The Vaccine Blog
youmevaccines@gmail.com
The Vaccine Blog
youmevaccines@gmail.com
COVID lockdowns, mental health and vaccine hesitancy
“Feels like life and society have permanently changed even after most of the pandemic has ended […] You can make plans and act towards them, but they can (and usually do) come undone in moments.”
Online alternatives help a lot, but it’s not the same and not enough.
This is just two people's experiences of public health measures during COVID from surveys carried out and published on theconversation.com
Still, others had differing experiences and perspectives of movement restrictions and other non-pharmaceutical interventions..
I spend more time with close friends. Less time with ‘acquaintances’. More time with reliable colleagues. Less time with ‘time‐wasters’.
“for decades had many online relationships all over the world. This has facilitated my ease at moving to online.”
When one reads these and other stories, as well as speaking to others about their experiences, one thing becomes clear. People's experiences of 2020 and 2021 were incredibly diverse. In other words - everyone saw the time period in a slightly different way. This is especially clear when we look back on it, 5 years since the virus causing COVID, Severe Acute Respiratory Syndrome Coronavirus 2 or SARS-CoV2, began circulating. Some were absolutely accepting of all interventions, others were unsure or on the fence to some degree, and others were on the other end of the spectrum entirely, frustrated with or rejecting all measures entirely.
However, regardless of where on the spectrum you are, one thing is clear. Mental illness during isolation is something that has impacted a huge number of people for a long time. Of course, the recent COVID pandemic has brought the issue to the forefront of public attention. With rapid developments in information sharing facilitated by the Internet, sentiments around public health interventions are spreading faster and more widely than ever before. However, nonpharmaceutical interventions have always been central to reduce disease transmission during outbreaks, epidemics and pandemics. Smallpox outbreaks, the 1918 influenza outbreak, seasonal polio epidemics - they all involved micro-level border controls and larger scale controls on movement. Despite this, they have been the subject of ongoing debates and discussion. How does isolation affect mental health? What are the effects of lockdown? Further, what are the mental health issues after the pandemic? Also, how do you overcome post-COVID anxiety? These are just a small sample of questions you`ll find if you look at the most commonly asked questions. With that in mind, I thought it would be appropriate to dedicate a post to discussing COVID-related isolation, as well as their benefits and drawbacks. I`ll also discuss how this can feed into vaccine hesitant perceptions.
The first thing I`m going to state is that quarantining, distancing, and other measures are crucial to control disease spread in the context of any large scale disease spread. I absolutely stand behind their safety and effectiveness. With that said, it's not always as straightforward as saying they did or didn't work in a binary sense. There are many variables that influence their effectiveness.
For instance, different countries restricted movement at different points in the early stages of COVID-19 emergence. Countries have different population densities, meaning that disease spreads more rapidly and easily in some areas relative to others. Also, some people altered their behaviors even before they were made mandatory. Further, travel restriction policies were not uniform across countries which may have also had an impact on disease cases. Different viral strains have different levels of contagiousness, which also factors into how easily they spread.
Also, some people were more diligent about sticking to some measures over others. That is, some may have been very strict with themselves about masking and handwashing, but not distancing, or vice versa. Finally, the most important point I would make is that we implemented multiple measures to reduce disease spread. That means masking, distancing, handwashing, and so on. Combined, they all contributed to the observed reduction in disease spread. So it's difficult to find a direct one-to-one relationship between one protective measure and a specific number of disease cases avoided. This becomes apparent when one looks into the research on the effectiveness of isolating people and other measures.
For instance, a 2022 study published by Yige Li and colleagues in the American Journal of Epidemiology investigated the effectiveness of localized movement restriction. The authors found that “the effects of localized lockdowns are strongly modulated by their duration and are influenced by indirect effects from neighboring geographic areas.” They also noted that extending localized lockdowns can certainly slow disease transmission; however it is insufficient to control disease cases if neighboring areas have not applied similar measures.
Further, in India, a 2022 study assessed the association of national and regional movement restriction with infection rates in Pune. The researchers examined the growth of confirmed patients before, during, and after movement was restricted throughout the first wave in Pune city, which reported the largest disease burden at the peak of the pandemic. The authors found that “national lockdowns contributed to significant delay of the growth of patients by approximately 8 weeks.” The authors also noted that they “flattened the COVID-19 pandemic curve with significant reductions in new patients and comparatively low infection rates during the nationwide and regional lockdown.”
Not only this, a 2022 study published by Mary A Shiraef and colleagues investigated whether border closures slowed the spread of SARS-CoV2., because prior to 2020 the impact of border closures on disease spread was largely unknown. The authors used data from the COVID Borders Accountability Project database. They found no evidence in support of border closures, however they did find a strong link between restricting movement on the national level and reduced spread of SARS CoV2.
A few things become very clear from this. The first thing that became apparent to me while reviewing the research is that, as with anything in life, timing is of the essence. Interventions need to be implemented early to achieve the most benefit possible. If they`re implemented too late, many individuals will already be infected and transmitting the virus. This drives disease incidences, hospitalisations and even deaths up.
Also, many other factors influence how effective any one intervention is. It's very difficult to isolate its impact from that of other factors. These other factors often interact in very complex ways over space and time. Further, the influence of these other factors can vary with time ie. people may have begun being very diligent about handwashing, for example, but were perhaps less likely to do so as the pandemic progressed. So restricting movement is crucial, but only if implemented everywhere and in combination with other strategies.
With that said, the research does show that the isolation did have a significant impact on wellbeing across different age groups, ethnicities, and regions.
Humans are incredibly social, so it`s unsurprising that anything that isolates us will cause mental distress. Factor in the stress of a global pandemic, and the results of research into mental health issues during 2020 and 2021 are quite intuitive.
For example, a 2023 systematic review was carried out by Urvashi Panchal and colleagues on the impact of isolation on child and adolescent mental health. The authors reviewed 61 articles including 54,999 children and adolescents. They found “psychological distress and highlighted vulnerable groups such as those with mental health difficulties, and risk factors such as lack of routine and excessive COVID-19 media exposure. “ They also note that communicating with family members about psychological distress and other interventions to support mental health needs to children and adolescents can help alleviate such negative impacts.
Such trends are also reflected on an international scale. In 2020, an international study on the impact of the pandemic on mental health was published in Public Library of Science (PLoS ONE). The authors surveyed just under 10,000 people across 78 countries and 18 languages. They investigated the specific outcomes of depression, stress, affect, and wellbeing. The authors found moderate levels of mental health when isolation was required at the population level. The highest level of mental health difficulties were found in approximately 10% of the population. Findings suggest that public health initiatives should target people without social support and those whose finances worsen as a result of public health interventions. Interventions that promote psychological flexibility may mitigate the impact of the pandemic.”
This highlights an important point I've mentioned - not everyone has the same experience of the same event. The authors described that the highest level of mental health difficulties were found in a relatively small proportion of the study population. This implies the existence of a spectrum of mental health difficulties during such stressful events, with those experiencing the mildest mental health difficulties at one extremity, and the aforementioned group experiencing the worst psychological issues at the other end.
These patterns of psychological distress are also reflected in trends in online searches. Indeed, a 2023 study by Richard Ramsawak and colleagues investigated key coping strategies used by populations in the Caribbean via Google trends searches. The researchers investigated whether the isolation implemented resulted in differential mental health challenges among English-speaking Caribbean countries. They found that a diverse set of strategies were employed by the study population; which can be subgrouped into positive and negative coping strategies. These included active and religion-based strategies to positively navigate the circumstances, as evidenced by increased searches for books, learning, exercise, religion, and meditation. However, there is also evidence of negative coping strategies, reflected in the increased searches for addiction and marijuana.”
The authors also note that such studies may highlight the types of psychological support that people are more likely to seek out and so be more motivated to engage in. A point I will add is that this also may be applied to other events causing distress at local, national or international scales. Further, the Internet is used globally by those of all ages, ethnicities and backgrounds. Therefore, insights from internet-based research can be applied to many different groups. Also, further research could investigate whether certain groups are more predisposed to resorting to negative coping strategies - and how to provide support to such groups.
The final point I'll add to this section is that the trend I mentioned in the previous section can be tracked through the research. People had very diverse experiences of the public health measures implemented. Further, the only way to investigate this is to ask people which involves self-reporting of psychological symptoms. That`s notoriously unreliable for both psychological and physical symptoms. Maybe an individual was experiencing a low mood while filling in a questionnaire, or surfing the web in the case of the second study I discussed. That mood may have influenced their answers and Google searches. However, it may also have changed within the next few hours. This is of course not to minimize the difficulties people experienced. It is simply to point out that self-reporting has limitations, and this is well known in scientific and medical communities.
Coming back to the main theme of my blog-how do mental health issues contribute to vaccine hesitancy? One might have an intuition that having such a difficult experience might make it difficult for some to trust healthcare authorities and providers and one might be right. However, correlation doesn't always equal causation. Are there other factors at play? As with everything, it is complex and there are of course many interrelated factors at play. This hasn't been well researched historically, however there is a growing body of literature on the topic.
For instance, a UK study published in 2022 investigated physical and mental health predictors of vaccine hesitancy. Interestingly, those with a physical condition were more likely to accept vaccination, however this did not apply to those with mental health issues. Other studies found a stronger, bidirectional relationship between mental distress and vaccine distrust across multiple Eastern countries, which in turn can lead to delay or refusal. This is especially true in some studies of patients with more severe anxiety disorders, depression, injection fears and various other phobias. Intolerance of uncertainty is a key theme that recurs in the research. With that said, much more research is needed in this area to clarify trends and to design the most effective supports for these individuals.
The key is that final sentence. We need more research because we were in a very uncertain, unanticipated and unstable time. For these reasons, we were underprepared to address COVID transmission and the impact of being isolated from each other for a prolonged period of time. It's crucial to understand how to reduce the impact of these restrictive measures on people in future scenarios. That certainly doesn't mean that public health measures weren't important, or that they weren't effective. It simply means that we identify groups who are most vulnerable to mental health issues and design the best support systems possible for them.
To summarize; public health interventions were crucial. However they also cause mental health issues. Everyone had very different experiences of them; which can be visualized as a spectrum from mild to moderate to more severe mental health difficulties. There is no perfect system, unfortunately. With that, relationships between factors causing mental health difficulties need to be more thoroughly understood. This will allow vulnerable individuals to access the best support in similar future scenarios. It will also allow for vaccine hesitancy to be understood as a function of mental health difficulties. Thanks for reading
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