As the video connection falters, I find myself yearning again for my old rituals as a primary care physician — the slow and calming washing of my hands outside the exam door, knocking, entering while exchanging smiles, and sometimes even hugs, and then catching up on life and family — all before the medical portion of the visit.
The video remains dark and, discouraged, I simply call my patient by phone. On the other end of the line is the tired voice of an older woman — a woman whose daughter and granddaughter I also care for. When I ask how she is, her voice cracks. “Doctor, I am lonely.”
While there is good news about the development of COVID-19 vaccines, the nation is buckling under rising infection rates, hospitalizations, and deaths, and we are still in a public health state of emergency. Indeed, recent data from the Institute of Health Metrics and Evaluation at the University of Washington predicts that COVID-19 deaths in the United States could be as high as 331,000 by the end of 2020.
Whereas the first phase of the pandemic focused our attention on state shutdowns, economic collapse, inadequate numbers of ventilators in hospitals, and front-line workers scrambling to secure enough personal protective equipment, we will likely have additional concerns during this second peak. This time, our lives will not only be marked by the rising death toll and economic uncertainty, but will also be coupled with the pervasive mental health toll that the coronavirus pandemic has taken. While there have been multiple studies on rising rates of depression and anxiety, there is another deeply pervasive and less highlighted public health menace on the rise: loneliness.
While many of us know the sinking feeling of loneliness, it’s not the same as being alone. It’s defined as the subjective experience of a difference between actual and desired social contact. When Dr. Vivek Murthy was US surgeon general under the Obama administration, he focused on loneliness as one of the key public health concerns facing Americans. His work was motivated by compelling data showing that, though seldom discussed, prolonged loneliness places people at higher risk of premature death than obesity, lack of physical activity, or air pollution. And while it may be difficult to believe, loneliness is just as dangerous to your health as smoking 15 cigarettes a day.
While Americans suffered from increasing rates of loneliness over the last several decades, the necessary social distancing strategies of COVID-19 have accelerated its effect and left certain populations more susceptible, including older adults living alone, low-income individuals, young adults, and teens. Reports indicate that more than one-third of adolescents have experienced high levels of loneliness during the pandemic, and this rate is probably an underestimation, given the stigma around reporting loneliness, especially among teens. Many low-income individuals, in addition to reporting higher rates of depression and anxiety during this time, also report higher levels of loneliness than before the pandemic. Countless people have lost their jobs and, with that, a sense of connection to work colleagues and to the dignity of work. That compounds their shame, grief, and the stress of facing an uncertain future.
In pre-COVID time, cities and states initiated some promising public health measures to help combat loneliness — such as community centers, public forums of connection, and even conversation benches — but few of these initiatives have gained a foothold in today’s pandemic world. Unless we begin to directly address and combat the rising crisis of loneliness in today’s vulnerable populations, the deleterious public health impacts will go unchecked.
In his new book, “Together: The Healing Power of Connection in a Sometimes Lonely World,” Murthy discusses the three circles of connection that can help stem the tides of loneliness: an inner circle of close friends and confidantes, a middle circle of occasional companions, and an outer circle of colleagues and community. In each of these communities, humans crave the experience of being seen and valued, even if with strangers.
While the public health sector can and must make important inroads in decreasing barriers to human connection and mitigating loneliness — such as working with public utilities to address the digital “redlining” that occurs in Black and Latinx communities, where Internet service is inadequate and oftentimes nonexistent, providing dramatically more accessible, reliable, and free COVID-19 testing, and creating equitable distribution of the COVID-19 vaccine once it is safely tested and vetted — we as individuals and communities must also directly create solutions to address the loneliness crisis.
There are inspiring examples of individuals taking steps to keep these circles of connection strong during the pandemic. My neighbors pulled out an old speaker and played a different song every night for the first six months of the pandemic — a time where we would gather on our own porches to sing and wave hello, making us feel more connected. There are stories of Zoom weddings where blessings were shared by small “breakout” groups of friends.
But these moments are still few and far between. Many of us feel that we have lost our ability and appetite to socialize. How can we wake up every day and remind ourselves about the importance of connecting to one another, especially as traditional gatherings such as Thanksgiving are now off the table? It starts with us. Pick up a pen and write an old friend, reach out to someone in your community who you know may be lonely and, when you come into contact with another, even if they are a stranger, ask — really ask — how they are doing.
While as individuals we have suffered many losses, perhaps we can also take this opportunity to recognize the collective experience of loss and, in doing so, bridge the gap of our own loneliness. As the poet W.H. Auden wrote, “We must love one another or die.” Indeed, until we address the rising crisis of loneliness, its toll will continue to grow, adding to the senseless losses of COVID-19.
Dr. Katherine Gergen Barnett is the vice chair of Primary Care Innovation and Transformation and the program director in the Department of Family Medicine at Boston Medical Center.