Physical vs. social distancing: The unintended consequences

Social distancing refers to the practice of deliberately increasing the physical space between people to prevent the spread of illness. If preventing illness is the primary objective, should this practice be called “physical distancing” rather than “social distancing”? While quibbling over semantics may seem trivial during a pandemic, it is important to remember that health issues such as high blood pressure, heart disease, obesity, anxiety and depression, have been linked to social isolation and loneliness. The protection we receive by distancing ourselves from others can have its own unintended consequences.

In 1960 only 4 percent of the U.S. population lived alone. That has increased to 11 percent, or 36 million Americans living in single-person households in 2019. One-person households now account for 28 percent of all households in the United States compared to only 13 percent in 1960. The proportion of one-person households is even greater in some European countries (Finland, Sweden and Germany are all over 40 percent) and metropolitan areas (Stockholm and London are over 50 percent).

While loneliness and living alone are related, they are not highly correlated. Social isolation is the objective separation from others, while loneliness is the subjective feeling or perception of being alone. During this period of nationwide calls for social distancing, those who experience a discrepancy between actual and desired social relationships, that is, those who feel lonely, are at particular risk of behavioral and physical health issues.

Apart from the potentially harmful impact of physical distancing on those susceptible to loneliness, epidemics and large-scale disasters are nearly always accompanied by mental and behavioral disorders, such as depression, post-traumatic stress disorder, substance use disorder, domestic violence and child abuse. The result is an increase in the new diagnosis of behavioral health disorders, as well as the exacerbation of symptoms in those who are already struggling with these conditions.

There is not only an opportunity, but an obligation, for the healthcare system to respond to behavioral as well as physical health challenges. Outreach to vulnerable individuals through digital technologies, particularly those that provide voice and video interaction, are critical. Mental health and primary care are the two types of healthcare visits most likely to be done through telemedicine, although these methods were not widely utilized before the COVID-19 crisis. It may take time for both providers and patients to adapt to virtual office visits, but necessity may accelerate this adjustment.

The psychological impact of living through a worldwide crisis in which people may be separated from their family, friends, jobs, social activities and support structures on which they rely is real. This impact may be felt long after the crisis has abated, but now is the time to act.

Steve Delaronde is director of consulting for Payer and Population Health Services at 3M Health Information Systems.

During a pandemic, information is gathered, studied, and published rapidly without the usual processes of review. Our understanding is rapidly evolving and what we understand today will change over time. Definitive studies will be published long after the fact. We share our thoughts and expertise based on currently available information.