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  • Anita Dormer
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    Sitting in my New York City apartment listening to the untamed wind and rain on my window in the solitude of skyscrapers during the covid-19 pandemic, I see another silent pandemic slowly creeping through our locked doors and windows.This spirit is a subject of our greatest poets and has been an nearly unobserved risk factor to our health.

    Loneliness is a silent killer and we are now at a higher risk than ever before.

    First a little story.
    As a precocious child from rural North Carolina where the nearest restaurant was 45 minutes away, the concept of loneliness seemed to me a lot like how Emily Dickenson described it–” It might be Lonelier with out the Loneliness” and is something I intuitively understood.Emily always capitalized the world Lonely like one would the word God.That alone is quite a statement.

    From telling my mother at age 6 that I thought God might be Lonely to being the little girl with braids who one old man called Rabbit because I ran around visiting the old folks on their blue floored porches listening to their stories of visiting Haints(southern for ghosts), fighting in the wars, seeing the first car or some other adventure, Literature was my companion and poets like
    Wordsworth-I wandered lonely as a cloud…., Shakespeare, Keats, Whitman and of course the master of ceremonies herself, Emily Dickenson were my constant companions.
    Lines like “I fear me this—is Loneliness-the Maker of the soul” were as close friends to me as your best physical friend might have been to you.

    Later as a pulmonary critical care physician, I remember a specific- catch this memory and learn from it- moment.I gleefully entered into an elderly patients room but observed his reticence to be discharged home after a long hospitalization. There was a sense of fear that prevailed over his room.
    I asked him what was the matter. I remember
    He answered me with the clearest tear filled blue twinkling eyes and said,”
    I am afraid of being Lonely again.”

    This one sentence has had a profound effect on my practice of medicine.

    I reconized there was a connection between Loneliness and our health.
    From that day on, I always had such things as touch therapy, hair dressers and music as an essential part of my ICU.I always asked the family to bring in a photo of the patients to put on the wall so that family and the staff could see the person as a person, not as a sometimes unrecognizable overinflated pillsbury doughboy look alike on a ventilator— no longer a human being.This was a real problem.

    Yet only in the recent years has the medical and scientific community begun to study the impact of loneliness.
    But exactly what is it?

    First of all loneliness is NOT the state of being alone.
    Loneliness is the physical and mental state of feeling isolated and irrelevant.A person may feel invisible to humanity and of no matter to anyone. I would define it as the state of feeling unloved. The old folks on the porch would call it
    “I just no longer matter.”
    A person can feel the loneliest in a crowded room or can be alone all day with their favorite book and never feel lonely at all.. Human have varying levels of the need for quality social interactions and much of this scientists have found is built into our genes.Poets seem to tolerate better than most and actually seem to welcome it as a companion for their creativity.But for many their brains are not wired for Lonely.
    50 percent of how we feel loneliness is gene related much like inheriting diabetes etc
    In fact, the location in our brain that lonely seems to hide out is the dorsal raphe nucleus.
    What i find very intriguing is that
    25 percent of the cells there make dopamine but scientists dont know the function of the other 75 percent Loneliness truly remains a mystery.

    One researcher named Cacioppo has a theory called The Ecolutionary Theory of Loneliness. It may not have the exact impact of Einsteins Theory of relativity but then again, it just might.He demonstrated much like Maslow’s hierachy of needs, that love and social interaction are essential for human well being and survival.Just as we seek to satisfy our hunger or thirst, we try to remove the disconnection from others.From studies in isolated mice, he determined that isolated mice become temporily hypersocial upon re-entering a social network.

    I believe we will certainly see such a rebound in socializing once the social distancing and quarantines are lifted.

    This all seems so obvious, but I was never taught about loneliness in medical school and I doubt most were.

    As physicians, we should be aware of the effects of Loneliness and isolation.

    In fact, in 2018 Britain appointed a Loneliness Minister of health named by the very British name of Tracey Crouch._ a character name right out of Dickens-to help combat Britain’s chronic Loneliness problem. According to the British Red Cross, one fifth of the British suffer from Chronic Loneliness. Governments around the world are increasingly aware of the health and economic impact of the state of a lonely nation.

    WHAT WE KNOW: What are some of the the health risks of Loneliness?

    In the Care Study, $6.7 billion in annual federal spending is attributable to social isolation among older adults. That staggering number is set to increase as our populations continue be on average more elderly. People just stopped having children and this problem carries a huge public health and financial punch especially when anticipating who will pay for social programs. Europe has a dire economic and social problem because birth rates have been extraordinarily low for generations.

    1.Increased risk of cardiovasular disease
    29 percent increase in risk of coronary heart disease and a 32 percent rise in the risk of stroke
    But its not just a matter of the heart!

    2. Increased risk for premature death
    The Holt-Lunstad study involving 3.4 million people revealed that physical and emotional isolation can lead to a 30 % chance of increased risk of premature death.

    3.Increased risk for depression… which carries in own health risk

    4. Increased Inflammation leading to increased disease states

    5. Increased Stress, increased cortisol

    6.Increased risk of having more severe symptoms of VIRUSES!

    A 2007 study by Cacioppo and Cole found that lonely people’s immune system seems to increase the bodies ability to fight bacterial infections and lowers the ablity to combat viral infections
    Loneliness is having a direct impact on what we are seeing play out on the world stage.A retrospective study one day I believe will reveal a significant factor in the Covid-19 mortality will be the level of social isolation the person had preceeding the illness.

    People have a greater degree of Loneliness age 75 and older. Often the elderly
    have lost most of their friends and maybe even some children by this point in life For the first 3 months after the death of a spouse, the risk for the living widowed spouse dying can be as high as 60 percent.

    I remember visiting on those old southern porches and hearing the theme that there just was nobody left anymore.They were all alone with their stories sitting there waiting to tell someone who would be interested to hear.

    The deep losses of each family we as society will feel for a long time
    The unknowable losses of talent —of inventors and of artists is a great great sadness to me.

    But this is not new.
    100 years ago almost to the day when we starting hearing about Covid-19, another pandemic cost us an extraordinary man.
    His name was Sir William Osler, the father of modern medicine. He died of complications from the Spanish Flu pandemic.
    Now here was a man well acquainted with the impact of loneliness and psychology on health.We may never really realize our devastating loss to this pandemic just as the Spanish Flu took the life of the greatest physician of the modern age.
    One of his quotes that has stayed with me through my years of treating patients and will serve us all again to remember.

    “The good physician treats the disease; the great physician treats the patient who has the disease.”

    For us as a society and especially for us as physicians, I hope this information about Loneliness might impact the way we manage all our patients, our covid- patients, our communities as they recover from this stress and isolation, our families, our children who are subject to isolation issues today in this computer age like never before, and our own selves.
    Make a list of of how you might effect change in loneliness in the people around you and then act on it.

    Be loving, be kind and when you feel lonely perhaps reflect on what has filled your heart with pleasure
    as Wordsworth did when Lonely crept into his his mood he recalled a host of golden daffodils.

    This Spring of 2020 may you find some way to have your heart and those you meet dance with the memory of a host of golden daffodils.

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