanding the physiological pathways of loneliness (the different ways that loneliness affects how your mind and body function) and developing social and psychological interventions to combat it.

For example, loneliness may alter the tendency of cells in the immune system to promote inflammation, which is necessary to help our bodies heal from injury, Dr. Cole said. But inflammation that lasts too long increases the risk of chronic diseases.

Loneliness acts as a fertilizer for other diseases,” Dr. Cole said. “The biology of loneliness can accelerate the buildup of plaque in arteries, help cancer cells grow and spread, and promote inflammation in the brain leading to Alzheimer’s disease. Loneliness promotes several different types of wear and tear on the body.

People who feel lonely may also have weakened immune cells that have trouble fighting off viruses, which makes them more vulnerable to some infectious diseases, he added.

Psychologially, physical isolation is the worst form of social isolation

The impacts of social isolation become worse when people are placed in physically isolating environments. For example, solitary confinement can have negative psychological effects on prisoners – including significant increases in anxiety and panic attacks, increased levels of paranoia, and being less able to think clearly.

Many prisoners also report long-term mental health problems after being held in isolation.
“Some people who have been held in social isolation against their will may develop long-term mental health conditions, such as post-traumatic stress disorder (PTSD)”, writes Science Alert

Are pandemics stressful and depressive? Count on quarantines to add more stress and depression and reduce the ability to fight them

The social experiment known as “the CV pandemic” (due to online censorship, I’m afraid to type its full name” is promoting the idea that everyone around is a potential walking biological bomb. I can’t think of a more stressful social situation, beats by far a war in which the enemy is clearly defined and usually distant. Unless you add a medical martial law to it.
Isolation promotes stress and depression, also depletes our abilities to fight stress and depression. Which is precisely the downward spiral you need in a stressful and depressive situation such as a deadly global pandemic.
Socially isolated people are less able to deal with stressful situations. They’re also more likely to feel depressed and may have problems processing information. This in turn can lead to difficulties with decision-making and memory storage and recall.
In fact, social therapies are highly rated as stress-deterring methods, as recommended by the Mayo Clinic Staff:
“A strong social support network can be critical to help you through the stress of tough times, whether you’ve had a bad day at work or a year filled with loss or chronic illness. And the lack of social support can lead to isolation and loneliness. Since supportive family, friends and co-workers are such an important part of your life, it’s never too soon to cultivate these important relationships.
A social support network is made up of friends, family and peers. Social support is different from a support group, which is generally a structured meeting run by a lay leader or mental health professional.”

Also read: “Social Isolation Stress Induces Anxious-Depressive-Like Behavior and Alterations of Neuroplasticity-Related Genes in Adult Male Mice”

Later update:

In New York City, a desperate coronavirus-stricken Bronx man tried to commit suicide-by-cop after calling 911 on himself, according to cops.

Health officials in other areas, including Portland, Oregon, saw the number of suicide-related 911 calls soar after the city’s coronavirus “state of emergency” declaration, with self-harm calls spiking 41 percent.

Isolation promotes inflammation, which promotes more isolation

The shock of social isolation could fuel inflammation in the body. And the immune system may affect a region of the brain processing fear and anxiety. “Inflammation can change people’s experiences of the social world and what they’re thinking,” says Naomi Eisenberger, a neuroscientist at the University of California, Los Angeles. That could make us more apprehensive about social interaction and lead to more isolation.

If the cycle continues, that could explain chronic isolation and the subsequent depression and illnesses plaguing the lonely. “There are things we can do to get out of a depressed or lonely state, but they’re not easy,” dr. Steve Cole says. “Part of the reason is because these negative psychological states develop some kind of molecular momentum.”

Past research has shown norepinephrine can increase production of immature monocytes – a type of white blood cell – in bone marrow. These monocytes demonstrate high inflammatory gene expression and low antiviral gene expression.

Researchers quoted by Medical News Today found that both lonely monkeys and humans had higher levels of monocytes in their blood. Further investigation found this is due to an increase in production of immature monocytes; monkeys repeatedly exposed to mild social stress experienced a rise in levels of these cells.

“Overall, the researchers say their findings suggest loneliness disrupts fight-or-fight signaling, which leads to increased production of immature monocytes, causing lower antiviral responses and increased inflammation. In turn, this may impair the production of white blood cells, partly explaining why lonely individuals are at greater risk for chronic illness.” – MNT

Loneliness and social isolation as risk factors for coronary heart disease and stroke

“Deficiencies in social relationships are associated with an increased risk of developing CHD and stroke” claims a study published by the British Medica Journal. And they’re heavily supported by other scientific works.
Sixteen electronic databases were systematically searched for longitudinal studies set in high-income countries and published up until May 2015. 23 papers met inclusion criteria for the narrative review. They reported data from 16 longitudinal datasets, for a total of 4628 CHD and 3002 stroke events recorded over follow-up periods ranging from 3 to 21 years. Reports of 11 CHD studies and 8 stroke studies provided data suitable for meta-analysis. Poor social relationships were associated with a 29% increase in risk of incident CHD (pooled relative risk: 1.29, 95% CI 1.04 to 1.59) and a 32% increase in risk of stroke (pooled relative risk: 1.32, 95% CI 1.04 to 1.68). Subgroup analyses did not identify any differences by gender.

First-year College Students Who Feel Lonely Have A Weaker Immune Response To The Flu Shot

A 2005 study at Carnegie Mellon University in Pittsburgh confirms how college challenges both mind and body, by demonstrating that lonely first-year students mounted a weaker immune response to the flu shot than did other students. The study appears in Health Psychology, which is published by the American Psychological Association (APA).
<<Sparse social ties were associated at a level of statistical significance with poorer immune response to one component of the vaccine, A/Caledonia, independent of feelings of loneliness. Loneliness was also associated with a poorer immune response to the same strain as late as four months after the shot. This supports the argument that chronic loneliness can help to predict health and well-being.
The independence of social-network size and loneliness as factors in immunity is supported by the observation that, says Pressman, “You can have very few friends but still not feel lonely. Alternatively, you can have many friends yet feel lonely.”
The finding could also help to explain why first-year students tend to visit student health centers more than older classmates; they can be unmoored socially as they adjust to their new circumstances>>, reports Science Daily.

Does grief help? Because we’re already grieving for the world we’ve just lost

“Yes, and we’re feeling a number of different griefs. We feel the world has changed, and it has. We know this is temporary, but it doesn’t feel that way, and we realize things will be different. Just as going to the airport is forever different from how it was before 9/11, things will change and this is the point at which they changed. The loss of normalcy; the fear of economic toll; the loss of connection. This is hitting us and we’re grieving. Collectively. We are not used to this kind of collective grief in the air” – David Kessler, one of world’s foremost expert on grief, in an interview for Harvard’s Business Review.
Kessler co-wrote with Elisabeth Kübler-Ross On Grief and Grieving: Finding the Meaning of Grief through the Five Stages of Loss. His new book adds another stage to the process, Finding Meaning: The Sixth Stage of Grief. Kessler also has worked for a decade in a three-hospital system in Los Angeles. He served on their biohazard’s team. His volunteer work includes being an LAPD Specialist Reserve for traumatic events as well as having served on the Red Cross’s disaster services team. He is the founder of www.grief.com which has over 5 million visits yearly from 167 countries.
He goes on saying: “We’re also feeling anticipatory grief. Anticipatory grief is that feeling we get about what the future holds when we’re uncertain. Usually it centers on death. We feel it when someone gets a dire diagnosis or when we have the normal thought that we’ll lose a parent someday. Anticipatory grief is also more broadly imagined futures. There is a storm coming. There’s something bad out there. With a virus, this kind of grief is so confusing for people. Our primitive mind knows something bad is happening, but you can’t see it. This breaks our sense of safety. We’re feeling that loss of safety. I don’t think we’ve collectively lost our sense of general safety like this. Individually or as smaller groups, people have felt this. But all together, this is new. We are grieving on a micro and a macro level.”

Later Update: As I predicted, calls to US helpline jump 891%, as White House is warned of mental health crisis

“Some federal officials worry the U.S. isn’t prepared to meet nation’s needs”. – ABC
“Mental health – major factor”, said Donald Trump in a briefing on 9th of April announcing he summoned country’s specialists to tackle the side-effects of the lock-ups.
This comes after March 29’s statements in which President Donald Trump suggested it is “common sense” to expect a “massive” jump in mental health issues. Apparently it’s not common at all, the topic is absent from the public agenda. “You’re going to have massive depression,” he said. “You’re going to have depression in the economy also. … [Expect] massive drug use, massive depression, mental depression, massive numbers of suicide.” – Source

Bonus: Isolation promotes heavy social media use, which promotes depression, which promotes more isolation and disease

Missouri University reports: “Browsing Facebook has become a daily activity for hundreds of millions of people. Because so many people engage with the website daily, researchers are interested in how emotionally involved Facebook users can be with the social networking site and how regular use can affect their mental health. Now, researchers at the University of Missouri have found that Facebook use can lead to symptoms of depression if the social networking site triggers feelings of envy among its users. Margaret Duffy, a professor and chair of strategic communication at the MU School of Journalism, says that how Facebook users use the site makes a difference in how they respond to it.

“Facebook can be a fun and healthy activity if users take advantage of the site to stay connected with family and old friends and to share interesting and important aspects of their lives,” Duffy said. “However, if Facebook is used to see how well an acquaintance is doing financially or how happy an old friend is in his relationship—things that cause envy among users—use of the site can lead to feelings of depression.”

I can go on forever with quotes from the most reputed specialists, and probably I will update this article as sources are abundant. I think we even have a case of “scientific consensus” (not that it matters, bandwagonning is a fallacy).
Mass isolation is a disaster for public health, and the subjective “short term argument” is compensated by the huge number of people affected, plus a trove of aggravating factors. And one factor is the worst.

I saved the worst for last:
This will be a recurrent event, as I’ve shown in my previous article. We’re never going back to the pre-pandemic way of life, these shocks will become the new normal in a few years.
“We’re not going back to normal. Social distancing is here to stay for much more than a few weeks. It will upend our way of life, in some ways forever. As long as someone in the world has the virus, breakouts can and will keep recurring without stringent controls to contain them”, writes Technology Review.
And when we’ll run out of viruses, someone will make more to keep the machine running, I’d add.
In a report  (pdf), researchers at Imperial College London proposed a way of doing this: impose more extreme social distancing measures every time admissions to intensive care units (ICUs) start to spike, and relax them each time admissions fall. Here’s how that looks in a graph.

You’re looking at a visual rendition of our social life, amplitudes ad frequencies being controlled by government, like a DJ.
Enter the era of social DJ-ing, the most modern branch of social engineering.

UPDATE JUNE 15 2020
A ton of scientific literature and media reports have come to support the findings of this article since its publication, I want to highlight just one item for now, for its incisive conclusions.
It’s a very recent work by French expert M ZELMAT of Laboratory of Clinical Biology, Hospital Center, France, titled “Facing COVID-19 by the Confinement : EBM, ‘MBM’ or ‘SBM’?”. It’s in prepublication on SSRN and it’s just been submitted to the British Medical Journal, so not yet approved. Download in .PDF

I’ll just copy/paste the conclusion:

“In medicine, there is only isolation and quarantine and the confinement of the general
population is not only a heresy (because it does not exist in medicine nor in epidemiology nor in infectiology nor in public health) but it is based on no scientific evidence. In medicine, we can’t and we have no right to set up a treatment or a preventive measure if it is not based on evidence (Evidence Based-Medicine). The confinement is, also, very dangerous for health, economy, education and peace. The governments must listen to real experts (who put public health before private interests), stop immediately all the lockdown measures and re-open everything (economy, hospital medical services, education, etc) because nothing in this virus justifies them ; this virus is, in the general population, mild and not very dangerous as we are told because it it causes 85% of mild forms, 99 % of infected people recover, it is not a danger for pregnant women and children (unlike the flu), it spreads less faster than influenza
viruses48 , children are not important drivers (unlike the flu), its mortality rate is similar to the flu or even lower and much lower than the coronaviruses that appeared in 2003 (10%) and 2012 (30%). Each year : flu virus infects worldwide 1 billion persons and kills 650,000 and tuberculosis, which is in the top 10 of death causes in the world and much more contagious (an untreated patient can infect 10 to 15 people) causes 10,4 million cases and kills 1,8 million people. Yet, we never talk about any health crisis. The entire hospital system of countries is absolutely not overwhelmed because saturation only concerns very few hospitals and this can be avoided by taking reasonable measures to manage this epidemic as we indicated and as Sweden did. The WHO must undergo a radical reform.
The confinement is truly the health scam of the 21st century, an enquiry must be done about it and those responsible in the WHO and Imperial College London must be questionned and if necessary tried.“

Declaration of interests : no competing interests.
Funding information : no funding by external sources.
Ethical approval statement : not applicable beacuse no human subjects were invloved and
no case reports/case series were included in this article.

To be continued?
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! Articles can always be subject of later editing as a way of perfecting them