As the coronavirus spreads exponentially across the United States, widespread social distancing is thought to be our best weapon against rampant transmission. Minimizing human contact can slow the rate of spread — flattening the curve — and avoid a surge of sick patients that would strain our health care system to a point where it cannot effectively care for them. State and local governments have imposed increasingly severe restrictions on the movement of Americans, and have ordered roughly 1 in 5 Americans to stay home.
The conundrum is that these mandates — prudent and necessary as they are — are overlaid against the backdrop of an epidemic of loneliness in the U.S. Avoiding events, parties, cafes, and even family gatherings is likely to increase social isolation among millions of Americans who already describe themselves as lonely. If the ultimate goal is holistic public wellness, we cannot ignore the unintended consequences of social distancing on other metrics of health.
In some ways, social distancing began well before the current coronavirus outbreak. From 1985 to 2009, the average size of an American’s social network, defined by number of confidants, declined by more than one-third. In a recent survey of 10,000 people, about 63% of men and 58% of women qualify as lonely. Considering the tight link between social isolation and depression, it is no surprise that young people today are more depressed than their parents or grandparents.
The dangers of diminishing human contact don’t end with mental health. As a physician, I’m struck by an emerging body of evidence that links social isolation to poor physical health. People who are socially isolated are more likely to be obese, have high blood pressure, and experience musculoskeletal problems. They’re more susceptible to viral respiratory infections (including, more than likely, Covid-19). They’re also at an increased risk of coronary heart disease and stroke. All told, social isolation increases the odds of dying prematurely — from any cause — by roughly 50%, on a par with smoking, and exceeding the risks of obesity or a sedentary lifestyle.
Much of our collective loneliness has been attributed to our growing reliance on technology. Social networking apps, online shopping, and on-demand streaming offer opportunities to streamline our lives that seem appealing at first blush but have inexorably reduced the amount of meaningful interaction we have with each other. The great paradox of our hyper-connected digital world is that we are actually driving ourselves further apart.
Before the emergence of Covid-19, conventional wisdom held that the cure for loneliness was intentional disconnection from our phones and devices in favor of good, old-fashioned face time. But now that human congregation is decidedly at odds with the interests of public health, let’s view this as an opportunity to test if we can use technology to help us feel less alone.
Video messaging is an obvious option that is within reach for most people, even for those with limited technical literacy. In a 2018 study of older adults, those who used video chat platforms such as Skype and FaceTime had almost half the estimated probability of depressive symptoms — a common byproduct of loneliness — as participants who used text-based communication. The researchers attributed the lower depression rates to the enhanced social and emotional connectedness that video messaging provides.
If video messaging isn’t feasible, even vocal communication is preferable to text or email. A study of preteen girls found that after experiencing a stressful event, girls who heard their mothers’ voices experienced a surge in the bonding-hormone oxytocin and a drop in cortisol, a stress hormone. These effects were not observed in girls who were allowed to interact with their mothers only through instant messaging.
Social media, though previously linked to a higher rate of loneliness and associated depressive symptoms among its users, may prove effective in combatting loneliness if used wisely. Recent research suggests that how people interact with social media is more important than how much they do. Instead of scrolling through feeds and offering likes, users who share personal thoughts through direct messaging or comments may foster goodwill and kinship in both themselves and their recipients.
A new wave of social platforms aim to enhance the quality of our digital interactions by actively eschewing the traditional volume-based constructs of “likes” and “follows.” Ikaria and Cocoon, for instance, are social networks built to include only the special people in our lives and are designed to enhance the quality of these existing relationships. Beyond social media, virtual assistant services like Monaru prompt users to take steps toward deepening connections with loved ones. Even artificial intelligence chatbots and robotic pets have been developed to reduce loneliness, particularly in older individuals, and research on their effectiveness has been promising.
Companies that offer technological solutions such as these could leverage the public’s increased demand for their services to test their effectiveness. This could come in the form of measuring loneliness with one of several validated scales before and after a period of use. It could also be done by studying how users interact with the platforms to identify the highest-yield strategies for mitigating loneliness.
Researches in public health, psychology, and sociology could offer expertise in collaboration. To expand the availability of digital loneliness solutions, companies might even consider offering some services for free, as other platforms such as fitness websites and streaming services have done. Even more important, they could consider providing additional technological support to older users, who are at highest risk for loneliness but tend to be less digitally inclined.
At this point in the trajectory of the Covid-19 pandemic, social distancing appears to be our reality for the foreseeable future. Let’s use this time to optimize technology to enhance our collective social health.
Nicole Van Groningen, M.D., is an internal medicine physician at Cedars-Sinai Medical Center in Los Angeles.