In recent days, family and friends have shared their own stories of the deeply challenging disconnection from loved ones. While mental health professionals certainly have a role to play in providing some level of relief to those affected, the most effective solutions have little to do with mental health clinicians. Instead, as I argued in a previous post, these solutions involve broad action that requires oversight of a high-ranking member of government. In this post, I focus on increased testing—or, as it might be called, “compassionate testing”—as a powerful tool to combat loneliness and other mental health challenges.
Consider the recent admission by President Rivlin, reported on Friday after the first day of Passover:
“’I have read the harsh reactions to the fact my daughter accompanied me during the holiday and I understand most of them,’ he said, adding that since his wife Nehama passed away last year, his children frequently assist with personal and professional matters when his office is not staffed over weekends and holidays.
‘I understand that if one is unfamiliar with the schedule as president, it is difficult to understand and I am sorry for that,’ he wrote.”
One justifiably can feel both compassion and outrage, both of which were part of my reaction. I feel compassion for an older man, recently widowed, who keeps close members of his family around enabling him to have the emotional strength to carry out his duties. It is not hard to understand his decision to do everything he can to have a comforting family member close to him when things are quiet.
But the article’s following sentence points to what many find outrageous and unfair:
“Rivlin’s office said that: ‘The president was accompanied and will be accompanied during the holiday by his daughter after she was tested for coronavirus and found to be negative.’”
Many people, myself included, are probably wondering how his daughter was able to get tested? Based on my experiences, this ability to be tested is not afforded to the average citizen. Take the following story as an example.
I personally know a 90-year-old man and his aide, both in quarantine due to exposure to a second caregiver who tested positive, who have been unable to get tested for over a week. Seder night would have been day 12 since exposure to the corona-positive aide, and neither have experienced symptoms. The corona-positive aide, who has been in complete isolation for close to 2 weeks, has been unable to get retested to allow him out of isolation, despite no symptoms for several days; in fact, his kuppah, which he is told is responsible for the retest, was unaware that his test results had come back positive three days after his positive test returned. Now, the 90-year old’s corona-negative aide has 24-hour duty, as no one else is allowed in, and they are unable to leave their apartment. The 90-year old spent the seder alone with this aide, who, despite not being Jewish, learned the mah nishtana to add the smallest sense of normalcy to the experience. Both the older man and the aide are exceedingly worried about whether symptoms of the virus will emerge, and are experiencing signs of depression due to their inability to go outside of the apartment. The isolated aide, for his part, has had no human contact in over 2 weeks, and everyone is concerned for his mental state.
I am certain this story is not unique. There are many more stories—both for those exposed, as well as for the general population struggling through these times—of people who are particularly vulnerable to the emotional distress of isolation: older adults, living alone, who are not allowed to have visitors; parents of a special needs child who could use someone to come to their home; single parents who can use cleaning or childcare assistance; children, whose families are known by the social welfare system, who are suffering by having no outside contact; people with preexisting mental health challenges for whom isolation is exacerbating their symptoms.
Of course, this issue is a public health concern. The more mental distress those quarantined feel, the more likely they are to violate the rules of quarantine and put other at risk. But the mental health concern should not be overlooked, and may be of even greater long-term consequence. Living in this agonized and uncertain state provides fertile ground for both acute episodes of mental disturbance, as well as long-term mental health challenges, as researchers found following the 2002 SARS outbreak in Asia.
What the public needs is a “compassionate testing” program to relieve the pressure for those who are especially vulnerable. Consider what might have happened if an effective Loneliness Czar, tasked with advocating for the mental health of those most affected, had been involved in this effort—if those suffering the most could have a close family member or friend with whom they can spend personal time? What would it have taken to give the 90-year old in my story—and thousands of others around the country in a similar situation–the Rivlin treatment?
- The government needs to provide funding to increase capacity at MADA and the kuppot to field and process testing requests and results. Based on anecdotal reports, the staff at MADA and the kuppot is stretched thin, and cases are slipping through the cracks.
- There needs to be increased funding to improve rapid testing capabilities. At the moment, those being tested can wait days to receive their results; such a delay can place extraordinary strain on the average person, and can be devastating for someone with other risk factors.
- The next step involves medical and mental health experts providing guidelines to these agencies to identify those most vulnerable to mental distress, and offer expedited rapid tests to allow for shorter duration of quarantine or isolation. These rapid tests would also be available for a small number of care-giving family members or personal aides who are identified as essential to the vulnerable individual.
- At the very least, if rapid tests are unavailable, these vulnerable individuals should be able to access standard testing for themselves and the selected essential family members or friends.
How would that have helped? For the 90-year-old with deteriorating spirits, imagine what spending seder with some family might have done; what going for a short walk outside his apartment might do; how calming of his anxiety it would be to know that he is negative; how relieving it would be to have the second aide to help him during nights, so his daytime aide can have a few hours off.
For the hundreds or thousands in similar situations around the country, they deserve to have their mental distress taken seriously by the government, who should provide serious proposals for how to reduce the burden of emotional pressure on the citizens. President Rivlin’s ability to do that for himself should serve as both the proof that this is necessary, and the model by which the government institutes a compassionate testing policy. The extraordinary steps we are taking as a country to protect the physical well-being of its most vulnerable citizens should also include steps to protect the mental health of those most negatively affected during this difficult time.