Coronavirus: Mass Quarantine May Spark Irrational Fear, Anxiety, Stigma

Megan Brooks

January 28, 2020

Mental health experts are warning of the potential deleterious psychological effects of the Chinese government's response to the rapidly evolving coronavirus (2019-nCoV) outbreak that originated in Wuhan, China.

China's mandatory mass quarantine of millions of people in more than 10 cities will likely exacerbate public anxiety levels, G. James Rubin, PhD, senior lecturer in the psychology of emerging health risks, King's College London, United Kingdom, and coauthor Simon Wessely, MD, professor of psychiatry, King's College London, point out in an opinion piece published online January 24 in the BMJ.

"How well these measures will work in containing the spread of disease remains to be seen. Even attempts to completely close national borders may do little more than delay an epidemic by two or three weeks," they write.

Regardless of whether mass quarantine succeeds in controlling the coronavirus outbreak, it is certain to have substantial psychological consequences, they add.

During disease outbreaks, it is natural for public anxiety to run high. However, Wessely and Rubin contend that mass quarantine ratchets up public anxiety by signaling that "authorities believe the situation to be severe and liable to worsen." In addition, quarantine is associated with "a perceived loss of control and a sense of being trapped," they note.

As of January 28, there were more than 4500 confirmed cases in 15 countries and more than 100 deaths. In the United States, there are five confirmed cases, all in people who recently returned from the city of Wuhan. An additional 110 people in 26 US states are under investigation for having the virus.

"People may be very concerned about the coronavirus, and it's a question of how much should we really be concerned," Lynn Bufka, PhD, a clinical psychologist based in Washington, DC, told Medscape Medical News.

"The annual flu is deadly, but we don't tend to freak out about it because it happens every year, we expect it, and we have an expectation of how it will play out each year," said Bufka, senior director for practice, research, and policy at the American Psychological Association.

With a new virus, "there is uncertainty, and that's what drives anxiety," she added.

Lessons From SARS

"All anxiety is certainly not bad," Neda Gould, PhD, clinical psychologist and assistant professor of psychiatry and behavioral sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, told Medscape Medical News.

"Some anxiety or fear can be a good motivator for people to become aware and make necessary changes, but it shouldn't interfere with our lives," she said.

David McKeown, MD, who authored an opinion piece in the Canadian newspaper the Globe and Mail last week, noted that it's important to recognize that a communicable disease epidemic can be both a biological and sociologic event.

McKeown, who served as Toronto's medical officer of health from 2004 to 2016, during the SARS (severe acute respiratory syndrome) outbreak in Toronto, knows firsthand how people may develop an irrational fear of persons from the part of the world where the virus originated.

When SARS hit Toronto, people who appeared to be Asian reported being shunned on public transportation and having trouble hailing cabs, McKeown noted. At the height of the SARS epidemic, he held a news conference at a once-bustling Chinese restaurant in the neighboring city of Mississauga in an effort to reassure anxious people that it was entirely safe to eat at such businesses.

"In a time of panic, sober reality can become a rare resource," he said. Yet, communicable-disease epidemics have power to spark levels of fear and anxiety that are "wildly out of proportion" to actual risk, McKeown noted.

Stigma the "Most Pernicious Effect"

The first step in combatting the "other" epidemic is to anticipate and address it directly, McKeown added. "The best prescription is frank and accurate information from credible sources ― and lots of it," he writes.

Similarly, Wessely and Rubin suggest that the stigma that accompanies mass quarantine is the "most pernicious effect."

"Previous incidents have seen residents of the affected areas socially shunned, discriminated against in the workplace and their property attacked. Unless active steps are taken to prevent this, the official imposition of a cordon may aggravate such effects. Vigilante-imposed isolation can follow or even run ahead of official quarantine," they warn.

Bufka and Gould agree.

"It's important that health providers be informed about what this new illness is and understand that at this point, there are very few cases in the US. We are fortunate to live in an era with global communication, so we can track these things much more rapidly and share information," said Bufka.

"People begin to feel anxious when there is a threat to their well-being or the well-being of their loved ones. Media hype sometimes plays a role, and some people just have a vulnerability to be more anxious than others. Communicating accurate and clear facts to patients is an important role of the healthcare provider," Gould added.

BMJ. Published online January 24, 2020. Full text

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