The pandemic paradox: The crisis of loneliness

With the second wave forcing more people into isolation, we are now facing another public health crisis with deadly consequences: loneliness. 

During this pandemic, we have stayed physically apart to keep our tribe alive. But it is staying in the tribe that has kept us safe as we have evolved. We’re wired to focus not only on physical threats – like COVID-19 – but also the danger of social disconnection.

“Togetherness is the most defining feature of human beings,” says UCLA professor and researcher Steve Cole. “This is the reason we don’t get eaten by all kinds of things bigger, better and stronger than us. The thing to know about loneliness is it’s a surprisingly strong danger signal for the human brain and togetherness is a strong safety signal.”

Loneliness is not just an uncomfortable emotion; it has profound public health implications. Cole describes how loneliness triggers a fight or flight stress signal that not only impacts our mental health but also gets interpreted by every tissue in our bodies, sacrificing immune function and favouring inflammation and worsening our risk of heart disease, Alzheimer’s, cancer and many other diseases.

Researcher and Brigham Young University professor Julianne Holt-Lunstad found a 50 per cent increased likelihood of survival for people with stronger social ties in her 2010 review of 148 studies. Social isolation exceeded the health risks associated with obesity, inactivity, heavy drinking, air pollution and smoking 15 cigarettes a day.

Thus, we are fighting one public health crisis at the cost of another. 

Ashley Miller, a child and adolescent psychiatrist and clinical assistant professor at the University of British Columbia, remembers her reaction at the start of the second wave of the pandemic: “When I first read the reports that young adults in their 20s and 30s were driving up COVID transmission, I was furious. My best friend is an ER doctor, and I couldn’t look past the fact that their fun was putting him and everyone else at even greater risk. I thought of my kids and my patients and colleagues and our vulnerable populations, and I just wanted to scream,” she recalls.

But then Miller thought again.

“I started to think about what are the valid human needs and obstacles that might account for the behaviors, in people of all ages.”

The need to connect with each other has been a matter of survival in the same way that staying apart is one now. Susan Pinker, psychologist and author of The Village Effect, says, “We have two opposing forces. On the one hand, we’re being told by public health authorities, ‘Stay away from people, no physical contact … And on the other hand, we have the evidence from social neuroscience … that tells us that we need social contact with others in order to be healthy and happy. So how do we reconcile those two?” asks Pinker. “Essentially, what’s good for us in terms of living a connected life, which is how we evolved, is bad for us in terms of infection transmission. And there’s even more of a paradox there because really our social life helps to build up our immunity.

“Even before the pandemic started, 30 per cent of North Americans said they are deeply lonely. So, I’m sure that that figure is double now.”

Loneliness “feels like hunger or thirst or lack of sleep might feel because it’s a biological need,” Pinker adds, referring to a study published by Massachusetts Institute of Technology researcher Livia Tomova that shows how acute isolation causes a social craving similar to the way fasting causes hunger on brain imaging.

UCLA’s Cole, who has a background in neuroimmunology and genomics, began researching the health effects of loneliness 15 years ago with the late John Cacioppo, a social neuroscience professor at the University of Chicago. Their studies repeatedly showed that loneliness triggers a stress response that signals our body to “lighten up on the antiviral response, double down on the inflammation and get ready for a wounding injury,” Cole says. “You can fight the viruses another day.”

It’s a fabulous way to fight off danger, he says, if the stressor is short term. “But if what frightens you is … the constant low-grade drizzle of threats to our security that characterizes modern life, if that’s going on every day and not just on rare occasions, then you’re feeling lonely, disconnected, mistrusting and disenfranchised from the rest of humanity every day.

“All of that kind of chronic threat signaling is constantly undermining this kind of optimal antiviral stance and ramping up this inflammatory biology.”

It’s not just immune function and inflammation that shifts with social contact, Pinker adds. “When you take care of other people in your network, you’re also taking care of yourself because when we give to others, when we look after others, we get an oxytocin rush from that.” Oxytocin, known as the bonding hormone, is released when mothers breastfeed their babies to promote attachment. It also is released with any social bonding and many studies show it helps regulate stress (reducing blood pressure and cortisol levels), increase pain thresholds and reduce anxiety.

Indu Subramanian, a UCLA neurologist and director of the VA Southwest Parkinson’s Disease Research, was completing a study on the effects of social isolation on Parkinson’s symptoms when the pandemic hit. Her study indicated that people with Parkinson’s who reported being lonely had a 55 per cent risk of worsening symptoms. “As COVID started to unfold, we were freaked out because this is the worst thing for a Parkinson’s patient,” she says. So, Subramanian, who is an advocate for “social prescribing” – valuing social contacts as an essential medicine – started a virtual support group and is rolling out a Compassionate Contact program to link patients and volunteers with similar interests.

As well as the physical toll, social isolation has had a profound effect on mental health. Since the pandemic began, 50 per cent of Canadians have reported worsening mental health and more than 20 per cent of younger adults have reported increasing substance use. Opioid overdoses have increased by 40 per cent during the pandemic in Canada.

Geriatric psychiatrist and University of Toronto Assistant Professor Vanessa Thoo says the isolation has worsened what was already a huge challenge for many seniors.

“It’s important from both a mental health perspective and also a cognitive perspective because we know social interaction is one of the key things that can reduce the risk of dementia,” says Thoo, who adds that the pandemic may have shown a way forward. “The sort of creativity that I’ve seen in terms of people visiting with family, either at windows or curbside visits, and the ability to use virtual technology has created a greater ease of connection that I’m hoping is something that will continue once the pandemic is over.

“Before it would be, ‘Well, they just can’t come.’ But now there’s a real possibility that we can continue to engage with these people with virtual family dinners, or virtual graduation of communion or whatever the big milestones are.”

Miller says isolation is not sustainable in the long run for younger people as well. “We can’t expect young adults to hold their breath until this is all over.  We need to keep communication open with the young adults in our lives and openly discuss the challenges they face, from finding jobs to relationships to mental health and building a post-pandemic future. They may be physically robust but they are the group suffering the most emotionally.”

Miller says that being forced apart has actually helped some people realize the importance of being together.

“We can battle loneliness and COVID together,” says Miller. “Rather than denying the intrinsic human need for connection with a group, we can think of harm reduction approaches, such as encouraging safer outlets for social interaction (such as outdoor meetings).

“Let’s engage youth leaders in developing these ideas more fully – they are the answer.”