When Less Means More: Less Medical Care Means More Self-Care

Unfortunately, COVID-19 isn’t the only thing that can make you sick these days. Luckily, as re-entry is becoming more common across the country, there are ways to “hack” your stay-at-home anxiety, improve your wellbeing and make sure you’re ready if social isolation comes around again.

Jan, 76, and Isabella, 4, are years apart in age and miles apart geographically. They don’t know each other, but they do have something important in common: chronic medical conditions that make them pros at social distancing.

Jan has a form of chronic hepatitis that affects her immune system, as well as chronic fatigue syndrome. Her husband of more than 50 years is her caregiver, and most days, the only person she sees. Apart from doctor visits and occasional haircuts, she stays home to avoid infection. Her children visit when they are in town. If she feels well, she can chat with neighbors from her porch.

Isabella was born with a rare disorder called CCHS, for congenital central hypoventilation syndrome. Her condition makes her stop breathing completely when she falls asleep, so she has spent her entire life around ventilators. Any respiratory infection puts her in the hospital, so her family is incredibly careful about hand-washing and limiting her contacts with people.

During COVID-19, her family’s way of life has become familiar to many more of us. Many more of us can now relate to the challenges Jan and Isabella face.

The pandemic threatens the mental and physical wellbeing of every American. People are seeking ways to manage their stress, but it isn’t enough.

According to a new survey conducted by The Harris Poll on behalf of Samueli Integrative Health Programs, nearly half of Americans (47%) report feeling socially isolated, according to the online survey of more than 2,000 adults over age 18 conducted in May 2020.

When Social Isolation is Your Norm

By now, you may be eager for the reopening that is happening around the United States. Eating in a restaurant, going shopping or getting together with family and friends seems intoxicating. But before you go back to “normal life,” consider people like Isabella, Jan and their families. What can we learn from the ways they cope? And if we need to isolate again, can we borrow some of their tools for preventing loneliness during isolation?

First, remember that social isolation and loneliness are not the same. Loneliness is negative feelings about being isolated, or even feeling isolated when you are actually with others – but both are associated with risks, including being less physically active and mentally healthy. Loneliness can also affect your physical health in very specific ways.

How Loneliness Can Harm Your Health

One researcher has found that being lonely, living alone and having poor social connections takes about the same toll on your health as smoking 15 cigarettes a day. Your risk of dementia, heart disease, depression and anxiety rise if you are lonely, as does your risk of death from any cause – up to 30 percent higher than for non-lonely people. Subjective loneliness, when you feel lonely despite the presence of other people, raises your risk of dementia.

All this may happen, researchers say, because loneliness raises the level of inflammation in your body, just as smoking and obesity do. Heard of C-reactive protein (CRP)? This substance is a marker for inflammation in the body. Being obese and being lonely both raise CRP levels, and its elevated presence is a strong predictor of heart disease. Feeling lonely can also make your immune system less effective. This is always risky, but especially now with a new virus making the rounds.

According to the recent survey more than one in four Americans report a lack of energy, difficulty sleeping, and exercising less. And nearly half of Americans (46%) also report that they are struggling to maintain their physical, mental, and spiritual health.

Researchers say there is no single factor that causes loneliness. But social isolation – being away from routine daily interactions with family, friends, coworkers and neighbors – is a likely cause for many of us. Here are some tips to help you deal with social isolation and loneliness.

Coping Tips

Manage your thoughts

A type of counseling called cognitive behavioral therapy, or CBT, can help you turn negative or despairing thoughts into positive ones. For example, CBT could help you change the recurring thought “The pandemic is never going to end,” to “Everything passes, and this will too.” A therapist specializing in CBT can teach you techniques such as “thought stopping” to turn off that negative inner voice and change your behavior. Adding a few minutes daily of thoughts for what you are thankful for also helps.

Keep socializing virtually

More than 25 percent of the U.S. population now lives alone. If this includes you, you may hear friends complain about kids, partners and pets and wish you were that lucky. Research tells us that social isolation is a major factor in loneliness, as is marital status. By now, you are likely longing to visit a coffee shop, your favorite pub or the mall. But as the United States slowly reopens for business, we still need safeguards to slow the spread of COVID-19. Here are some ways to decrease your isolation while staying safe.

Use the phone

An old AT&T slogan, “reach out and touch someone,” equates touch with hearing your loved one’s voice on the phone. This 1987 commercial shows how the voice conveys nuance and warmth. Tired of texting? Try an old-fashioned voice call. Grab a beverage and simply listen to a friend or loved one. We challenge you to try this at home!

Try a new (to you) technology

The Harris Poll found that 83% of those surveyed say that they are using technology to help in that struggle. You might want to download a new app, such as Twine, designed for “deep conversations.” (One of the sample convos on its home page says, “I’m avoiding friends on Facebook.”) Grandparents, including Dame Judi Dench, are using TikTok to connect with grandchildren they can’t see in person. You can binge watch with your friends using Rave or Kast, or leave video messages using Marco Polo.

Many traditional interventions for loneliness, stress and anxiety are available online. The app 7 Cups connects you with trained volunteers who can talk through mental health concerns with you. BetterHelp.com can help you find a professional counselor to meet with remotely.

More video chats?

If you haven’t tried a video happy hour or hangout, now is the time, and apps and platforms abound. We’ve all heard a lot about Zoom, but have you tried LifeSize, BlueJeans or Google Duo or shared your screen on Squad? Challenge yourself to meet up with a friend or two each weekend. Book clubs are now meeting online, houses of worship are live streaming their services and choirs are gathering on Zoom. Belonging to social groups lowers your risk of death, as studies of older adults show.

For those who are truly homebound, like older adults, people with chronic illnesses like Jan or with a compromised immune system like Isabella, regularly scheduled video chats with family or friends can give everyone something to look forward to. They are a good way to do a visual check-in. I video chat with my 93-year-old mother, who is now confined to her room every evening.

If loneliness has convinced you of the need to find a partner, online dating remains an option, though for now it has to stay online. You can find a list of activities and “dates” at CNet.com. Avoid thinking “I can’t date now,” and replace it with “I can really get to know someone before we meet.”

Do Some Good

Gratitude and giving are two things we know give us a boost. Gratitude – from simply saying thank you, to keeping a journal – can make you physically and psychologically healthier, help you sleep better and make you more resilient. You can practice gratitude by:

  • Having a “gratitude buddy.” Each day, commit to texting each other 3 to 5 things you are grateful for.
  • Keeping a gratitude journal. Write down 5 things you are grateful for each night before going to sleep.
  • Write thank-you notes. Do you ever have time? You do now! Send grateful emails or do it the old-fashioned way with pen and paper. Grocery stores are open, so you can even pick up a few cards. Or use that stationery you haven’t touched in years and send someone an old-fashioned letter, telling them how much you appreciate them.

Giving money might not be an option if you are unemployed or your business is closed. But you may have skills people need, such as sewing (sew masks for a hospital or your neighbors) or a love of walking (help older or otherwise at-risk neighbors by walking their pets). Bringing over meals to people shut in helps through both heart and stomach.

A simple way to help others is to reach out to friends, family and even acquaintances and ask how they are doing. Hearing caring words in a friendly, familiar voice can make your grocery checker or letter carrier’s day – and knowing you’ve helped someone else can also make you feel good, too.  Here are some more ideas.

Treat isolation as a retreat

This may be the ultimate in mental reframing. While we’ve been ordered to stay home, people also pay good money to go on socially isolated retreats. Drew, a single executive, recalls the 10-day silent yoga retreat where he went deeper and deeper into his anxieties to finally find peace. Living in utter silence, a type of social isolation, helped him “hear” his inner wisdom.

Try some journaling in your “isolation retreat.” It’s proven to reduce stress, and you can gather valuable information. Try the following to get you started.

  • 10 things I miss about life before quarantine
  • 10 things that seem most important in life now
  • Changes I’d like to make now that I can go places
  • Things I’ve learned

Write without stopping or censoring yourself, and keep it private if you prefer. Consider any insights an achievement. You may wind up changing jobs, working at home more or home schooling your kids as a result of what you’ve learned in quarantine. You might decide it’s definitely time to date or get a roommate or pet, or move closer to family.

Unplug

If you’re isolated with family or a partner, put down the technology once in a while. Here are some ways to do this.

  • Turn off Netflix or whatever other streaming service has dominated your life lately.
  • Sit quietly near your partner or kids. Read a “real” book.
  • Take a walk, run or bike ride together. With gyms closed, we are seeing parent-child exercise buddies, couples, and families.
  • Play a question game, like 23 Questions or 36 Questions. Or play a board game together.
  • Puzzles or coloring are great ways to occupy the mind with calm and create something beautiful.

Doing a physical project can benefit both mind and body. We have seen neighbors building garden sheds, patios and pizza ovens, laying sod and woodworking. Doing something that’s out of the norm and requires skill can lift you out of a funk and help you work up a healthy sweat, busting stress in the process. Plus, if the weather is nice, you might see neighbors.

Connect in person, from a distance

Some neighbors walk their toddlers around the cul-de-sac every afternoon. Between her and the garden is more than 6 feet, so we can have a lightly shouted conversation for as long as the wee ones tolerate. You may feel safe chatting to a neighbor who sits on their porch, if you stay on the sidewalk. Want to exercise? The running track at a school has lanes about 4 feet wide, so if you stay 2 lanes apart, you are appropriately distant from others. Add an extra lane if you like.

Prepare and plan

Being away from friends and family so long may drive you into a frenzy of hugging. So, plan ahead for what you will do when you see people. You might agree to give everyone a big smile and virtual hug – arms wide, but staying 6 to 8 feet apart. We’re going to have to wash our hands, wear masks and limit our contacts for a while, so make sure you have a favorite hand soap, hand sanitizer and masks if you need them.

You’re not alone. No, really.

One thing we know about loneliness? It’s common. The United Kingdom has a Campaign to End Loneliness. The American Association of Retired Persons (AARP), runs the Connect2Affect program to help seniors feel less alone. And the Commonwealth Fund is offering solutions from around the globe for loneliness due to the social isolation caused by COVID-19 precautions.

So, it’s not just you. Today, do just one thing to break your loneliness bubble, whether it’s asking the grocery checker how they are doing or scheduling a video chat with a friend. One thing tomorrow, one thing the next day. Like wearing a mask or washing your hands, taking steps to combat social isolation is an important way to take care of your health.

Managing Health Issues During Social Isolation

With all the emphasis on avoiding COVID-19, you may find you’ve not only been isolating socially, but also from medical providers that you would see if the pandemic wasn’t happening.

The Harris Poll showed that a majority of Americans cited disruptions in obtaining regular and preventative healthcare services: 55 percent said they were scared to get healthcare during the pandemic. This was felt most acutely by people who had an income reduction during the pandemic (64% vs. 46%). Nearly half (45%) of all those surveyed have failed to get preventive healthcare (e.g., wellness visits, standard vaccinations, screenings, etc.).

At a time when healthcare is needed the most, a majority of people are scared to seek it out. This not only leaves people without critical immediate care, it also halts necessary preventative care that is vital to chronic disease prevention and management. This change in healthcare access will likely have dangerous repercussions for the long-term health of our country.

Regular checkups with specialists, seeing mental health providers or reaching out to a primary care physician with a health concern may seem inappropriate or unimportant during this time. However, that’s not the case. Chronic conditions are the same risk factors that increase serious illness from COVID.

Physicians and nurses are still here for you. Many doctors are currently using telemedicine to care for their patients, from email to phone or video visits. If your physician feels it’s necessary, they will tell you to come into the office. Your general health is also important, so take advantage of this technology and stay connected to your health care providers.

Thriving in the New Normal

For some of us, age, disability, mobility issues or a chronic condition have made social isolation the norm. It might be your new reality if your area is under stay-home orders, or if we need those orders again to prevent the spread of COVID-19. You might also feel isolated if you lost your job or are working permanently from home (dealing with social isolation is a routine challenge for folks living their freelance dreams). Relative isolation, or staying home from time to time, may become more familiar.

If you are not isolated right now, or are looking forward to getting out, it’s worth considering those who live with social isolation and loneliness regularly. What can you learn from them about coping? How can you connect? Like home schooling or making your own mask, it takes some creativity, but you are likely to learn something useful and make valuable connections for the future.

Learn more about the recent Harris Poll here.


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