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In many ways Claudia (not her realname), a 33-year-old art dealer, feels pre-

pared for the covid-19 lockdown in London.As a recovering alcoholic who has had a“mental breakdown or two”, she has spenttime in rehab. Her movements there wererestricted. She had to follow a strict rou-tine, waking and eating her meals at thesame time each day. That routine is nowserving her well. Along with the rest of Brit-ain, she is in lockdown as the country bat-tles to slow the spread of covid-19. Its in-habitants are allowed out of their homesonly in the most limited circumstances.The government has told people to avoidmeeting anyone they do not live with, evenfamily members.

“On difficult days I tell myself to makethe bed, have a shower and eat,” says Clau-dia. Each morning she writes down thingsthat she is grateful for: she no longer livesin a “sober house” with 12 other women,but in a flat on her own; her sister’s newbaby, whom she has not yet met, is healthy.She also avoids social media. Even so, she is

anxious: “I worry that in a week or two I willfeel like screaming.”

Traumatic events, from natural disas-ters to war, can damage people’s mentalhealth. The covid-19 pandemic is no differ-ent. It has brought the fear of contagionand of loved ones falling sick. It has createdhuge uncertainty about every aspect of life.And with a fifth of the world under lock-down, protracted isolation is also bringingloneliness, anxiety and depression. Quar-antines and “social distancing”, policymeasures needed to slow the spread of thenovel coronavirus that causes covid-19, areagainst human nature. Touch and socialnetworks are essential for both people andnon-human primates: female baboonswho have more grooming partners, orfriends, exhibit lower levels of cortisol, astress hormone.

It has been less than a month since theItalian government imposed a nationalquarantine, but the strain on people’s men-tal health is starting to show. More than13,100 people there have died from co-vid-19; at least two nurses who were work-ing in intensive-care units where they weretreating patients suffering from the diseasehave killed themselves. The Italian nation-al nursing federation said that one of thenurses who committed suicide, DanielaTrezzi, had been off work ill and that MsTrezzi was deeply worried that she had in-fected patients (though the local health au-thority said she had not tested positive). InGermany, which imposed restrictions afterItaly, the finance minister of the state ofHesse, who was said to be deeply worriedabout the economic impact of the pandem-ic, killed himself on March 28th.

Awareness of the strain on people’smental health is growing. In Britain PublicHealth England, a government agency,along with the Duke and Duchess of Cam-bridge, released a set of guidelines on “themental health and well-being aspects ofcoronavirus” on March 29th. In the sameweek, 62% of Britons said that they werefinding it harder to be positive about thefuture compared with how they felt beforethe outbreak, according to Ipsos mori, apollster. “People are struggling with theemotions as much as they are strugglingwith the economics,” said Andrew Cuomo,governor of New York, America’s hardest-

Covid-19 and mental health

Only connect

How will humans, by nature social animals, fare when cut off from one another?

International

52 The self-improvement industry

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52 International The Economist April 4th 2020

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hit state, on March 21st. Four days later heset up a free hotline for those whose mentalhealth was suffering.

Some are particularly susceptible tostress during a pandemic. Health-careworkers are most exposed to the virus. Thesense of camaraderie and of being part of ateam that is helping people can buoy theirspirits. But many doctors and nurses arebeing forced to isolate themselves awayfrom their families because they may be in-fectious, which adds to their strains, points

out Dhruv Khullar, a doctor in New York. The lack of personal protective equip-

ment for medics in many countries willonly make that stress worse. NicholasChristakis, now at Yale, worked as a doctorin the 1990s during the hiv/aids epidemic.There was a “lot of fear among health work-ers that if you looked after an aids patientyou would contract the disease,” he recalls.But back then they had enough protectiveequipment. That made the risk of infec-tion, which comes with the job, more bear-

able. Covid-19 is much easier to catch. “Thecurrent situation is like sending a firemaninto a building naked,” he says.

Among the population at large, somemay be especially worried. Those who havelost their jobs, who now number in the mil-lions, may have lost not just their income,but also their identity, routine and much oftheir social network, says Jan-EmmanuelDe Neve, head of the Wellbeing ResearchCentre at Oxford University.

Single people who once whiled awaytheir days with friends, or those who liveseparately from their partners, suddenlyfind themselves spending most of theirtime alone. Many who exercise in teams orgroups—or simply enjoy spending timeoutside—have to make do with a crampedliving room and online classes. Mike, a 29-year-old Briton who works in finance inBrussels, is relieved that so far he is still al-lowed out for runs (though police movehim along if he sits down to catch hisbreath): “Otherwise I’d just feel like Robin-son Crusoe with Netflix.” Isolation will af-fect the mental health of even those whoappear to be in less danger from the virus:67% of Britons between the ages of 18 and34 said they were finding it hard to remainupbeat, compared with 54% of those be-tween the ages of 55 and 75.

If lockdowns stretch on for months, oldpeople will suffer particularly acutely.Even before they were confined to theirhomes, they were more likely to feel lonely.Elderly women in Europe are more thantwice as likely as men to live on their own.They rely on seeing family and friends tokeep up their morale, or simply for a rou-tine. Alfredo Rossi, an 80-year-old in Casal-pusterlengo, one of the first areas of Italy tobe put under lockdown in February, saysthat what upsets him most about the re-strictions is being unable to see his grand-children who live just 16km (ten miles)away in Piacenza across the River Po.

Domestic violence, already endemiceverywhere, rises sharply when people areplaced under the strains that come fromconfined living conditions and worriesabout their security, health and money,says Phumzile Mlambo-Ngcuka, the headof un Women, a un agency. Based on earlyestimates, she thinks that in some coun-tries under lockdown, domestic violencecould be up by about a third.

The scale of the lockdowns is unprece-dented. But research into previous trau-matic events and other types of isolationoffers some clues about the likely mental-health fallout. According to a rapid reviewof the psychological effects of quarantines,published on March 14th in the Lancet, a

“Up off your chairs and just startlifting those feet,” chirps a woman

sporting green leggings as she marchesenergetically. Diana Moran, a fitnessexpert known as the Green Goddess, wasa staple of 1980s British breakfast televi-sion. Now in her 80s, she is making acomeback. In a new morning slot she isencouraging older people, many ofwhom are in isolation to avoid infection,to stay active. As lockdowns force theworld to stay at home indefinitely, manyare turning to their screens to stay sane.

Meditation apps, digital fitness class-es and online cookery courses are boom-ing. Zoom, a videoconferencing servicenow worth around $40bn through whichmany such classes are broadcast, hasbecome one of the most important “so-cial wellness” companies, reckons BethMcGroarty of the Global Wellness In-stitute, a research group. Those stuckinside are desperate for company.

On YouTube average daily views ofvideos including “with me” in the title—convivial baking, studying and declutter-ing are all available—have increased by600% since March 15th compared withthe rest of the year. Last week dj d-Nice,an American disc jockey, drew over100,000 virtual partygoers to his “ClubQuarantine” on Instagram Live.

The stuck-at-home are also keen toimprove themselves (see chart). Down-loads of the top five recipe apps doubledin China during February’s lockdown. InBritain John Lewis, an upmarket depart-ment store, has reported a five-foldincrease in sales of its Marcato pastamachine compared with typical sales forthis time of year. Kettlebells and yogamats are selling like toilet paper. JoeWicks, a trainer who posts workoutvideos online, saw subscriptions to hischannel more than double after helaunched live physical-education les-sons for kids no longer able to burn off

their energy at school. During the firstweek of classes 15m viewers joined in.

The popularity of live group activitieschallenges the idea that you have to bephysically present to be together. Peoplewho work out in groups are more com-mitted and get more health benefits thanthose doing so alone. It is also showingjust how much can be “experienced”from the comfort of the couch, raisingthe bar for experiences such as concertsand classes in the post-covid world.

Even before the pandemic, fitnessfans wondered whether paid-for onlineplatforms such as Peloton, a home exer-cise-bike company, could replace gyms.That debate will pump up further if gymsgo bust because of the shutdowns.

It seems more likely that the strangebut temporary state of lockdown willboost sectors that were already growing.Mental-health apps were flourishingbefore covid-19. Downloads of the fivemost popular “mindfulness” apps grewby 85% in 2018. In the last week of MarchHeadspace, a meditation app, saw a19-fold jump in users completing a calm-ing exercise and a 14-fold surge in thosedoing a “reframing anxiety” session.

Net benefitsSelf-improvement

With millions stuck at home, the online wellness industry is booming

Alexa, I’m boredWorldwide Google-search traffic, peak=100By search term, 2020

Source: Google Trends

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Sex tips

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Make bread

Jigsaw

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The Economist April 4th 2020 International 53

2 British medical journal, some studies sug-gest that the impact of quarantines can beso severe as to result in a diagnosis of post-traumatic stress disorder (ptsd). The con-dition, which may include symptoms suchas hyper-vigilance, flashbacks and night-mares which can last for years, became aformal psychiatric diagnosis in 1980, whenveterans were still experiencing stressfrom the Vietnam war, which ended in 1975.

One study from 2009 looked at hospitalemployees in Beijing who in 2003 were ex-posed to severe acute respiratory syn-drome (sars), which, like covid-19, iscaused by a coronavirus. The authorsfound that, three years later, having beenquarantined was a predictor of post-trau-matic-stress symptoms. Another study,from 2013, used self-reported data to com-pare post-traumatic-stress symptoms inparents and children who had been quar-antined because they lived in areas affectedeither by sars or the h1n1outbreak in 2009,with those who had not. It found that themean post-traumatic-stress scores werefour times higher in children who had beenisolated. Among the parents who had beenquarantined, 28% reported symptoms seri-ous enough to warrant a diagnosis of atrauma-related mental-health disorder.For those who had not been in isolation,the figure was 6%.

The longer a quarantine goes on, thegreater the effect on people’s mentalhealth. Another study, which also looked atthe impact of sars, found that those whowere quarantined for more than ten dayswere significantly more likely to displaysymptoms of ptsd than those confined forfewer than ten days.

Cynthia Dearin, a consultant in Austra-lia who spent four years in Iraq between2006 and 2010 in various military campsthat restricted her movement, said thatwhenever she returned to Iraq after a “de-compression break”, she felt an “instant

Baghdad depression”. Living in a war zoneis very different from living through a pan-demic, but she sees parallels in the loss offreedom and the sense of danger. “We alsohad the choice to leave the lockdown,” shereflects. “What is different now is that no-body can escape.” In Iraq many of her con-temporaries turned to alcohol to numb theboredom and the fear. Increased sales of al-cohol suggest that many are doing thesame today. In Britain they were up by two-thirds in the week to March 21st comparedwith 2019, according to Nielsen, a market-research firm.

Those who have willingly isolatedthemselves in less traumatic circum-stances may provide examples of how toease the current crisis. In addition to theloneliness they experience, astronauts,who spend prolonged periods away fromtheir loved ones or indeed any other hu-man beings, suffer from disturbed sleep,heart palpitations, anxiety and moodswings. Cooped up together, they may alsofall out with their fellow crew members.

Couples who suddenly find themselvesin enforced proximity may sympathise.There are reports that some cities in China,such as Xi’an and Dazhou, have seen a spikein divorce proceedings since the lockdownwas lifted in parts of the country in earlyMarch. Writing in the New York Times, ScottKelly, a former astronaut who spent a yearon the International Space Station, sug-gested that keeping a routine and writing ajournal can help ease loneliness. He alsoencouraged people to get outside, if theycould. He found that after “being confinedto a small space for months, I actually start-ed to crave nature—the colour green, thesmell of fresh dirt, and the feel of warm sunon my face.”

Even under the tightest restrictions,people find ways to cope. “People are redis-covering that they live in roads full of peo-ple,” says Robin Dunbar, an anthropologist

and evolutionary psychologist at OxfordUniversity. Neighbours can be irritating,but in a crisis they can also be a comfort.

Groups have formed in many places tosupport local vulnerable people. Accordingto Julianne Holt-Lunstad, an expert inloneliness at Brigham Young University,studies have shown that those who feelthey have “supportive people” in their so-cial networks are less likely to react tostressful circumstances than those who donot. Simply knowing you have others onwhom you can rely can reduce spikes inblood pressure and heart rate, she says.

Live in fragments no longerAbigail, a 32-year-old charity worker inBrussels, says that her student neighboursused to get on her nerves because theyplayed loud music. But as she spends thelockdown alone, she has got to know them.She now welcomes their music: “Theybring the party.” In Belgium, Britain, Italyand the Netherlands people have started toclap and bang pans from their windowsand doors to thank medics and other es-sential workers.

Talking to friends and family over videocalls helps, too—though the clunkiness ofmuch of the software makes them an im-perfect substitute for an encounter in per-son. A pixelated version of spending timewith a friend merely slows down the “rateof decay” of that relationship, says Profes-sor Dunbar, but will never be able to replacethe experience of seeing someone in theflesh. “You have to see the eyeballs—thewhites of the eyes—and be able to physi-cally hold on to them,” he says, in order tomaintain a friendship and feel a socialbond. For Claudia that moment will comewhen her football team, which for her isboth exercise and a kind of group therapy,can meet up once more, rather than justchat virtually. “It is going to be beautiful,”she says. 7

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