COVID-19 pandemic and social distancing: economic, psychological, family, and technological effects

Abstract Introduction The concept of social isolation is currently understood as a measure of epidemiological containment that aims to reduce the speed of spread of the disease, enabling health services to prepare their resources to cope with the likely increase in demand, while also seeking to provide additional protection to groups considered to be at higher risk. Objective The present narrative review aims to compile and synthesize the literature related to social isolation produced during the COVID-19 pandemic in 2020. Method This study is a narrative review of the literature on social isolation in the context of the COVID-19 pandemic. Results 73 publications were included for full-text reading and were classified into the following categories: levels of social isolation, economic effects, family relationships, health system, mental health of the population, and use of technology. Conclusions It is necessary to plan an escalation of responses to the consequences of the pandemic, especially in view of the increased demand on the health sector and social services. The negative effects of social isolation can be prevented by public policies that offer a response to the economic recession, maintenance of social work, encouragement of quality care in mental health services, and community support for vulnerable families.


Introduction
The COVID-19 pandemic started in December 2019 in Wuhan (China), with the emergence of a specific coronavirus, known as SARS-CoV-2. Worldwide spread of the virus reached pandemic severity in March 2020, as declared by the World Health Organization. 1 The first confirmed case in Brazil was registered on February 26, 2020, in the state of São Paulo 2 and, since then, the number of cases and deaths due to COVID-19 has been increasing daily. Thus, in order to contain the overwhelming dissemination, certain technical safety precautions have been adopted to take a more stringent approach to public health protection. Such containment measures have been adopted in all countries involved 3,4 and include mandatory use of face masks, implementation of social distancing, cancellation of events (conferences, sports competitions), strict travel restrictions, closure schools/universities and most of the workplaces (except essential health services, press, food and primary assets). On the other hand, some countries were slow to carry out epidemic control measures, suffering the consequences of vacillation by central authorities. 5 Social isolation includes measures such as avoiding contact with family and friends, preference for home delivery of essential items, and reduction of social coexistence, which when it does take place, should observe a minimum distance of two meters between people. 6 Although social isolation is effective as a public health measure to contain viral spread, in psychological terms it can arouse fears, uncertainties, and despair. 7,8 Additionally, the impact on the economy and health Prompt dissemination of the findings should contribute knowledge on how to better care for people in general. 9 Against this background, this study aims to review the literature related to social isolation produced during the COVID-19 pandemic in 2020. It is expected that analysis of this scientific production and its synthesis in this article will provide a concise and well-founded source to be read by professionals involved in the care of people in isolation.

Method
This study is a narrative review of the literature on social isolation in the context of the COVID-19 pandemic.

Results
After a careful perusal of the abstracts identified, 73 publications were included for full-text reading and were classified into the following categories: levels of social isolation, economic effects, family relationships, health system, mental health of the population, and use of technology.

Socioeconomic aspects
In this category we integrate issues related to levels of social isolation, economic effects, and health systems.

Levels of social isolation
Non-pharmaceutical isolation policies, such as social distancing, have been proven to be the only possible response to stop the spread of the virus when it comes to a pandemic. 10,11 However, different strategies for centralized and decentralized social distancing exist.
Centralized strategies refer to governments granting tax relief and tax holidays; whereas a decentralized strategy is restricted to conscious isolation (neighbors of affected children isolate themselves from those infected) and selfisolation (individuals aware of their illness sever social ties in their ego network). 12  In Germany, where different isolation measures were adopted for vulnerable people, the mortality rate was lower. 10 Social isolation was not seen as a positive measure Nevertheless, in spite of the predominantly negative scenario, the long stay at home can reconfigure our consumption habits, making people more sustainable, frugal, and responsible in terms of use of resources and of finding ways of reusing them creatively. 5 The pandemic always affects the most vulnerable people the most violently: street people, slum dwellers, and others. These individuals are isolated in extremely unhealthy conditions, in which basic health care is practically impossible; in this regard, there was also increasing work informality in several countries. 3 Government actions can be decisive in coping with these issues 5 ; there must be joint efforts by the government, the private sector, and individuals to reduce the economic impact of the pandemic. Some possible measures are suspension of taxes and establishment of universal basic income for the most vulnerable populations. 18,19 The pandemic is causing a period of economic recession in many countries, causing a complex pattern of health crises with worsening mental health, and increasing the number of homicides and suicides; it is known that low income also increases psychosocial stress. 20 In this context, it is possible that substance use may increase among the population. 3 Additionally, there are concerns about scarcity of supplies, which have led to irrational hoarding behaviors, and concerns about the significant financial losses also cause damage to psychological well-being. 21

Health systems
Health systems in several countries are suffering due to the excess demand caused by the pandemic.

Interpersonal aspects
In this category we integrate issues related to family relationships, violence, and mental health.

Family relationships
Changes in family relationships and routines due to social isolation have an impact on mental health and psychological well-being. 24 27 Furthermore, social isolation from the pandemic may increase the risk of child abuse; this risk assessment is based on the increase in child abuse during school holidays, which also worsens during natural disasters, such as hurricanes. 28 According to ONU Mulheres (the Brazilian chapter of UN Women) 29  There is also fear for the future, which generates uncertainty and a lot of insecurity, also linked to the rise of fake news about the pandemic. 35,38 Uncertainty about contamination and death or about infecting family and friends can also cause dysphoric mental states. 41 Individual coping strategies include different activities that provoke pleasant mood and improve quality of life to overcome existential adversities, such as hobbies, physical exercise, reading, films, meditation, prayers, home maintenance, strengthening (or not) family bonds, studying, and listening to music, 5,47 in addition to interventions based on arts and life skills. 38 It has also been suggested that sources of information about the pandemic be limited, and a regular routine be maintained, mainly in terms of sleeping and eating, and that help should be requested when needed. 9,35 It is important to ensure that basic supplies (such as food, water, and medical supplies) are accessible, to reinforce a sense of altruism, 6 and to pay attention to one's own needs, feelings, and thoughts. 25

Use of technology
One of the measures employed to make isolation feasible is implementation of remote working, with online activities and revision of priorities (activities that do not require travel). There is an incentive to engage in intentional activities during this period to minimize the effect of isolation, for which use of technology is essential. 18 Additionally, increased use of technology to access online gaming platforms has also been observed, 48 and there have been increases in online gambling. 3 New health surveillance technologies have evolved with the pandemic, using machine-learning analysis for data collection, selection, and interpretation.
For example, digital contact tracking is performed by analyzing people's virtual accesses, identifying potentially infected people, tracking their contacts, and assessing social distancing. 49 Other examples include Google's and Facebook's initiatives for tracking infected people. 50 On the other hand, ethical issues are raised by health surveillance and it is considered a dilemma of safety versus privacy.
With regard to psychological care in the midst of a pandemic, a number of different modalities are offered.
There are psychological listening channels via phone call or online platforms. 9,51,52 In the Brazilian scenario, formal psychological care remains online 53,54 or, when proven necessary, in person. 51,55 There is also an offer of psychological help through structured letters. 56 However, it is necessary to consider that a portion of the population has limited access to the internet, which limits the possibility of offering them support at this time. Furthermore, even if there is access, it is possible that there may also be difficulties with using smartphones or computers, as with the elderly 25 and it is therefore recommended that psychological services be provided via telephone in these cases. 21,54

Discussion
The review conducted in this study identified several forms of impairment of people's mental health. Most people have symptoms of distress, in addition to the fact that patients with pre-existing mental disorders are at risk of their clinical condition worsening due to suspension or reduction of activities at health centers.
The psychological damage resulting from isolation stands out. It has been referred to as the "parallel pandemic" and will need specific coping strategies. 37 Modification of the form of care delivery to mental health patients is a consequence of the reality of social distance. 35  anxiety, and disorganization of routines, with changes in eating and sleeping. 17 In this context, psychoeducational interventions are revealed as important strategies, such as booklets and informative materials in general, 8,57 monitoring fake news, providing alternative support and service channels, and stimulating research to target prevention and mental health care policies. 25 Xiang et al. 58  This study has some limitations, inherent to its and community support for vulnerable families. Such measures, in the long run, will be decisive for the health for the population, especially its mental health.