SINGAPORE — She felt isolated, helpless and “like a prisoner” trapped in her own home. Just days into her home quarantine, private tutor Serene Ho felt an immense sense of loss and was stressed and worried.

The 45-year-old was given a quarantine order on Feb 12 after a church staff member, whom she had met about a week before, was confirmed to have Covid-19.

She goes for worship services at the Grace Assembly of God church, the largest Covid-19 cluster here so far with 23 people having been infected by the coronavirus that causes severe acute respiratory symptoms such as pneumonia.

Ms Ho, who lives alone, said: “The first three days were bad because all I could think about was my loss of freedom and privacy. I kept counting down to my day of ‘release’.

“I can now understand a tiny bit of why the loss of freedom and contact with familiar people is tormenting for prisoners. It was hard for me to reconcile the fact that I was kept away when I was not sick.”

Ms Ho is among the 2,749 people who have completed their quarantine orders in Singapore, as of Feb 28 noon. About 190 people are still under quarantine.

​Once an infected patient is identified, the Ministry of Health (MOH) will closely monitor all close contacts of the patient and as a precautionary measure, the contacts will be quarantined for 14 days from their last exposure to the patient.

Quarantine orders have legal force, with severe penalties for non-compliance. First-time offenders may be fined up to S$10,000, jailed up to six months, or both.

STRESS OF DEALING WITH UNCERTAINTY

Most of Ms Ho’s stress during her quarantine period stemmed from the day-to-day uncertainties. Besides taking her temperature three times a day, she also had to anticipate video calls from MOH officers who would ask her to show them her surroundings via her mobile phone to ascertain that she is at home.

“I have a habit of putting my phone on silent mode but because I had to be alert to calls from MOH, I had to put it on sound mode. I did not know when they would call. When I missed a call, I was asked why I wasn’t at my phone. That added stress to the many uncertainties each day,” she said.

The first time she got the order, an officer from MOH went down to her home to serve her the letter for the quarantine order and checked her temperature. She was also given a thermometer to monitor herself during the period.

Adding on to the anxiety of not knowing if she would come down with a fever the next day, Ms Ho also worried about the people who had been in contact with her.

When she received the phone call about her quarantine order, she was tutoring a student, who is in lower primary school.

“I felt the great burden of possibly causing this child and her family to be quarantined. What about my friends whom I had met?” she wondered. In the end, none of them were quarantined.

“Of course, I understand the rationale for these inconveniences,” Ms Ho said, “but it was mentally stressful.”

She also felt helpless and useless because she was no longer free to go out to get groceries or buy her own meals.

Her friends helped her to get food and daily necessities and later, church members arranged for volunteers to sponsor and deliver two meals to her daily.

After a while, Ms Ho decided that she needed a focus and was motivated to be strong and healthy for the sake of her student and the family, as well as friends she met before the quarantine. If she did not fall sick, they would not need to be in her shoes.

On the last day of her quarantine, she could go out after noon. Officers from MOH went to her home to give her the application form for an allowance scheme.

The Quarantine Order Allowance Scheme was set up to mitigate financial impact for those who have been served quarantine orders under the Infectious Diseases Act. Claims of S$100 a day can be made by people who are self-employed and by employers for their employees.

After her quarantine, Ms Ho said that she was truly happy to go out and get some sunshine and fresh air. She also resumed her tuition lessons and is thankful that the girl’s parents were understanding about her situation.

QUARANTINE BLUES

An individual who has, or is suspected to have, an infectious disease is quarantined or isolated to limit the spread of communicable disease in the community.

It is ordered for the greater public good, but what is the psychological impact of being isolated, even if it is within one’s own home?

Clinical psychologist Vyda S Chai of Think Psychological Services said: “Being confined can have negative psychological effects on an individual’s well-being, including significant increase in anxiety, panic attacks, increased levels of paranoia and being less able to think clearly.

“It will not be uncommon for individuals to feel frustrated, irritable or stressed when being made to undergo quarantine.”

After being held in isolation, some may also report long-term mental health and psychosomatic symptoms that may originate from or is made worse by emotional stress, such as respiratory ailments, gastrointestinal disturbances, migraine and tension headaches, and other bodily aches and pain.

Associate Professor Tan Ern Ser from the National University of Singapore (NUS), a sociologist, said that there are different degrees of isolation.

Certain quarantine situations and spaces may be more psychologically distressing than others.

While some people under quarantine may miss their familiar lifestyle, feel bored, are distressed or unused to the experience of lack of freedom, a short-term quarantine will generally not adversely affect someone for the long term.

Assoc Prof Tan said: “Assuming there are no (underlying) psychological disorders, I wouldn’t consider a 14-day isolation to be severe, especially if the person still has access to a digital device and Wi-Fi and can keep track of the day and time.”

However, being in a small space would likely be especially dreadful for people who suffer from claustrophobia, he added.

Ms Chai said that while serving home quarantine orders or stay-home notices may be stifling and stressful, at least individuals are in the comfort of a familiar environment with a definite quarantine duration.

Commenting on those who are quarantined away from home, such as the hundreds of people on board the Diamond Princess cruise ship who were infected and held in quarantine off the port of Yokohama in Japan earlier this month, Ms Chai said it is possible that the trauma of being out at sea indefinitely might stay with them for some time — depending on each individual and how distressed they had been while being kept onboard.

Being confined on a ship or vessel can also induce cleithrophobia, the fear of being trapped.

“Individuals may experience panic attacks when they feel trapped.

“(People quarantined that way) crying, physically lashing out, freezing up and attempting to run away are very common. And if they are unable to leave the situation, they might also begin perspiring profusely, feel their pulse rate rising and develop symptoms of physical illness,” she said.

WAYS TO STAY SANE WHILE IN QUARANTINE

While uncertainty can cause distress, providing clear, transparent and accessible information remains the key in managing stress during a disease outbreak. Ms Chai observed that this is what the Singapore Government has done so far.

Associate Prof Tan of NUS suggested using the time spent in home quarantine to accomplish certain goals, such as picking up a new skill, writing short stories or finishing books that you mean to read but have set aside during busier moments.

“Setting goals allows one to feel that one is doing something meaningful or useful and not wasting their time,” he said.

Ms Chai offers more tips on maintaining good mental health while under home quarantine:

• Get information from reliable sources.

• Talk to other members of your family about the infection because understanding the illness will reduce anxiety.

• Reassure young children using age-appropriate language.

• Keep up with a normal daily routine as much as possible, for example, shower and take your meals at regular timings.

• Maintain a positive attitude.

• Think about how you have coped with difficult situations in the past and reassure yourself that you will be able to cope now, too. Remember, a quarantine will not last for long.

• Keep in touch with the rest of your family members and friends via phone, email or social media.

• Exercise indoors regularly — it is a proven treatment for stress and depression.

• Schedule time for relaxation — practise deep breathing, read or keep your mind stimulated by learning something new while surfing the Internet.

• If you are quarantined with other family members, take everyone’s needs into account when you plan activities. Make sure everyone gets the opportunity to spend some time alone.

• Plan “time out” from one another. You could split the family into teams that occupy different areas of the house — for example, dad with one child in the living room and mum with the other child in the bedroom. Swop the next day.

• Accept that conflicts and arguments may occur. Try to resolve them quickly or use distraction tactics for young children.

For Ms Ho, the quarantine turned out to be a period of spiritual and personal growth. She spent most of her time praying and watching sermons on YouTube, which helped her overcome her emotional distress and sense of isolation.

After getting over her initial sense of loss, Ms Ho also took a few practical measures, such as watching the news to keep track of the Covid-19 developments and keeping her home clean.

She is thankful for the practical, emotional and spiritual support rendered by her friends and church members.

“I think having a faith or having plans on how to spend our time meaningfully would stop the mind from being fixated on the day of release. Being adaptive to changes would also help,” she said.

She also urged people who are given quarantine orders not to blame anyone for their predicament.

“It can happen to anyone.”