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ORIGINAL ARTICLE
Year : 2020  |  Volume : 29  |  Issue : 2  |  Page : 310-316  Table of Contents     

The experiential impact of isolation and quarantine on patients during the initial phase of the COVID-19 pandemic in India


1 Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
2 Amity Institute of Behavioral Health and Allied Sciences, Amity University, Noida, Uttar Pradesh, India
3 Government Hospital, Panchkula, Haryana, India
4 Advanced Pediatric Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India

Date of Submission07-Sep-2020
Date of Acceptance10-Feb-2021
Date of Web Publication15-Mar-2021

Correspondence Address:
Dr. Shubh Mohan Singh
Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ipj.ipj_178_20

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   Abstract 


Background: Most countries around the world have been affected by the COVID-19 pandemic. Although there are quantitative studies on the effects of the COVID-19 pandemic on health-care professionals and other population groups, there are few studies that have evaluated the experiences of patients in the initial phases of the pandemic. Aim: This study aims to conduct a qualitative study assessing the experiences of the patients in isolation and quarantine in the initial stage of the COVID-19 pandemic. Methodology: The present study was a qualitative study through telephonic interviews with patients in isolation and quarantine due to COVID-19 from April 4 to 12, 2020. Patients in isolation had confirmed COVID-19 and were mandatorily admitted in specially designated COVID hospitals. Patients in quarantine were suspected to have COVID-19 due to symptoms or contact with confirmed patients with COVID-19. Results: The experiences could be classified as having psychological impact, interpersonal impact, social impact, behavioral changes and impact on occupational aspects. The experience was predominantly unpleasant and characterized by anxiety, stigma, ostracization, guilt, and worry about the future. Conclusion: The experiences of the individuals in both the groups emphasize the importance of addressing psychological stressors. It could be concluded that individuals and their families would accordingly benefit from effective interventions to deal with the negative experiences they have been through due to the present pandemic.

Keywords: COVID-19, isolation, psychological impact, quarantine


How to cite this article:
Kumar K, Jha S, Sharma MP, Sharma R, Singh SM. The experiential impact of isolation and quarantine on patients during the initial phase of the COVID-19 pandemic in India. Ind Psychiatry J 2020;29:310-6

How to cite this URL:
Kumar K, Jha S, Sharma MP, Sharma R, Singh SM. The experiential impact of isolation and quarantine on patients during the initial phase of the COVID-19 pandemic in India. Ind Psychiatry J [serial online] 2020 [cited 2021 Apr 21];29:310-6. Available from: https://www.industrialpsychiatry.org/text.asp?2020/29/2/310/311144



The COVID-19 pandemic has affected all the countries of the world. Different countries and regions of the world are experiencing different trajectories of morbidity and mortality. The experience of India with regards to COVID-19 was characterized initially by an extensive lockdown, low number of patients, extensive misinformation with regards to COVID-19, stigmatization of healthcare workers, panic and associated behavioral manifestations in the population.[1] Health-care providers (HCP) including doctors were also psychologically affected by the COVID-19 pandemic in India.[2]

While there are some quantitative studies with regards to the impact of the COVID-19 pandemic on HCP and other groups of populations, studies dealing with patients are missing. This pandemic like the ones in the past is unfolding in stages, each of which requires a different response.[3] The study of these experiences in each of those stages can be useful in handling the pandemic better.

Qualitative methods of describing experiences may have advantages over conventional quantitative scale-based approaches.[4] There are some qualitative studies that have dealt with the experiences of HCP and caregivers looking after patients with COVID-19.[5],[6] However, to the best of our knowledge, there are no studies that have assessed the experiences of the patients with COVID-19.

This population is of significance because it is likely that the first few patients who were confirmed to be suffering from COVID-19 or suspected to be infected underwent a unique experience. These patients were infected with a hitherto unknown disease about which much had been heard from the experience of other countries, the disease itself was associated with misinformation and there was fear and stigmatization as evidenced by many news reports of ostracization of family members of ill people, or how people refused to accept and cremate bodies of family members who had died because of COVID-19.[7]

We planned this study to study the qualitative experience of patients in isolation and quarantine due to COVID-19 in the initial phase of the pandemic in India.


   Methodology Top


The protocol of the study was reviewed and passed by the institute ethics committee. The present study was conducted as a qualitative study through telephonic interviews with patients in isolation and quarantine due to COVID-19 from April 4 to 12, 2020. Patients in isolation were those with confirmed infection and who were mandatorily admitted to especially designated COVID hospitals. Patients in quarantine were those with suspected COVID-19 due to symptoms or contact with confirmed patients with COVID-19. These patients were usually admitted in specially designated wards. The duration of stay was around 14 days as per the prevailing guidelines and required two negative tests over a period of 1 week for discharge from the ward. If the patient tested positive, he/she was shifted to the COVID ward.

Patients were approached through the treating doctors and asked if they may be interested in participation in the study during the time period mentioned above. Successive willing patients were approached telephonically and explained about the study. If they agreed to participate, written informed consent was obtained and a formal telephonic interview was conducted in the 1st week of admission and recorded with the patient's consent. The audio files that were later transcribed and analyzed.[8]

A detailed socio-demographic profile of each participant was taken. An initial broad data-generating question was used such as: “When did you first feel that you were suffering from symptoms which could be indicative of COVID-19 and what was your reaction to the same?;” “Who informed you and What was your first reaction when you were diagnosed with possible/COVID-19 and how much did it impact you?” Open-ended follow-up questions were also used to obtain detailed descriptions, and examples; “How does it feel to be separated from your family/or significant other,” “ do you miss anyone or worry about anyone;” “How does it feels to be isolated/quarantined,” “how are you feeling now,” “what challenges did you encounter,” “How have people at home and in the community treated you after been diagnosed or quarantined?,” Probing questions such as “Please tell me more about your experience,” “feel free to elaborate on each and every feeling you have or you are experiencing right now,” “a little more if you can explain your current situation” were used to enhance the depth of discussion and questioning.

The transcripts and implications were discussed and agreed upon by the authors. All the authors are proficient in English and the vernacular language in which the interviews were conducted.

We continued the patient recruitment until we reached a point of theme saturation.[5]


   Results Top


We recruited five patients each in the isolation group and quarantine group. The sociodemographic details of the participants are presented in [Table 1].
Table 1: Sociodemographic details of participants in the study

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In both groups, the experiences could be described under the following headings-psychological impact, interpersonal impact, social impact, behavioral changes, and impact on occupational aspects [Table 2].
Table 2: Psychological/interpersonal/social/behavioral/occupational impact of quarantine and isolation (with selected verbatim accounts)

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It was found that the experiences of participants in quarantine were marked with features of anxiety and worry. They experienced cognitive (expecting the worst outcome), behavioral (restlessness, pacing), physical (sleep disturbances, headaches, body aches/pains), and psychological (mood swings, feeling fearful) symptoms. Most of them reported feeling guilty for being potential “spreaders” of COVID-19. They also felt victimized at the hands of others who ostracized them and their families (e.g., people looked at me with hatred as if I was a corona carrier; neighbors moved out of our building leaving my family alone). They were unable to comprehend people's rejection. This exacerbated the guilt they felt toward their families as they were facing discriminatory behavior for no fault of theirs (e.g., neighbors avoided any and all forms of interaction). Fearing similar rejection from extended family and friends, most participants did not disclose their quarantine status with others, which led to feelings of loneliness. They felt helpless and hopeless about their situation and looked to blame someone (self/others) for their current predicament.

The experience of patients in isolation was marked by depression and anger. They reported experiencing fear of death and having to come to terms with real-life worries (e.g., “who will look after my family and children once I am gone”). Majority of them reported remorse at not being careful enough and putting themselves and their families through this tough time (e.g., “why did I not take more precautions”). Almost all participants victimized themselves, however it was observed that this was largely due to their negative perception of events around them (e.g., “I know the treating staff has to maintain distance however why are they not talking to me;” some insisted on meeting extended family/religious leaders in spite of being aware that it was not possible). They reported feeling angry towards society for discriminating against their families. This anger was even directed at the treating staff for not displaying any empathy/concern beyond their basic duties. Most participants reported feeling a sense of void since they had been unable to perform any of the roles that they identified themselves with (e.g., father, mother, nurse). Accordingly, they reportedly turned to faith/religion to help them through this uncertain time.

In addition, most of them were in different stages of grief-denial of being infected, anger at being infected, feeling helpless in the current situation. This feeling of helplessness coupled with low mood, decreased appetite, disturbance in sleep and feelings of hopelessness led to an increased awareness of mortality and fear of death. In addition, being in quarantine and isolation, the participants were deprived of opportunities to socialize with others. Furthermore, those in isolation underwent extreme emotional and behavioral reactions where the anger outbursts were more frequent and volatile, marked with features of panic attacks.

Participants in both groups reported turning to faith and religion to seek strength in these times. Participants also reported an increase in the usage of phone and internet as a means of communication with family and a distraction.


   Discussion Top


Common to both the groups was the unpleasant nature of the experience. The experiences in both groups were similar with regards to the themes but with significant differences in the content of those themes. These differences could be explained on the basis of socio-demographic and familial circumstances, the time (number of days following the communication of possibility of disease or diagnosis) at which the interview was carried out, and factors that were specific to the isolation or quarantine status.

The findings indicate that irrespective of the group that they were in, all individuals exhibited manifestations of stress across psychological, social, behavioral, occupational, and personal domains.

The experiences of the individuals in both the groups emphasize the importance of addressing psychological stressors. The individuals and their families would accordingly benefit from effective interventions to deal with the negative experiences they have been through due to the present pandemic. The findings stress the need for providing mandatory psychological services to individuals and their families undergoing quarantine or isolation. As expressed during the shared experiences, it was found that counseling or therapy should focus on enhancing coping skills, relaxation strategies, and problem-solving skills. In addition, counseling or therapy should focus on dealing effectively with death anxiety, for individuals in isolation. For instance, it may be useful to provide patients with knowledge about the fact that most patients are asymptomatic and recover uneventfully.

Another important aspect brought to attention deals with the training of HCP in managing their patients effectively (including themselves as many of the patients in the study population were HCP). Training of HCP should include the management of the psychological reactions in self and their patients.

The reactions of patients in this study were somewhat similar to those that have been described in the past.[9],[10] There is a need to address the issues of stigma and abuse surrounding patients and relatives with COVID-19.[11]

The limitations of the study include the cross-sectional nature of assessment and the small sample size.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Chakraborty K, Chatterjee M. Psychological impact of COVID-19 pandemic on general population in West Bengal: A cross-sectional study. Indian J Psychiatry 2020;62:266-72.  Back to cited text no. 1
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2.
Chatterjee SS, Bhattacharyya R, Bhattacharyya S, Gupta S, Das S, Banerjee BB. Attitude, practice, behavior, and mental health impact of COVID-19 on doctors. Indian J Psychiatry 2020;62:257.  Back to cited text no. 2
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WHO | Current WHO Phase of Pandemic Alert for Pandemic (H1N1) 2009. World Health Organization. Available from: http://www.who.int/csr/disease/swineflu/phase/en/. [Last accessed on 2020 Jun 12].  Back to cited text no. 3
    
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Al-Busaidi ZQ. Qualitative research and its uses in health care. Sultan Qaboos Univ Med J 2008;8:11-9.  Back to cited text no. 4
    
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Liu Q, Luo D, Haase JE, Guo Q, Wang XQ, Liu S, et al. The experiences of health-care providers during the COVID-19 crisis in China: A qualitative study. Lancet Glob Health 2020;8:e790-8.  Back to cited text no. 5
    
6.
Sun N, Wei L, Shi S, Jiao D, Song R, Ma L, et al. A qualitative study on the psychological experience of caregivers of COVID-19 patients. Am J Infect Control 2020;48:592-8.  Back to cited text no. 6
    
7.
When Families in Punjab Refused to Light Pyres of their COVID-19 Deceased: The Tribune India. Available from: https://www.tribuneindia.com/news/punjab/when-families-in-punjab-refused-to-light-pyres-of-their-covid-19-deceased-66921. [Last accessed on 2020 Jun 12].  Back to cited text no. 7
    
8.
Frommer J. Qualitative research in diagnostic processes. Psychopathology 1999;32:121-6.  Back to cited text no. 8
    
9.
Raven J, Wurie H, Witter S. Health workers' experiences of coping with the Ebola epidemic in Sierra Leone's health system: A qualitative study. BMC Health Serv Res 2018;18:251.  Back to cited text no. 9
    
10.
McMahon SA, Ho LS, Brown H, Miller L, Ansumana R, Kennedy CE. Healthcare providers on the frontlines: A qualitative investigation of the social and emotional impact of delivering health services during Sierra Leone's Ebola epidemic. Health Policy Plan 2016;31:1232-9.  Back to cited text no. 10
    
11.
Mental Health and Psychosocial Considerations during the COVID-19 Outbreak. Available from: https://www.who.int/publications-detail-redirect/WHO-2019-nCoV-MentalHealth-2020.1. [Last accessed on 2020 Jul15].  Back to cited text no. 11
    



 
 
    Tables

  [Table 1], [Table 2]



 

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