Coronavirus disease 2019 (COVID-19) has caused incalculable loss and suffering for people across the globe, with more than 7 million people infected and over 400,000 deaths as of early June. Extraordinary measures have been taken worldwide to control the spread of the virus. In the United States, beginning in early March, governors shuttered schools and businesses where people congregate, such as restaurants, bars, and retail stores. Large companies ordered employees to work from home or furloughed those no longer needed. Public health officials advised everyone to stay at home except to get food or other needed supplies, thereby cutting people off from family, friends, and community activities.
Though necessary and effective, these measures have had significant social ramifications, including isolation; economic hardship; family relationship stress; disruption of education; erosion of mental health; surging domestic violence; and severe strain on already vulnerable populations, such as the elderly, at-risk children, the homeless, immigrants, and people struggling with alcohol and substance abuse. We report here on some of these ramifications-not to assert their importance over others but to provide a snapshot of the social fallout of the pandemic.
Economic hardship. The restrictions on businesses and stay-at-home orders have caused financial distress for millions of Americans. According to the Bureau of Labor Statistics, by the first week in June, 21 million people were out of work, and the unemployment rate had grown to 13.3% (compared to 3.5% in February), the highest rate recorded since the Great Depression. Some people have been out of work for months, and the surge in applications for unemployment benefits has overwhelmed many state government systems, leaving people without money for basic necessities such as rent, food, and transportation. According to a Kaiser Family Foundation (KFF) poll conducted in late April, 42% of adults reported that they or their partners have lost jobs or taken cuts in salary or hours, and 29% said they had fallen behind in paying bills or can't afford basic household expenses. In a Siena College Research Institute (SCRI) poll of residents of New York City, the first epicenter of the pandemic in the United States, 77% of respondents reported being concerned that the coronavirus will cause them serious financial problems.
Mental health. The COVID-19 pandemic has caused psychological distress in frontline health care workers, people infected with the virus, and the general population. Multiple studies conducted in China, where the earliest cases occurred, found increased anxiety and depression during and after the height of the pandemic. In the KFF poll, 56% of Americans reported at least one negative effect on mental health and well-being due to stress related to the pandemic, and in a study conducted by the Pew Research Center, a third of Americans reported high levels of psychological distress while social distancing. Those directly affected by the virus, such as first responders and medical personnel, are at greater risk for serious mental health sequelae. In the Pew study, 65% of frontline health care workers and their families had negative mental health effects related to COVID-19. In studies of health care workers during the outbreak in Wuhan, China, frontline workers consistently reported moderate to severe psychological distress and anxiety.
Isolation and the elderly. Social distancing is difficult for everyone, but older adults are at particular risk for significant negative consequences. Long before the pandemic necessitated social distancing, loneliness was recognized as a serious public health problem for the elderly, increasing the risk of anxiety and depression, cognitive impairment, cardiovascular disease, functional decline, and death. In a University of Chicago study of adults ages 70 and older, 33% of respondents reported having more feelings of loneliness since the pandemic began (see http://www.norc.org/PDFs/JAHF%20TSF/JAHF_TSF_NORC_topline_42720.pdf). For many older adults, social connections are made in community settings such as senior centers and churches, all of which closed when social distancing regulations were put in place. Those who already were suffering from isolation because of a lack of family or friends are at even greater risk because services they rely on, such as meal delivery programs, may be disrupted or unavailable, severing opportunities for interactions with others and jeopardizing access to necessities.
Homelessness. The more than 500,000 homeless people in the United States are another population under duress during the COVID-19 outbreak. A recent epidemiological study of COVID-19 among homeless people in Boston extrapolated a rate of 46.3 cases per 1,000 homeless people compared with 1.9 in the Massachusetts general adult population (see https://deepblue.lib.umich.edu/bitstream/handle/2027.42/154734/Baggett%20Deep%20). At one large shelter, 36% of the people tested positive-yet, alarmingly, given the close quarters in which they were living, very few of these infectious individuals exhibited symptoms. According to Josephine Ensign, director of the University of Washington's Homelessness Research Initiative, homeless people are at greater risk for dying from COVID-19 infection because many of them have serious underlying health problems, lack access to hygiene facilities, stay in overcrowded shelters that facilitate the spread of disease, and lack access to comprehensive and culturally appropriate health care. "The most difficult elements for individuals who are homeless are the shrinking and unpredictable nature of basic services like feeding programs, food pantries, and day shelters combined with the increasing social isolation, fear of contagion, and stigma that has come from this pandemic," Ensign told AJN. With the economic fallout of the virus, experts predict a dramatic increase in the number of homeless. It's unknown to what degree the job market will rebound, and protections in place now to prevent evictions won't last forever. This will leave many individuals and families with months of overdue rent to catch up on, placing them at risk for joining the ranks of the homeless.
Domestic violence. Stress brought on by the COVID-19 pandemic has led to a global surge in domestic violence. Calls to domestic violence hotlines increased by 30% in France, while in Australia there was a 75% increase in Google searches for help with domestic violence. In China, the number of domestic violence cases in Hubei Province tripled during the height of the pandemic there. And, in the United States, police departments report as much as a 35% increase in domestic violence incidents as well as an increase in the intensity of violence. A number of pandemic-related factors contribute to increased violence in the home, experts say, including job loss, financial uncertainty, and the stressful conditions of people living under home confinement, including children unable to go to school. The increased risk of violence coincides with fewer options for escape, since domestic violence shelters are reportedly overtaxed and family or friends who may previously have provided refuge now cannot because of social distancing requirements. It is also difficult-and potentially dangerous-to attempt escape or call for help while the abuser is at home, which is more likely to be the case during the pandemic.
Finding the positive. Despite myriad challenges, the COVID-19 pandemic has some positive aspects. Don Levy, the SCRI's director, said that in response to the SCRI poll, about 75% of New Yorkers said they are "enjoying the small things even more now [and appreciate] having the extra time with those that they are close to."
Krystyna de Jacq, director of the Psychiatric Mental Health Nurse Practitioner Program at Pace University, told AJN that it is OK to find positives despite the suffering wrought by the virus. "We need to separate those two things," she said. "My appreciation of something good in this doesn't cause someone else to suffer or die." The upheaval of this pandemic offers opportunity as well. Public discussion is already underway about how, once work, school, and community life resume, societal changes can be made to strengthen social support systems and address existing social and economic inequities.-Karen Roush, PhD, RN, FNP-BC, news director
Resources
Center on Addiction, the Buzz Blog: http://www.centeronaddiction.org/the-buzz-blog
Centers for Disease Control and Prevention, Coronavirus (COVID-19): http://www.cdc.gov/coronavirus/2019-ncov/index.html
Child Welfare Information Gateway, COVID-19 State Child Welfare and Related Health Resources: http://www.childwelfare.gov/organizations/?CWIGFunctionsaction=rols:main.dspList
Coalition for the Homeless, COVID-19 Update: http://www.coalitionforthehomeless.org/covid-19
Mental Health America, Mental Health and COVID-19-Information and Resources: https://mhanational.org/covid19
National Alliance on Mental Illness, COVID-19 Resource and Information Guide: http://www.nami.org/Support-Education/NAMI-HelpLine/COVID-19-Information-and-Res
National Domestic Violence Hotline: http://www.thehotline.org/help
National Resource Center on Domestic Violence: http://www.nrcdv.org
Substance Abuse and Mental Health Services Administration, National Helpline: http://www.samhsa.gov/find-help/national-helpline
World Health Organization, Coronavirus Disease (COVID-19) Pandemic: http://www.who.int/emergencies/diseases/novel-coronavirus-2019