COVID-19: How Isolation May Hurt Our Ability to Fight Coronavirus - Rolling Stone
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The Price of Isolation

America faces a hidden epidemic of loneliness that may make us more vulnerable to the pandemic

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Illustration by Ana Juan for Rolling Stone

On the same May day that the World Health Organization made the announcement that one of the many effects of the COVID-19 pandemic would be a worldwide crisis in mental health, I found my own mental stability challenged by a photo on Twitter. The picture heralded France’s return to school, and depicts a play yard covered with large, spaced-out, chalk-drawn squares in each of which is deposited one tiny French child. A girl sticks her toes out of her box. A cross-legged boy stares at the ground. In their pigtails and floral tops and Velcro sneakers, they are “playing” all alone, together.

It’s a vision that is imponderably sad, for all the obvious reasons. And it’s a distillation of what, essentially, we’ve all been through. Though there are innumerable aspects of what has happened during the coronavirus pandemic that our psychology can’t possibly compute — how to wrap one’s head around hundreds of thousands dead, around millions of jobs lost? — what we all have known and experienced in excruciating detail is the scope of our own solitary struggle, be it the 65th day of seeing other living souls only through the screen of a computer or the 82nd day of trying to balance a regular full-time job with being a teacher, line cook, referee, or maid. Or the third day venturing back out into a world where mortal danger could still be floating invisibly through the air. In some form or another, we’ve all been in our depressing little boxes, eyes fixed dolefully on the ground.

What we don’t know is how this will ultimately affect us. The last time a pandemic kept this much of the globe at home, carrier pigeons were in rotation, women couldn’t vote, and people still occasionally died from blisters. A study of the 2003 SARS epidemic — localized though it was — found that “quarantined persons … exhibited a high prevalence of psychological distress,” with PTSD observed in almost 30 percent of cases. The longer someone was isolated, the greater their chance of developing PTSD grew. Now, as the need to socially distance goes on for months (even possibly, in some form or another, years), we cast about for analogs to help us envision how we might cope. To what can we even compare this moment? The teched-up confines of space travel? A dystopian novel come to life? Recently, I came across a depiction of an otherworldly existence full of “physical danger, a hostile climate, dependence on external supplies, isolation, enforced small-group togetherness, restricted mobility and social contact, and the disruption of normal recreational and professional activities.” It was describing Antarctica. It may as well have been describing my Wednesday afternoon.

In the face of a global catastrophe, the impulse humans have to band together when bad things happen, our so-called disaster-convergence instinct, is now hemmed in by the number of people in our immediate household and the pixelated faces of a social circle however many far-flung miles away. The large-scale social media experiment of the past 15 years may have been priming us for just such a moment as this — when whole swathes of our lives would migrate online — but we also know that it’s an experiment that’s failed at replicating the type of social interactions we humans need to thrive. “We’ve seen in large epidemiologic studies that using social media isn’t necessarily correlated with better connection,” says public-health expert Brian Primack, the former founding director of the Center for Research on Media, Technology, and Health. “In fact, it’s often connected with feeling lonelier.”

Regardless, we certainly know that none of this feels right. “I feel like I’m stoned all the time, but without the fun parts,” a friend texted me the other day, summing up what is possibly the COVID-era human condition. I laughed out loud, but of course she couldn’t hear me. Right now, our screens are our own little boxes, keeping us together while keeping us apart.

Man is by nature a “social animal,” Aristotle wrote some 2,348 years ago, though modern science has shown that it’s probably the other way around: Being social is what made us human. Cooperation among our prehistoric ancestors helped solve, if somewhat imperfectly, the problem of how to fit a large brain through a small, bony pelvis; the young of the species could be born dramatically premature compared to other animals if more than one adult was around to care for them. That care required a give-and-take that favored the survival of those whose caregivers worked well together. Better social skills allowed for the development of bigger brains, and those bigger brains, in turn, allowed for the development of more social skills.

According to Matthew Lieberman, a founder of the field of social cognitive neuroscience and author of the book Social: Why Our Brains Are Wired to Connect, evolution could have favored any number of attributes when it came to brain development, but what it chose to favor was our ability to socialize with others. A 2015 study Lieberman co-published in The Journal of Cognitive Neuroscience showed that the brain basically has two modes: one used for engaging with the physical world (thinking about where to find food, for instance) and another for considering mental states, for seeing other people as psychological entities with thoughts and feelings of their own. Using MRI imaging, Lieberman’s team found that this second mode, the “social brain,” as he calls it, is actually the default. Every chance the brain has, even if only for seconds, it goes back to priming itself for the next social interaction. “Evolution has apparently decided that’s the most important thing that we can do with our brains’ spare time,” says Lieberman. “We are literally wired such that, when other distractions fall away, our brain automatically switches to a mode that’s more social in nature.”

How we use that mode, however, is highly variable. “Introverts and extroverts both have similar, total social needs,” says Lieberman. “But they manifest and are satisfied in very different ways.” In extroverts, the dopamine reward network — which is triggered by external stimuli and sensory input — is more active. Introverts get a bigger hit from the neurotransmitter acetylcholine, which warms up when we turn inward. This explains the fact that, while isolation can be measured objectively, loneliness is highly subjective, a function of whether or not one’s social expectations are being met. Some of us are better at modulating our expectations than others, and some of us have lower expectations to begin with. Some of us feed off of solitude — and then feel guilty that this time of suffering for so many has been a creative or emotional boon for us. Others have felt the need to text everyone they’ve ever dated, going for social breadth in a time when immersive depth isn’t accessible.

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Kids return to school in France during the COVID crisis. Loneliness has been linked to negative health outcomes.

Lionel Top

How well this can work out is a matter of conjecture. “Our biology has evolved over millennia to respond to social cues,” Primack says. “The new media that we use can try to emulate a lot of those things, but to what extent are they really capturing the essence of those social necessities?” In fact, it’s been found that texts and emails don’t move the needle when it comes to meeting social needs — though more intimate forms of communication like talking on the phone (and presumably Zooming) do. Social media is more complicated. A 2018 study of 18- to 30-year-olds found that the odds of depression were significantly lowered by face-to-face emotional support, but significantly heightened by reliance on social media. Another study found that decreasing time on social media reduced feelings of loneliness in 18- to 22-year-olds. Yet when technology use (including email, Skype, and Facebook) was studied in older adults, it was linked to lower rates of loneliness and better psychological outcomes. The key, according to Primack, may be how we’re using these tools, whether they’re simply a way of projecting a version of ourselves out into the ether or whether they’re fostering real social connections we otherwise wouldn’t be able to have.

Still, even under the best of circumstances, there are limits to what technology can achieve. As infants, human attachment is developed through the sense of touch, and that need likely doesn’t go away. Removing even one of the senses from the full sum of social interaction affects animals in ways that still aren’t entirely understood. “There have been this whole series of very elegant studies in a rodent population where they take away one sensory input and show how that totally dysregulates the rodent body,” says Naomi Eisenberger, a psychologist at UCLA who specializes in the neuroscience of social connection and who (speaking of social connection) happened to marry Lieberman after the two did a study showing that social rejection activates the pain regions of the brain (so much so that its effects can be mitigated by Tylenol). “The implication for this is that being able to smell somebody else may really regulate one of our physiological systems. Being able to touch somebody else may regulate another of our physiological systems in very specific ways.” Women born without the ability to smell, for instance, report having trouble trusting their partners; men have less interest in sex. In other words, being able to socialize using only some of our sensory inputs can leave us feeling dysregulated, can upset systems that we didn’t even know were thrumming along below the surface of our conscious.

In extreme cases — solitary confinement or being taken as a prisoner of war — the lack of social stimulation becomes so pronounced that the brain seems to invent stimuli for itself. Sleep and mood are dysregulated. Heart palpitations and hallucinations occur. But even in much less extreme cases — even when taken on voluntarily — isolation can have unexpected effects, as was famously illustrated by the outcome of the 1968 Sunday Times Golden Globe yacht race, in which nine men competed to be the first to do a solo, nonstop circumnavigation of the globe. Only one sailor, Robin Knox-Johnston, finished the mission, after 313 days alone at sea. But Johnston would likely have lost to an eccentric Frenchman named Bernard Moitessier had Moitessier not found the solitude so compelling that he abandoned the race altogether and just continued sailing, feeding cheese to seabirds and circling the globe more than one and a half times before landing in Tahiti. A fellow competitor named Donald Crowhurst, meanwhile, spent much of the trip concocting fake coordinates as he drifted around the Atlantic, plagued by loneliness and depression. After more than eight months, he capped a rambling 25,000-word philosophical treatise with “I have no need to prolong the game,” and presumably threw himself into the sea.

As individual as the experience of isolation may be, America as a nation entered this pandemic particularly ill-equipped to handle it. For years, we have been engaged in what former Surgeon General Vivek Murthy has called a “loneliness epidemic.” According to the most recent census, more than a quarter of Americans live alone (the highest percentage on record) and more than half are unmarried (with marriage rates at historic lows). People are having fewer children, volunteering less, and reporting lower levels of religious and other forms of affiliation. These markers may all seem too anachronistic to say much about our modern age, but Americans also feel more lonely: The percentage who say they are has doubled since the 1980s, from 20 percent to 40. In 1985, when a large-scale survey asked respondents how many people in their life they could discuss meaningful things with, the average was three. By 2004, that number had dropped to two. “But here’s the more devastating part of the survey,” says Jamil Zaki, director of the Stanford Social Neuroscience Laboratory and author of The War for Kindness: Building Empathy in a Fractured World. “In the Eighties, the average was three, but the most common response was also three. In the 2000s, the average was two, but the most common response was zero. So it’s not like people were really satisfied with their social connections before this pandemic hit.”

According to Steve Cole, the director of the UCLA Social Genomics Core Laboratory, this “loneliness epidemic” is actually a public-health issue. Around the time when scientists were mapping the human genome, Cole looked to genes to solve the mystery of why closeted gay men were dying from AIDS faster than others: He found a clear difference in gene expression, proving that the closeted guys were in a perpetual low-grade fight-or-flight mode, suppressing the body’s ability to fight viruses and pivoting instead to inflammation. “That is the body’s first line of defense against injuries, particularly wounding injuries,” Cole explains. “When we feel insecure, our physiology essentially gets us ready to be hurt, because through the bulk of our evolutionary history when we weren’t feeling safe, we were likely to get bitten or speared by something.”

Around the time he was making this discovery, Cole was approached by John Cacioppo, a social neuroscientist interested in the link he was seeing between loneliness and negative health outcomes. “In the back of my mind, I was like, ‘What is this loneliness garbage?’” scoffed Cole. “‘This isn’t going to add up to much.’” Cacioppo pulled frozen blood samples for a group of people he had been following for 10 years, and Cole looked at the genes of the ones they knew were most lonely and the ones they knew had a lot of social support. “When we ran the analyses, it just couldn’t have been clearer,” Cole tells me. “The lonely people were showing much higher levels of these gene transcripts that are involved in inflammation, and simultaneously lower expression with the genes that are involved in viral responses. I was like, ‘Wow, I’ve never seen such a clear biological signal in anything I’ve ever done.’ This was a biological explanation for what John had been seeing in the epidemiology — if you wanted the body to be making more heart attacks, cancers, and Alzheimer’s cases, this is exactly what you would do. And if you wanted the body to be crappy at fighting viral infections, this is also what you would do.” That left the pair with another question: “What the hell? Why would loneliness do this to a body?”

The years they spent trying to figure that out amounted to the first study ever to use the whole human genome to look at a social epidemiological risk factor in humans, and what it determined was that loneliness is a perfect way to make the body feel threatened, to tell it that no one is around to pass on a virus but also that no one is around to help fight off a predator, to tend a wound, to share resources. Loneliness, which has since been found to be a medical risk factor on par with smoking and obesity, may not feel like an active threat to us emotionally, Cole says, “but biologically, man, the memo is making its way down into our nervous system and our tissue and fertilizing chronic disease and undermining our antiviral defense. And at this particular time, neither of those seem like great results.”

What this means is that those of us experiencing the loneliness of social isolation may actually be less equipped to fight off the coronavirus. Even more alarming, it has also led some scientists like Sheldon Cohen to question whether it could impact the effectiveness of a potential vaccine. Cohen once did a study in which he gave college freshmen the flu vaccine and over the course of several weeks asked them questions about their social life. “With college freshmen, you tend to get a lot of lonely kids,” Cohen says. “So we had a good distribution of loneliness. Those who reported being lonely after we gave them the vaccination produced less antibody than those who were not.”

In fact, they didn’t even have to report being lonely: The effect was seen in those who had few social interactions, even if they seemed unfazed by their isolation; loners were not spared the biological results of their solitary lifestyle. “Both loneliness and social isolation — and interestingly, they almost weren’t correlated at all — were having a negative impact on the response to the vaccination,” Cohen tells me. It seems that the body knows it’s alone. And the body responds accordingly.

Sometimes, though, the body can be tricked. When Cole and his colleagues started looking for ways to combat the physical effects of loneliness, they didn’t find that positive emotions made a difference at all. But one thing did: “It was something called eudaimonic well-being, which is a sense of purpose and meaning, a sense of a commitment to some kind of self-transcendent goal greater than your own immediate self-gratification. People who have a lot of connection to some life purpose? Their biology looked great.” Even when researchers compared lonely people with purpose to social butterflies without it, purpose came out on top. In other words, it’s possible when we’re doing things to better our society, the body assumes there’s a society there to better. We’re technically alone, but it doesn’t feel that way.

Which has profound implications in the moment in which we currently find ourselves, a moment when the physical isolation and disconnection the virus has inflicted is now layered over the clear divisions and systemic inequities that have always plagued our country. In the midst of our solitude, we’ve been confronted with the terrible knowledge that people of color are dying of the virus at the highest rates and that 40 percent of families making less than $40,000 a year have lost their livelihoods. We’ve been confronted with the killings of Ahmaud Arbery, Breonna Taylor, and George Floyd. We’ve been confronted with the lie that the virus is a great equalizer. We’ve witnessed the many ways it isn’t.

There may be a societal benefit to being in the grip of what have been called “positive illusions” — to having an outsize view of our chance of success in life, an outsize belief in our control over our environment, an outsize faith in the competence of our government and the systems around us. For communities that can maintain those illusions, those outsize beliefs can become self-fulfilling prophesies, and it can be traumatic to let them go. Yet, there is also evidence that trauma makes societies kinder and more community-minded. “We didn’t enter this virus a healthy society. We entered it having a serious crisis of connection,” says Niobe Way, a developmental psychologist at NYU, who researches how society imposes isolation on itself. “Our culture is clashing with our nature. But we can change our culture. We do it all the time.”

If a great irony of the coronavirus is that its dangerous curves have forced us to reckon with how connected we are while also forcing us to keep apart, a great heartbreak of the disease is that it has underscored the many ways in which we were profoundly disconnected to begin with. When the masks come off and the chalk squares are washed away and we venture out from our metaphorical boxes, we will find that we’re changed, of that there is no question. The real question is: Will we have changed enough?

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