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THE IMPORTANCE OF SOCIAL SUPPORT DURING GLOBAL CATASTROPHES 1
The importance of social support during global catastrophes – community losses during the
COVID-19 pandemic
Marlena Ormsby
American College of Healthcare Sciences
CAP 501 – Dr. Janet Ludwig
December 11, 2022
THE IMPORTANCE OF SOCIAL SUPPORT DURING GLOBAL CATASTROPHES 2
Abstract
With consideration to the myriad ongoing effects of the COVID-19 pandemic, this literature
review explores loneliness, social isolation, and alienation and their associated effects on health
and quality of life. The purpose of this review was to develop an understanding of correlative
variables and effects of loneliness, social isolation, and alienation, including groups most at risk,
exacerbative effects both independent of and related to the COVID-19 pandemic, and to review
solutions demonstrating the importance of social and community support as integral aspects of
public health and healthcare. The research illustrates that loneliness, social isolation, and
alienation have substantial measureable physiological, psychological, and emotional health
effects. Risks associated with vulnerability to these experiences were significantly influenced by
sociological and economic factors. Experiences of social isolation and loneliness have been
significantly exacerbated by the effects of the COVID-19 pandemic, and this was additionally
impacted by insufficient social support and social disconnection during periods of quarantine and
isolation, all of which has had notable psychological and sociological effects on already
vulnerable groups. Feelings of alienation were influenced by various sociological factors
including ineffective communication regarding risks and appropriate preventative strategies
associated with SARS-CoV-2 transmission, as well as politically motivated misinformation that
contributed to social discord, blame, and stigma. The research demonstrated that vulnerability to
loneliness was associated with all of these variables, and demonstrated the greatest overall health
impact, though more research on this topic is needed. Solutions have been proposed to alleviate
the severity of these experiences, with consideration to the sociological and economic factors,
groups, and confounding variables most associated with vulnerability to loneliness, social
isolation, and alienation, as well as potential limitations to these solutions.
THE IMPORTANCE OF SOCIAL SUPPORT DURING GLOBAL CATASTROPHES 3
Introduction
As of the date of this writing, there have been a total recorded number of 649 million
reported infections and 6.65 million people have died of SARS-CoV-2 worldwide, with over
32.9 million of those infections and 113,174 of those deaths having occurred just in the last three
months (COVID-19 Dashboard: The Center for Systems Science and Engineering at Johns
Hopkins University, 2022). For the first few years of the pandemic, many people were socially
isolated due to public safety measures that had been put in place to reduce the spread of this
virus, but these measures varied from one place to the next, and lockdown did not mean the same
thing for everyone. The intertwined psychological, sociological, and economic effects of the
pandemic have reached everyone in unequal measures, and for many people, forced closures and
lockdowns came with insufficient social support, shining a spotlight on already substantial
systemic and economic inequities (DeLuca, Papageorge, & Kalish, 2022; Perry, Aronson, &
Pescosolido, 2021; Wickenden et al., 2021).
The COVID-19 pandemic has had, and continues to have, broad and profound effects on
people worldwide. Such a global catastrophe could be much better navigated with clear and
concise communication of risks by public health officials, which would help to nurture a sense of
compassion for those who may be most at risk, thus increasing the efficacy of strategies that
reduce spread of infection, mortality rates, stressed healthcare systems, and other fallout effects,
unfortunately, the opposite has too often been demonstrated (Escandón et al., 2021). There has
been a great deal of associated trauma and social division throughout the COVID-19 pandemic.
With the exacerbative effects of scapegoating, xenophobia, and racism, these factors all
contribute to experiences of stigma, alienation, loneliness, and social isolation and deepen the
fractures in social perceptions (Akour et al., 2021; Charron, Lapuente, & Rodríguez-Pose, 2022;
THE IMPORTANCE OF SOCIAL SUPPORT DURING GLOBAL CATASTROPHES 4
Dionne & Turkmen, 2020; Goode et al., 2020; Vandrevala et al., 2022). Additionally, the public
health information shared via social media, news media, and even through health authorities
themselves has frequently been contradictory, and there has been a great deal of misinformation
regarding risks associated with SARS-CoV-2 infection (Basch et al., 2022). Mixed messages to
the public suggesting a return to “normal,” despite ongoing infection and casualties, further add
to the confusion, division, and turmoil. Consequently, this can make it difficult, if not
impossible, for most people to accurately assess what "personal risk" means (Basch et al., 2022;
Charron, Lapuente, & Rodríguez-Pose, 2022; Escandón et al., 2021).
The ripple effects of such divided viewpoints and ambiguous public health messaging
have long-reaching and potentially devastating consequences that, over time, will affect
everyone in some way or another. Using human anatomy as an illustration, every cell, tissue,
organ, and system plays a role in homeostasis, and every action, function, and dysfunction
influences the health and status of equilibrium throughout the body, regardless of how easily
perceivable the effect. Ideally, a cooperative society similarly strives for equity and balance and
understands that protecting the most vulnerable benefits the most strong as well, and can thus
exist in a state of social homeostasis, which is much more sustainable than existing in chronic
states of dysfunction. This philosophy is well demonstrated in the case of the pandemic. Lower
rates of infection and mortality occurred where layered social safety measures were utilized (i.e.,
mask-wearing, standing 6 feet/1.8 meters apart, isolating when infected, and getting vaccinated)
as compared to communities where people were unwilling or unable to comply (Escandón et al.,
2021; Schmitz et al., 2022). The social division consequently increases complacency to feedback
minimizing the losses and ongoing effects of the SARS-CoV-2 virus and associated variants
(Dionne & Turkmen, 2020). Such factors negatively influence an individual’s ability to make an
THE IMPORTANCE OF SOCIAL SUPPORT DURING GLOBAL CATASTROPHES 5
informed risk assessment and impact compassion and concern for those still affected, in turn,
magnifying feelings of isolation and alienation among those who are high-risk and/or still
utilizing safety and precautionary measures for the protection of themselves and others (Dionne
& Turkmen, 2020; Shakespeare, Ndagire, & Seketi, 2021; Vandrevala et al., 2022). Among the
countless devastating effects of the pandemic, loneliness, isolation, and alienation have been
pervasive factors that need to be included in the discussion as they can have substantial effects
on psychophysiological health and may influence sociological behaviors in harmful ways
(Bueker & Horstmann, 2021; Emerson et al., 2021; Goode et al., 2020; Hwang et al., 2020;
Patulny & Bower, 2022; Preusting et al., 2021; Rui & Guo, 2022; Schmitz et al., 2022; Veazie et
al., 2019).
Sociological, psychological, emotional, and environmental health factors such as
loneliness, social isolation, and alienation are essential but disproportionately represented aspects
of healthcare and throughout the pandemic when these aspects were particularly important they
have also been among the most neglected. For clarity, social isolation is defined throughout this
review as an objective absence or infrequency of contact and interactions between a person and a
social network or sufficient social networks (e.g. many people may have limited access to choose
or modify their present or immediate social networks, thus simply having “a social network”
may be insufficient to prevent objective social isolation, particularly in cases of marginalization
and disability); loneliness is defined as a subjective feeling or state of being alone, separated, or
apart from others, conceptualized as an imbalance between desired social contacts and actual
social contacts; and alienation is defined throughout this paper as the state or experience of
being isolated from a group or an activity to which one should belong or in which one should be
involved, and may be relative to any impeding factor, whether it is objective, subjective, and/or
THE IMPORTANCE OF SOCIAL SUPPORT DURING GLOBAL CATASTROPHES 6
systemic (e.g. bigotry, lack of accessibility, and/or related to the pandemic) (Gardiner et al,
2018). While the three are analogous to one another, there are nevertheless important distinctions
to be made concerning the circumstances that create these experiences and how they may overlap
and compound one another. It is unfortunately too easy to dismiss such feelings and experiences
as a natural part of life as most, if not all, people will experience them at some point, and many
may experience them regularly or for significant portions of their lives. As humans are wont to
do, people adapt to their circumstances and do the best they can to mitigate such feelings;
however, the circumstances of the COVID-19 pandemic have made this a much more
complicated endeavor for many already at-risk groups (Maudrie et al., 2021; O’Keefe et al.,
2021; Power et al., 2020; Schmitz et al., 2022). Loneliness, social isolation, and alienation occur
on a spectrum and as part of an interplay of a wide range of contributory and mitigative factors,
all of which can have substantial effects on quality of life and long-term emotional,
psychological, and physiological health. It is, therefore, of utmost importance, particularly in this
time of global crises, to include social and peer support in the conversation about public health
and human quality of life. The purpose of this review is to develop an understanding of
correlative variables and effects of loneliness, social isolation, and alienation, including groups
most at risk, exacerbative effects both independent of and related to the COVID-19 pandemic,
and to review solutions demonstrating the importance of social and community support as
integral aspects of public health and healthcare.
Methods
The research was selected based on specific criteria and relevance to loneliness, social
isolation, and alienation both independently and in association with the COVID-19 pandemic;
potential solutions and mitigative or exacerbative factors, including public health adjustments,
THE IMPORTANCE OF SOCIAL SUPPORT DURING GLOBAL CATASTROPHES 7
masking and social distancing, remote and hybrid options for work, school, and social events,
telehealth services, online, phone, social media, and other forms of community, social, and peer
support including potential limitations and positive and negative effects; impacts of the pandemic
on various groups; studies on various states of lockdown and isolation; and any other data that
was deemed relevant or contributive to loneliness, social isolation, and alienation or feelings of
otherness; and how these factors may influence health.
A total of 234 resources were collected, simply and systematically reviewed, sorted,
categorized, and organized in bookmark folders, with 70 of the most relevant and high-quality
studies and/or systematic reviews downloaded in PDF format and reviewed in additional depth to
be included or eliminated as necessary. Only peer-reviewed systematic reviews and original
research from 2018-2022 were included in the final results, and relevant research articles were
retrieved via google search using relevant key terms from sites such as PubMed/NCBI, MDPI,
and ResearchGate. Additionally, all included articles have been reviewed for high ethical
standards, participant-informed consent, objective reporting, and high quality.
Results
Main Topic - Loneliness, social isolation, alienation, and COVID-19
The purpose of this review was to develop an understanding of correlative variables and
effects of loneliness, social isolation, and alienation that have become exacerbated by the
COVID-19 pandemic. Additionally, support systems were investigated to alleviate these
conditions through social and community engagement in global catastrophes and as integral
aspects of public health and healthcare. Studies have been selected to examine the measurability
of loneliness and social isolation and evaluate ways to attenuate this problem as a corollary of
THE IMPORTANCE OF SOCIAL SUPPORT DURING GLOBAL CATASTROPHES 8
COVID-19. The topics studied were, first, to determine quantifiable parameters of loneliness and
social isolation. Secondly, psychosocial and political factors were investigated as variables that
directly contribute to and exacerbate feelings of ostracism, social isolation, and alienation.
Thirdly, in order to discern vulnerable groups of people such as the aged, lower socioeconomic
groups, marginalized groups, and those without proximal family and who were single or
divorced/separated were the primary focus. Lastly, solutions and supporting factors were
evaluated to alleviate the magnitude and effects of social isolation.
Methods of measuring loneliness, social isolation, and alienation
To begin the review, it is important to establish that loneliness and social isolation, like
many stressors, may have measurable psychological and physiological effects, however, it is also
important to be aware that this comes with the caveat of a wide range of variables that influence
the degrees of and susceptibility to loneliness, isolation, and/or alienation that one experiences.
This measurability was first demonstrated in a psychometric analysis study in which Manera et
al. (2022) established that viable scales could be developed to measure loneliness and social
isolation with consideration to their significant impacts on physical and mental health. Their
study aimed to evaluate trends in social conditions via population-level monitoring, identify
highly vulnerable groups, monitor the impact of necessary pandemic policies, and estimate the
pervasiveness of these concerns for those at greatest risk (Manera et al., 2022). Analyzing 10
items in 2 waves of the Household, Income, and Labour Dynamics in Australia (HILDA)
Survey, they obtained data from 15,637 respondents in the first wave and 15,693 in the second
wave. They found similar attributes across both waves, with an average age of 46 years, 30%
with long-term health conditions, and 10% who spoke a language other than English (Manera et
al., 2022). Via calibration and cross-validation, their data demonstrated high reliability and
THE IMPORTANCE OF SOCIAL SUPPORT DURING GLOBAL CATASTROPHES 9
measurement consistency across waves, gender, and age, and accuracy was supported by
significant correlations between sub-scales and measurements of psychological distress and
mental health, with individuals who met the threshold criteria for loneliness and social isolation
consistently demonstrating greater odds of poor mental health and psychological distress than
those who did not meet the threshold criteria (Manera et al., 2022).
Patulny & Bower (2022) helped to substantiate and add dimension to the findings by
Manera et al. with an in-depth literature review and qualitative survey analysis investigating the
spectrum of variables influencing loneliness and examining whether changes in social interaction
during COVID-19 lockdown had disproportionate effects on particular groups. The results
indicated a need to consider residual effects, such as a long-term decline in social interaction and
the consequent increase in loneliness. Their qualitative survey study had a primary group of 2065
participants and a subgroup of 795 Australian adults recruited between July 7 and December 31,
2020, and correlated with the literature they reviewed, demonstrating that lockdown had direct
and ongoing isolating effects on particular groups more than others (Patulny & Bower, 2022).
Reviewing documented experiences of digital socialization both before and during the pandemic,
they found that increases in videoconferencing, social media, and online gaming related to
COVID-19 were helpful to some people in compensating for reduced in-person social interaction
and creating new connections. However, in the cases where people lacked social capital,
accessibility, or were dissatisfied with online interaction as compared to face-to-face interaction,
these experiences had an exacerbative effect on loneliness and feelings of isolation (Patulny &
Bower, 2022). Increased unemployment during the COVID-19 pandemic exacerbated degrees of
loneliness, and a significant difference was found between those who were employed and those
who were not. Other exacerbating factors included technical illiteracy (most frequently in aged
THE IMPORTANCE OF SOCIAL SUPPORT DURING GLOBAL CATASTROPHES 10
individuals); digital saturation (younger groups who spent a significant amount of time online
and those who worked or went to school online); divorce, separation, or single status, and those
not proximal to or lacking family. Regarding potential long-term concerns, people who were
disabled, had low income, or lacked strong social ties experienced significantly higher levels of
loneliness and social isolation both during and after lockdown (Patulny & Bower, 2022).
Due to the global nature of COVID-19 and how it has impacted social and economic life,
it was essential to look at variables from as many countries as possible when measuring
loneliness, social isolation, and alienation. As O’Sullivan et al. noted in their research, it is also
imperative to look at loneliness as a multidimensional experience composed of social, emotional,
and existential variables (2021). Utilizing a cross-sectional multinational survey available in 11
languages and which documented 23,609 participant responses from 101 countries, a
comparative assessment was made investigating pre- and present pandemic experiences of
loneliness, associated health and social impacts, and global risk factors independent of culture or
country (O’Sullivan et al., 2021). In this study, O’Sullivan et al. hypothesized that the incidence
of loneliness would be substantially higher during the pandemic, that socioeconomic factors
were likely to be more significantly associated with loneliness than with social isolation, and that
formal caregivers would be at increased risk of loneliness and social isolation compared to non-
caregivers (2021). They found that loneliness increased from 6% to 21%, with 21% of total
participants isolated based on their usual connections and 13% experiencing a notable increase in
social disconnection relative to COVID-19 quarantines (O’Sullivan et al., 2021). O'Sullivan et al.
found that groups with the highest risk of severe to moderate loneliness included those with
insufficient financial resources; poor physical and/or mental health; poor neighborhood rapport
or residence of that neighborhood <4 years; and/or involuntarily lived alone; and noted that the
THE IMPORTANCE OF SOCIAL SUPPORT DURING GLOBAL CATASTROPHES 11
most common exacerbating variables were unemployment/in education/training, increased
alcohol consumption, reduced physical activity, insomnia, and dissatisfaction with video calls
(2021). Dissatisfaction with video connection was particularly relevant during quarantine and
lockdown periods.
Just as Manera et al. (2022), Patulny & Bower (2022), and O'Sullivan et al. (2021) have
established the measurability of loneliness, social isolation, and associated cofactors, it is
additionally important to measure this complex human experience through indicators of social
connection and effects on well-being. Emerson et al. (2021) conducted a cross-sectional study
surveying a nationally representative sample of disabled and nondisabled adults aged 16-64 in
England to examine personal demographic characteristics and living circumstances to determine
which variables were associated with social connection exposure rates. They additionally
examined consistent associations between the prevalence of exposure to loneliness, low
perceived social support, and social isolation in conjunction with indicators of personal well-
being such as life satisfaction, enjoyment of life activities, happiness, and anxiety, as well as
whether or not disability had a significant effect on these relationships (Emerson et al., 2021).
Their samples were derived from three annual rounds of an English Community of Life survey
from 2016-2019, with an average of 5,000 participants each, as the U.K. government generally
uses this survey to identify and monitor community engagement, volunteering, and social
cohesion issues. Emerson et al (2021) found that people with disabilities experienced a
substantially higher prevalence of loneliness, low social support, and low social connection than
their non-disabled peers and were 51% more likely to be socially isolated, and this was most
prevalent in younger disabled adults who were unemployed, living in rented or other housing,
living alone, and had reduced access to environmental assets. However, the hindering effects of
THE IMPORTANCE OF SOCIAL SUPPORT DURING GLOBAL CATASTROPHES 12
loneliness were most significant for adults living as couples, in rented or 'other' housing, and
with reduced accessibility and neighborhood interaction. Across all groups, loneliness most
consistently demonstrated adverse effects on well-being, followed by low perceived social
support, with social isolation demonstrating the lowest impact on personal well-being
measurements for life satisfaction, enjoyment of life activities, happiness, and anxiety (Emerson
et al., 2021).
Among the measurements necessary to examine associative factors of social deprivation,
Zhu et al (2021) examined correlations between social isolation, alienation, and PTSD and any
associative influence with anxiety and depression. They hypothesized that social distancing was
likely to exacerbate alienation and that people with high levels of depression were likely to
experience exacerbated or perpetuated incidence of PTSD due to associations with loneliness,
feelings of worthlessness, apathy, and an increased likelihood of social withdrawal. In contrast,
individuals with high anxiety tended to disclose more, which may have the effect of releasing
psychological stress (Zhu et al., 2021). This philosophy was investigated using a cross-sectional
survey with stratified random sampling that included 6666 residents of Wanzhou District in
Chongqing city, with a stated ratio of 70.8% men and 29.2% women between 35-70 years of age;
the results of which demonstrated a significant association between alienation and symptoms of
PTSD. Zhu et al. found that alienation was directly associated with an objective absence of social
support that would have otherwise provided an alleviating effect, and proposed that this lack
could have a reductive effect on emotional/psychological resistance (2021). They also found that
higher levels of anxiety exacerbated the effect of alienation. Overall, the results of their statistical
analyses indicated that negative emotions and alienation are both predictors for PTSD symptoms
and that their direct and indirect effects are moderated by levels of anxiety (Zhu et al., 2021).
THE IMPORTANCE OF SOCIAL SUPPORT DURING GLOBAL CATASTROPHES 13
Anxiety, depression, and PTSD were significant factors that, under the necessary
restrictions of COVID-19 lockdown, demonstrated an exacerbative effect on feelings of
alienation, as illustrated by Zhu et al. (2021) in their study. Thus it was necessary to investigate
these variables further. Using an eight-country cross-sectional survey design, Schluter et al.
(2022) investigated for any associations between COVID-19-induced isolation and/or quarantine
and emotional/psychological outcomes of Generalized Anxiety Disorder (GAD) and Major
Depressive Episode (MDE). The study included 9027 adult participants, 32.5% of whom were
indicated with probable GAD and/or MDE. Quarantine and/or isolation was a common
experience, with 13.8% quarantined for travel or health requirements, 6.5% for close contact,
8.3% for COVID-19 symptoms, and 5.3% for COVID-19-positive infection. They found
significant related risks of GAD and/or MDE associated with those who were quarantined
compared to those who were not (Schluter et al., 2022). Over the course of 12 months after the
first SARS-CoV-2 case was determined, they found that 23.6% of participants were indicated for
probable GAD, 27.8% for probable MDE, 32.5% with GAD and MDE, and noted that these
numbers increased over time (Schluter et al., 2022).
The details of these connections can be better established by examining the psychosocial
and psychophysiological mechanisms that occur in conjunction with loneliness and isolation. In
a literature review, Yanguas et al. found that social support and capacity for personal control
notably influence physiological processes that affect the body's immunity, metabolism,
inflammatory capacity, and cardiovascular health (2018). Their review demonstrated that social
isolation and loneliness correlated with increased HPA (hypothalamic-pituitary-adrenal) axis
activity resulting in increased catecholamine blood levels, increased cortisol levels, and vascular
resistance with a consequent decrease in glucocorticoid receptor sensitivity. Yanguas et al. also
THE IMPORTANCE OF SOCIAL SUPPORT DURING GLOBAL CATASTROPHES 14
found that social isolation and loneliness were significant risk factors for morbidity and mortality
mediated by neuroendocrine stress mechanisms (2018). These factors are all of relevant concern
as chronic social isolation and associated HPA axis activation results in elevated sympathetic
nervous system (SNS) activity (i.e. increased sensation of a threat), causing elevated anxiety,
hostility, insomnia, fatigue, depression, and decreased impulse control (Yanguas et al., 2018).
Loneliness and concomitant chronic HPA axis dysregulation was also found to be associated
with alterations in cellular function and significant age-related deterioration in cognitive ability
with an associated elevated risk of dementia (Yanguas et al., 2018).
Ward et al. gave a closer examination to mortality and associations with social isolation
and loneliness, and through a literature review and questionnaire study, they found that mortality
risks associated with real and perceived social isolation were comparable to well-established risk
factors such as smoking (2021). They noted that necessary social distancing measures related to
the COVID-19 pandemic have exacerbated loneliness and social isolation among older adults,
and this has substantially increased concern among public health practitioners. The questionnaire
data were obtained from The Irish Longitudinal Study on Aging, a prospective study of
community-dwelling adults aged 50 and up in the Republic of Ireland. Participant households
were chosen using multi-stage stratified random sampling, with the first wave collected from
2009-2011 and follow-up waves collected in two-year intervals over a seven-year follow-up
period. Through this process, Ward et al. found consistent associations between deaths from
neoplasms and cardiovascular diseases and participants who demonstrated the highest scores for
both loneliness and social isolation compared to those who demonstrated lower loneliness, lower
isolation, or reduced scores in both categories (2021).
Pandemic Politics
THE IMPORTANCE OF SOCIAL SUPPORT DURING GLOBAL CATASTROPHES 15
There are other vulnerabilities and correlations to COVID-19-related psychological
issues to be considered as well, which brings the focus of this review to pandemic politics.
Intersections between oppressive forces such as racism, transphobia, ageism, and classism
influence the sociological and systemic impacts of the COVID-19 pandemic and need to be
investigated (Cooper & Jones, 2022; Dahl, 2022; Kia et al., 2022). It is essential to include these
aspects in the discussion on loneliness, social isolation, and especially in regard to alienation.
Psychosocial and political factors are powerful exacerbative contributors to alienation, and may
increase social isolation and ostracism of already vulnerable groups of people as well as
deepening social and community fractures.
As Goode, Stroup, and Gaufman outlined and as has been well illustrated throughout
history, during uncertain times people seek what they perceive to be 'normal' based on whatever
they have been socialized to accept as their parameters of normality (2020). Organized religion
and nationalism are good examples of the group mentality sociological phenomenon and are, for
many people, perceived as helpful in creating a sense of existential stability. However, the
creation of such perceptions often includes blame, stigma, and an in-group vs. out-group
dichotomy, which can easily be manipulated and perpetuated via social and news media
depending upon the source of information (Goode et al., 2020). Indicators of the present
circumstances, such as people wearing masks to protect each other and reduce viral spread, are
reminders of the current pandemic state and may be perceived by people questing for normality
as “other.” As Goode et al. outlined and as has been well illustrated throughout history, political
othering during times of crises often targets migrants and ethnic minority groups, and during the
COVID-19 pandemic there has been a significant rise in stigma, discrimination, and violent
xenophobia, especially toward Asian and Jewish people (2020). It should be noted however that
THE IMPORTANCE OF SOCIAL SUPPORT DURING GLOBAL CATASTROPHES 16
such targeting may include anyone not considered to be part of the “in-group,” or who is
perceived to be disruptive to these nationalist viewpoints (Dahl, 2022; Kia et al., 2022; Schmitz
et al., 2022; Wang, 2022). While the impacts of such nationalist ideologies may go unnoticed by
those in more privileged or unaffected situations during perceptively normal times, these effects
become much more pronounced during crises as people seek to regain their perceptions of
control over their lives and to engage in those social rituals used as identity features (Goode et
al., 2020). This study illustrated the wide-reaching consequences of political othering and
alienation using examples of various states and expressions of nationalism throughout time,
demonstrating that pandemic othering serves to exacerbate discord and has significant effects on
societal cohesion and on public health, such as has been demonstrated in anti-mask and anti-
lockdown protests (Goode et al., 2020).
The significance of these concerns was reinforced by Dionne & Turkmen in their
literature review examining global politics and how, in terms of racial inequality and stigma,
crises such as the COVID-19 pandemic further exacerbate the oppressive factors that directly
affect marginalized groups (2020). They compared politics of othering and blame between
historical pandemics, including the 1918 flu pandemic, smallpox outbreaks, the third bubonic
plague, SARS, Ebola, HIV/AIDS, and the present COVID-19 pandemic, and found consistencies
and recurring political themes structured on blame and othering across the pandemics (Dionne &
Turkmen, 2018). Among the concerning psychosocial effects in this study were the documented
cases of increasingly targeted violence based on infection status, religious identity, and/or
ethnicity, and public health effects that were the direct result of political figures shifting blame
and responsibility to at-risk and marginalized groups (Dionne & Turkmen, 2018). Such evasive
pandemic politics have contributed to policy inaction, disproportionate allocation of resources,
THE IMPORTANCE OF SOCIAL SUPPORT DURING GLOBAL CATASTROPHES 17
and demonstrably lead to a sense of exceptionalism or imperviousness in majority populations
who are led to feel safe by these divisive politics and avoid health protective behaviors as a
directly associated result (Dionne & Turkmen, 2020).
The resistance to pandemic policies, expressed as a constraint on “freedom” by
nationalist ideologues, as well as the associated stigma and political othering, has had a
significant impact on the experiences of marginalized groups due to increased risks associated
with outcomes of viral infection and psychological effects of oppression and alienation (Schmitz
et al., 2022). Lesbian, gay, bisexual, transgender, and queer (LGBTQ+) people are among those
marginalized groups who have been historically targeted and stigmatized during pandemics and
have experienced rising discrimination and structural violence throughout the COVID-19
pandemic, consequently increasing feelings of alienation, social isolation, and loneliness, and
exacerbating challenges in accessing necessary medical care (Dahl, 2022; Kia et al., 2022;
Schmitz et al., 2022).
Experiences of Vulnerable Populations
As the prior studies have demonstrated, the psychological and public health impacts of
misinformation, political division, stigma, and alienation throughout the pandemic have been
multidimensional in their consequences (Dahl, 2022; Dionne & Turkmen, 2020; Goode et al.,
2020; Kia et al., 2022; Schmitz et al., 2022). Furthermore, potential cause and effect variables
associated with vulnerability to social isolation, alienation, and loneliness have been measured
and outlined, with significant correlative consistencies demonstrated across countries, age
groups, and periods both before and after the start of the pandemic. As many of the key factors
influencing these vulnerabilities have been identified, it is important to shift the focus to more
THE IMPORTANCE OF SOCIAL SUPPORT DURING GLOBAL CATASTROPHES 18
directly consider the associated psychophysiological impacts and experiential perspectives of
vulnerable populations.
One significantly understudied group in the discussion on loneliness and social isolation
is children and youth, who, like aged populations, are among the most vulnerable and
marginalized people worldwide. Due to the systemic and social effects of ageism, there are many
parallels in the marginalization of youth and aged populations that need to be more deeply and
objectively investigated (D'cruz & Banerjee, 2020; de la Fuente-Núñez et al., 2021; Krekula et
al., 2018; Sánchez-Izquierdo et al., 2022; Wang, 2022). Unfortunately, this is another
sociological aspect on which views may be deeply divided and often influenced by bias.
Throughout this investigation, it was noted that substantial research had been conducted during
the pandemic with a focus on aged groups relative to their elevated risk of acute outcomes of
SARS-CoV-2 infection as well as high vulnerability to loneliness and social isolation. However,
research documenting such vulnerabilities in youth populations was found to be substantially less
frequent, and in studies that did consider the impacts on children and youth, the data was most
often documented from the perspectives of the parents or guardians (Imran et al., 2020;
Kyeremateng et al., 2022).
With consideration to this concern, Imran et al. investigated literature documenting the
psychological burden of quarantine on youth populations in relevant disaster-related events,
including COVID-19, Influenza A virus subtype H1N1 pandemic, Severe Acute Respiratory
Syndrome (SARS), Avian Influenza, disorders requiring mechanical ventilation, Ebola, cancer
survivors, Methicillin-resistant Staphylococcus aureus infection, World War II, and Tsunami
(2020). In the studies specific to COVID-19, significant emotional and behavioral changes were
noted. Younger children were prone to regressive and emotionally needy behaviors, and older
THE IMPORTANCE OF SOCIAL SUPPORT DURING GLOBAL CATASTROPHES 19
children demonstrated increased anxiety, restlessness, and/or withdrawal while in quarantine.
Children who were quarantined were substantially more likely to develop acute stress disorder,
adjustment disorder, grief, and PTSD than those who were not (Imran et al., 2020). It was noted
that higher rates of PTSD were experienced by children who were quarantined for longer than
ten days; however, time vs. quarantine effects was insufficiently examined in the studies they
reviewed. Similar to the findings in adult study populations, children and adolescents who were
quarantined experienced higher levels of anxiety, distress, depression, and a negative impact on
physical health with a likelihood of reduced physical activity. While this review demonstrated
that quarantine-related stigma, discrimination, and social exclusion were most frequent when
associated with infectious diseases, the included Ebola studies demonstrated that stigmatization
and social exclusion continued well after quarantine (Imran et al., 2020). Additionally, Imran et
al. noted that these experiences of alienation and social exclusion included children who had
cancer and physical disability (2020). Based on the data reviewed and the impacts of these
effects on youth populations, Imran et al. included proposals for holistic solutions to help
alleviate the negative psychological impact (2020), which will be reviewed and examined with
other considerations for solutions later in the results.
Five interview studies have been reviewed in order to develop a better understanding of
socially isolating experiences from the perspectives of highly vulnerable groups. The first of
these considers the experiences of COVID-19 survivors who underwent ICU hospitalization and,
in many cases, required intubation. While conducting semi-structured interviews via phone and
video calls with 15 individuals, Piras et al. found that the most frequently occurring correlations
that emerged from survivors' experiences were fear, isolation, and loneliness (2022). Their
interviews found that impaired perception of what was happening acted as a protective factor,
THE IMPORTANCE OF SOCIAL SUPPORT DURING GLOBAL CATASTROPHES 20
and patients were often unaware of the severity of the situation while in ICU. Devastating
psychological and physiological post-viral effects (often referred to as Long-COVID) were also
common outcomes for the interviewees, further impacting feelings of isolation and quality of life
(Piras et al., 2022). The most common association with fear reported in this study was directly
associated with loneliness and a fear of being alone, with loneliness as a substantial source of
stress throughout the hospital stay. The fear of being alone was noted by the interviewees as
having been heightened by the necessity of quarantine to prevent spread of the virus and the
consequential inability to receive visits from loved ones or visit with other patients (Piras et al.,
2022). In the cases where patients were able to contact family through telephone or video call,
this was noted to have a substantially beneficial effect and helped to alleviate the intensity of
loneliness experienced during their hospital stay; and similar benefits were experienced when
patients were able to establish friendly relationships with healthcare staff or other inpatients
(Piras et al., 2022).
As Patulny & Bower (2022), Emerson et al. (2021), and Imran et al. (2020)
demonstrated, people with disabilities and/or chronic health issues have an elevated risk of
loneliness, social isolation, and alienation. These issues and their correlations with the COVID-
19 pandemic are further examined in an in-depth literature review and interview study. In an
effort to Wickenden et al. (2021) conducted narrative interviews with 75 people between 29-50
years of age with physical, visual, hearing, intellectual, psychosocial, or multiple disabilities,
with nearly everyone interviewed twice to determine impacts over time. Interviewees were from
Bangladesh, Nepal, Kenya, Nigeria, and Uganda. Those interviewed shared common experiences
reflecting feelings of destabilization, disorientation, uncertainty, shock, fear, loss, confusion,
anxiety, conflict, depression, and despair specifically related to the profound effects of the
THE IMPORTANCE OF SOCIAL SUPPORT DURING GLOBAL CATASTROPHES 21
COVID-19 pandemic; and these experiences were compounded by exacerbated discrimination,
isolation, and feelings of rejection or ostracism by members of their communities (Wickenden et
al., 2021). The secondary effects of necessary social restrictions included a disruption in
community life, community services, and social supports, which resulted in increased violence
and safety risks for people with disabilities and their caregivers, especially women and girls
(Wickenden et al., 2021). Although the protective necessity of quarantine and lockdown was
well understood, interviewees felt imprisoned in their homes, and this impact was more
substantially felt when they knew others who did not quarantine or follow restrictive measures
(Wickenden et al., 2021). Loneliness from social isolation and related loss of contact with social
networks was found to be a significant psychophysiological health factor, and was exacerbated
by inaccessibility issues relative to costs of associated tech as well as integral accessibility
features (e.g. subtitles and alternative text for images) not considered in the move to digital.
Among the experiences documented in the interviews with disabled individuals, depression,
anxiety, sadness, guilt, increased suicidal ideation, and a sense of social abandonment was
frequently noted (Wickenden et al., 2021).
With the concerns of increased risks of acute COVID-19 health outcomes and social
isolation complicated by a wide range of accessibility concerns, the degrees to which
marginalized people have been affected by the pandemic are significantly more than average and
barriers to social support are many (Vandrevala et al., 2022). Ethnic minority groups and
migrants face many of the same socioeconomic and psychosocial barriers that disabled people do
as well as additional sociological restrictions connected to racism. With regard to such issues,
Vendrevala et al. documented experiences of alienation, stigmatization, and system-level
mistrust through interviews with Black African, Caribbean, Indian, Pakistani, and Bangladeshi
THE IMPORTANCE OF SOCIAL SUPPORT DURING GLOBAL CATASTROPHES 22
community members from across the UK (2022). Their study aimed to investigate how the
complex interplay of ethnicity, migration status, religion, and socioeconomic disadvantages
disproportionately influenced the risk of exposure to SARS-CoV-2 and the risk of acute
outcomes. They found that those interviewed had experienced disproportionate levels of social
isolation and alienation and described feelings of social abandonment, alienation, and ostracism
relevant to misrepresentation in pandemic safety information shared through news media and
public health agencies and in regard to pandemic politics (Vandrevala et al., 2022). In regard to
associations with political systems of mistrust, they found that participants did not seek out
testing or treatment for self-protection but rather for the protection of family and community and
out of a need to provide for their families; and Vendrevala et al noted that participants felt that
media representation of COVID safety information favored a privileged position that did not
reflect the reality of their own experiences or those of other people in their immediate
communities (2022).
In terms of privilege, accessibility, and vulnerability, people experiencing homelessness
are an exceptionally high-risk group in every capacity, and are far too frequently excluded from
public health and population research. Bertram et al recognized this concern and examined the
severity of disproportion of the impact of COVID-19 in terms of loneliness among homeless
populations in Hamburg, Germany (2021). They documented experiences of social isolation
among homeless people with consideration for the effects of loneliness on health and with a
concern for psychophysiological health effects in particular, and to identify sociodemographic
and situational factors that increased risk of loneliness as well as self-perceived risk of
transmission. Bertram et al. (2021) proposed that such studies were of significant importance
particularly because loneliness may influence social behaviors in ways that are of concern to
THE IMPORTANCE OF SOCIAL SUPPORT DURING GLOBAL CATASTROPHES 23
pandemic safety, in that homeless people experiencing acute loneliness may be less likely to
contact social workers or counselors when they are needed. The long-term goal of the study was
to identify homeless individuals who could benefit from targeted interventions such as facilities
and tools for personal hygiene and access to safe isolation and adequate treatment in the event of
SARS-CoV-2 infection (Bertram et al., 2021). Conducting in-person interviews with 130
homeless individuals between 19-86 years of age, they found that nearly half (48.5%) had
experienced significant loneliness, social isolation, and stigmatization. Bertram et al noted that
this already substantial ratio becomes even more concerning when compared to other studies
documenting the ‘general population’ (2021). In terms of sociodemographic variables, Bertram
et al found that most frequent associations with experiences of elevated loneliness were being
single, originating from Germany, having to share sleeping spaces with >3 people, and in those
who had a higher self-awareness of COVID-19 infection risk (2021).
Among those most vulnerable to loneliness, social isolation, and alienation; incarcerated
and formerly incarcerated people need to be included in this conversation. Unfortunately they are
among the populations who frequently get left out of public health research. So too was this
concern noted by Moak, Leban, and Reuter, as they examined the effects of COVID-19 on
reentry processes of formerly incarcerated individuals in the U.S. and made a comparative
investigation to determine whether technology based support groups could provide adequate
social support and function as a viable alternative option to face-to-face support groups to reduce
social isolation and improve well-being (2022). The focus groups for this study were comprised
of 77 participants who had access to specialized Zoom virtual support groups hosted 4x per
week, and a comparative group of 41 who did not have access to virtual support groups and
received only limited support services through a day reporting center and a Firehouse Shelter in
THE IMPORTANCE OF SOCIAL SUPPORT DURING GLOBAL CATASTROPHES 24
Alabama. The study was done in cooperation and consultation with the Offender Alumni
Association (OAA), a nonprofit organization composed of formerly incarcerated individuals
(Moak et al., 2022). 85.71% of the OAA participants expressed that the meetings provided them
with support and connection, 79.62% agreed that the OAA Zoom meetings provided them with
support comparable to in person meetings, and 83.11% of participants agreed that OAA should
continue to use the Zoom support groups after the pandemic. Moak et al. also found that use of
technology such as Zoom, phone calls, and text to maintain social connections during COVID-19
was a regular habit among 77.92% of OAA members during the restrictive periods of the
pandemic (2022). OAA participants demonstrated strong social support and strong social
networks on nearly every indicator, low loneliness, low social isolation, and overall well-being
was found to be largely positive (Moak et al., 2022). Although the participants still experienced
perceived stigma, the survey scores indicated this experience was substantially less than in other
studies with formerly incarcerated individuals. Moak et al. noted substantially lower scores for
social support and social networks for the non-OAA members who did not have access to the
Zoom, however the differences for loneliness and stigma were not as substantial (2022).
Participants noted that a significant factor as to the effectiveness of OAA support was that the
program is run by formerly incarcerated people with whom they shared similar experiences and
who had firsthand understanding of the challenges of the reentry process, demonstrating the
substantial benefits of peer support (Moak, Leban, & Reuter, 2022).
Supportive strategies for bridging social gaps and alleviating isolation
As Moak, Leban and Reuter demonstrated in their study, strategies such as Zoom video
support groups can provide significant positive results even in very complex situations (2022).
With digital communication platforms like teletherapy, video chat, online multiplayer games,
THE IMPORTANCE OF SOCIAL SUPPORT DURING GLOBAL CATASTROPHES 25
text, phone calls, email, and various social media platforms, there seem to be a wide range of
potential support mediums and alternative methods of engaging in social interaction that do not
require face-to-face or in-person socialization (Imran et al, 2020). However it has been
demonstrated throughout this review that the most at risk vulnerability groups may experience
positive results and caveats disproportionately. For example, people with disability, chronic
illness, and/or limited income have the combined obstacles of accessibility and affordability
concerns, which affect their ability to access online classrooms and work environments as well
as their ability to connect with others on social platforms (Wickenden et al., 2021). Many online
sites still do not provide adequate accessibility options such as subtitles on videos and alt-text for
images, and these concerns could be addressed through consultations with disability advocates
and study groups to improve work platforms and educational environments as well (Emerson et
al, 2021; Imran et al., 2020; Wickenden et al., 2021).
For people with low social capital or perceived insufficient social networks, social media
may subjectively equate to shouting into a void, and may prove more an exacerbating factor to
loneliness and social isolation than a mediating one (Patulny & Bower, 2022). Seeking out online
social groups based on similar interests could be helpful in establishing more substantial
connections. For example art, music, crafts, or online reading or writing groups could be an
excellent solution as these may help people develop connections that may otherwise be difficult
or socially awkward to establish. Research investigating the supportive benefits of art including
online art and learning programs demonstrated that engagement in arts and cultural activities
significantly improved feelings of social connection and mental well-being throughout the first
two years of the COVID-19 pandemic (Mak, Fluharty, & Fancourt, 2021; Perkins et al., 2022).
Additionally, at-home creative activities such as digital arts, writing, music, crafts, and reading
THE IMPORTANCE OF SOCIAL SUPPORT DURING GLOBAL CATASTROPHES 26
were found to be substantially helpful in coping with the emotional effects of the pandemic
across multiple populations and provided the additional benefit of supporting self-development
(Mak, Fluharty, & Fancourt, 2021; Perkins et al., 2022). These are important supportive options
to be considered as all population groups can benefit to varying degrees from participation in
creative activities and methods of creative expression may be widely variable and adapted
according to needs, resources, and personal interests (e.g. painting, dancing, baking, singing,
knitting, juggling, etc.).
People who are unfamiliar with digital platforms or technology may also feel out of their
element when in person options are limited, and may avoid using such platforms due to the
resulting anxiety (Patulny & Bower, 2022). Patulny & Bower suggested IT training programs for
aged populations to support increasing digital literacy (2022), and this could be beneficial to
anyone in any adult age group who needs help adjusting to unfamiliar technologies. As well as
expanding social connection and quality of online social interactions, IT training programs could
open avenues to a wide range of additional resources. Adversely, those who are already saturated
with digital interface may not feel comforted by having online platforms as their primary avenue
for social interaction, and may benefit more from time spent outdoors, sitting and taking a break
away from the screens or taking a walk outside with caretakers, family, or other loved ones.
Research on possible benefits of green spaces for alleviating social isolation and loneliness have
demonstrated that urban greening programs and group outdoor health walks are not only
beneficial to cardiovascular and mental health, but may provide a relatively safe outlet for
improving and establishing social connection and significantly reducing feelings of loneliness
(Astell-Burt et al., 2021; Irvine et al., 2022).
THE IMPORTANCE OF SOCIAL SUPPORT DURING GLOBAL CATASTROPHES 27
It is important to consider that not everyone will have the same requirements or social
needs, and while some people benefit from connecting with others and widening their social
networks, others prefer to interact with smaller, closer networks (Patulny & Bower, 2022). For
people who prefer other avenues of socializing outside of in-person contact or online chat, phone
calls can provide a beneficial option. As Piras et al found in their interviews with COVID-19
ICU survivors, utilizing smartphones for video chat and phone calls is an integral support option
for patients who must be physically isolated from loved ones for health and safety (2022).
Courtesy phone calls from volunteers could also be of great benefit, particularly to those who are
quarantined or in the hospital and do not already have social connections. For example,
Normandin et al evaluated the supportive value of courtesy phone calls to hospitalized patients
and found that among call volunteers and patients who received the calls, over 72% of
participants in both groups felt less isolated and lonely and the volunteers were pleased to be able
to help amidst pandemic safety needs (2022). In regard to long-term application, patients without
pre-established social networks favored maintaining the phone calls, and the volunteers agreed
that such methods of social outreach could be beneficial for immunocompromised, high-risk, and
otherwise isolated patients who could not receive visits even outside of the pandemic needs
(Normandin et al., 2022).
Social support options are needed in other capacities as well, and one crucial aspect of
support is having access to healthy, nourishing foods. Nurturing the whole body is essential in
maintaining psychological and physiological health and influences coping abilities through
trauma or prolonged periods of stress. Unfortunately, food insecurity is another concern that has
been exacerbated by the pandemic. As such, accessibility to community support options such as
the Supplemental Nutrition Assistance Program (SNAP) and expansion of health and nutrition
THE IMPORTANCE OF SOCIAL SUPPORT DURING GLOBAL CATASTROPHES 28
support services are of particular importance (Hawkins et al., 2022; Kang et al., 2022). Where
environmentally viable, community and neighborhood gardens with nutritious fruits, vegetables,
and herbs could be established as an extension of these social supports. In fact, not only can
community gardens help to alleviate socioeconomic stress and increase local and community
options in accessing healthy foods, such endeavors can serve to bring communities and
neighborhoods closer together (Kou et al., 2021). Research investigating benefits of community
gardens during the course of the COVID-19 pandemic found that community garden projects
provided mental health benefits, established and strengthened neighborhood connections, helped
nurture trust, and provided a safer outdoor option for individual and group activities (Kou et al.,
2021). Furthermore, this research demonstrated that the technical details involved in establishing
and maintaining community gardens provided an excellent medium for establishing
communication between neighborhoods and had the additional benefit of providing a community
avenue for the organization of virus spread prevention measures (Kou et al., 2021).
Communication is demonstrably among the most integral aspects of social and
community support, and ambiguous or mixed information is dangerous, has made risk
assessment more complicated, and contributes to feelings of alienation. As Escandón et al
illustrated in their research, meaningful public health communication and science-based policies
recognizing nuance, uncertainties, local context, and social determinants of health are necessary
to reduce incidence of misinformation and establishment of false dichotomies that otherwise
negatively influence response to public health measures (2021). Terminology has been an
essential aspect of this, for example many people may not understand or be able to assess risk
based on terms like "airborne" as compared to scientific meaning conveying the nature of aerosol
transmission, and a clear understanding and explanation of aerosol transmission is needed in
THE IMPORTANCE OF SOCIAL SUPPORT DURING GLOBAL CATASTROPHES 29
order to help educate people so they can make informed choices (Escandón et al., 2021).
Understanding of efficacy and benefits of mask usage is additionally imperative in helping
people to make informed choices; however barriers to mask usage also include affordability,
quality concerns, and supply issues, as well as sociocultural and sociopolitical meanings and
associations, bringing the discussion back to the importance of clear, unbiased, science-based
communication (Dionne & Turkmen, 2020; Escandón et al., 2021; Goode et al, 2020). One
method fits all policies ignore concerns of privilege, resources, and racism and such an approach
only serves to exacerbate inequities (Power et al., 2020). Furthermore, as there is no singular
protection by itself that guarantees 100% effective prevention from transmission of the SARS-
CoV-2 virus it is necessary to communicate the benefits of a multi-layered approach to safety
(Escandón et al., 2021). Ineffectual or misinformative communication erodes trust in public
health and reduces compliance with intervention efforts, and effective communication of risks
and harm reduction approaches promote awareness and cooperation with mitigative efforts
(Escandón et al., 2021; Kyeremateng et al., 2022; Schmitz et al., 2022).
Adequate pandemic response and mitigation are reliant on healthcare infrastructure,
technical understanding, and nonpartisan cooperation across countries and regions, and this is all
greatly influenced not just by the quality of public health communications but by accessibility to
social supports as well (Escandón et al., 2021; Imran et al., 2020; Maudrie et al., 2021). Among
those social supports, additional efforts are needed by health authorities and officials to mitigate
infection and mortality rates as much as possible while minimizing the impacts of quarantine and
isolation (Brooks et al., 2020). This requires more equitable distribution of essential services and
supplies where they are most needed (e.g. food programs, shelter and housing support, access to
sanitary and protective supplies including masks, access to treatment and healthcare services, and
THE IMPORTANCE OF SOCIAL SUPPORT DURING GLOBAL CATASTROPHES 30
widely available access to free testing and vaccination sites) (Bertram et al., 2021; Escandón et
al., 2021; Imran et al., 2020; Maudrie et al., 2021). As it presently stands, systemic biases have
contributed to policy inaction and disproportionate allocation of resources throughout the
pandemic and have left many groups vulnerable (Dionne & Turkmen, 2020, Escandón et al.,
2021; Kyeremateng et al., 2022; Schmitz et al., 2022).
Among the populations most vulnerable to the devastating effects of the pandemic, there
are approximately 370 million Indigenous people worldwide who, due to generations of systemic
racism and colonization, inequitable access to healthcare and resources, and substantial
underrepresentation in research and politics, are prone to significantly higher mortality rates and
risks of acute outcomes (Maudrie et al., 2021; O’Keefe et al., 2021; Power et al, 2020). Poverty,
food and water insecurity, and inadequate access to necessary social services and infrastructures
all increase these vulnerability concerns (Maudrie et al., 2021; Power et al., 2020). Additionally,
it is important to consider that mental and spiritual health impacts associated with COVID-19
losses are especially profound in cultures with values emphasizing the importance of family,
community connection, and intergenerational learning (O’Keefe et al., 2021). In consideration of
these issues, O’Keefe et al set out to develop a culture based public health support resource for
Indigenous children and families, and through a collaboration with the Johns Hopkins Center for
American Indian Health; 14 Indigenous mental health, health communications, allied child
development, and public health professionals representing 12 tribes; and a Native American
youth artist, a storybook was produced (2021). The book, titled “Our Smallest Warriors, Our
Strongest Medicine: Overcoming COVID-19,” was made available online free of charge and
42,364 copies were printed and distributed to tribal programs and health departments, as well as
partnering communities, schools, and libraries (O’Keefe et al., 2021). The book demonstrated a
THE IMPORTANCE OF SOCIAL SUPPORT DURING GLOBAL CATASTROPHES 31
sense of community benefit, strength, and hope in the face of the pandemic through the depiction
of Indigenous characters and real community experiences, and through the art of storytelling,
shared coping strategies and safe methods of maintaining social connectedness with family and
friends while adhering to necessary pandemic guidelines of physical distancing (O’Keefe et al.,
2021). The book additionally provided parent resource materials, collaborative activities, and
activities which promoted understanding of ancestry and intergenerational family connection,
traditional languages, strength, communication, and community support (O’Keefe et al., 2021).
As this study has demonstrated, there may be many different media and methods for
communities to establish and/or maintain connections and communication, as well as to share
important cultural values and messages that help people to carry each other and themselves
through difficult times.
Summary
With increasing globalization, advancing technology, and the ongoing risks concerning
pandemics, wars, and increasing food and housing insecurities, these variables highlight
inequities across the world and make it clear that vulnerable groups of people need reliable social
and community support, most especially during times of instability and crises. There is a
significant increase in research on these concerns, and it is of substantial importance to address
the inequities and implement supportive methods at the global, national, community, family and
individual level.
Conclusion and Recommendations
The purpose of this review was to develop an understanding of correlative variables and
effects of loneliness, social isolation, and alienation including groups most at risk, exacerbative
THE IMPORTANCE OF SOCIAL SUPPORT DURING GLOBAL CATASTROPHES 32
effects both independent of and related to the COVID-19 pandemic, and to review solutions
demonstrating the importance of social and community support as integral aspects of public
health and healthcare.
The research demonstrated that loneliness, social isolation, and alienation have
measurable emotional, psychological, and physiological effects and are influenced by an
appreciable range of sociological variables (Emerson et al., 2021; Manera et al, 2022; O’Sullivan
et al., 2021; Patulny & Bower, 2022). Factors influencing vulnerabilities (such as age related
risks and low income) remained largely consistent across the studies; however different
vulnerable groups had different compounding isolation variables. For example, the experiences
of disabled people were greatly impacted when accessibility needs were not considered in the
transfer to online classrooms, and this was further compounded by income and resource
limitations such as unaffordability of computers and other equipment (Emerson et al, 2021;
Wickenden, 2021). Indeed, socioeconomic vulnerabilities of all types are significantly influential
factors. This is further compounded by caveats such as technical inexperience (i.e. digital
illiteracy), dissatisfaction with video connection, and insufficient social capital (e.g. social
influence), all additional relevant factors that further influence experiences of social isolation and
loneliness (Emerson et al, 2021; O’Sullivan et al., 2021; Patulny & Bower, 2022).
It is important to acknowledge the ways in which so many of these variables stack upon
one another, compounding the experience for the individual and adding to isolative effects. It is
additionally necessary to take into consideration that loneliness, social isolation, and alienation
are entwined in a cascade of health related side effects including increased anxiety, depression,
PTSD, and neuroendocrine dysregulation (Schluter et al., 2022; Yanguas et al, 2018; Zhu et al,
2021). Dysregulation of neuroendocrine systems such as the HPA (hypothalamic-pituitary-
THE IMPORTANCE OF SOCIAL SUPPORT DURING GLOBAL CATASTROPHES 33
adrenal) axis in a chronic or acute state of isolation may be associated with secondary effects
such as increased perception of threat with a consequent increase in anxiety, hostility, fatigue,
insomnia, and with decreased impulse control. These effects in a long-term context may
additionally be associated with an elevated risk of dementia and cognitive decline (Yanguas et al,
2018). Particularly in regard to depression, these effects may additionally increase likelihood of
social withdrawal (Zhu et al., 2021).
Although loneliness, social isolation and alienation have been experiences affecting
health and well-being throughout the existence of humanity, the research highlighted that
circumstances directly correlated with the COVID-19 pandemic have greatly exacerbated these
concerns (Dionne & Turkmen, 2020; O’Sullivan et al., 2021; Patulny & Bower, 2022; Schluter et
al., 2022). Most factors that were found to contribute to these experiences were consistent
globally and included socioeconomic variables as well as limitations secondary to necessary
social restrictions and quarantine periods, however misleading and ineffectual information
spread via social and news media further complicated the associated risk variables (Escandón et
al., 2021). Political scapegoating related to ill-informed perceptions of the pandemic led to
escalating social expressions of xenophobia, racism, and ableism, and this had significant
fracturing effects within communities as well as adverse effects on allocation of resources, social
behaviors, and accuracy of risk assessments (Dionne & Turkmen, 2020; Goode et al, 2020).
Such misinformative and politically motivated messaging made some groups seem
unavoidably prone to morbidity and mortality with others designated as exceptional or
impervious to acute risks (Dionne & Turkmen, 2020). This, in turn, reduced likelihood of
empathy and socially supportive behavior and encouraged a misinformed acceptance of levels of
contagion and casualties that could otherwise be avoided with everyone doing their part to
THE IMPORTANCE OF SOCIAL SUPPORT DURING GLOBAL CATASTROPHES 34
protect and be protected (Escandón et al., 2021; Dionne & Turkmen, 2020; Goode et al, 2020;
Vandrevala et al., 2022). The divisive messaging increased reluctance to participate in protective
measures and influenced perceptions of such measures. For example, masking was regarded as a
signal of “otherness” or adverse to the desired perceptions of normality (Goode et al., 2020).
These perceptions led to protests urging the banning of masks, ending lockdowns, and in general
a desire to return to “normal” associated with an adamant denial of the potential risks of infection
(Escandón et al., 2021; Dionne & Turkmen, 2020; Goode et al, 2020; Schmitz et al., 2022). Not
only do these factors exacerbate division among communities and encourage an attitude of
indifference, in more extreme cases they make already vulnerable people targets for misplaced
blame, assault, and violence (Dionne & Turkmen, 2020; Goode et al, 2020). These misaligned
social behaviors increased risks of viral infection and further impacted the psychological and
emotional burdens on populations who were acutely susceptible to social isolation, alienation,
and loneliness, leading to associated feelings of ostracism, guilt, depression, and suicidal
ideology (Bertram et al., 2021; Imran et al, 2020; Vandrevala et al., 2022). Clear, concise,
scientifically informed communication is imperative in helping to avoid and alleviate such social
discord and associated harmful effects.
Though the wide range of options in digital interaction seem like an ideal solution for
social connection in cases where in-person interaction is not safe; this comes with affordability
and accessibility concerns, requires a measure of technical comfort and familiarity, and is less
effective in cases where a person is already digitally saturated or living much of their life online
(Patulny & Bower, 2022). Furthermore, the supportive solutions ranging from access to video
support groups to nutritional foods are affected by socioeconomic and accessibility factors,
indicating that in all cases social inequities are a consistent root factor, and individual solutions,
THE IMPORTANCE OF SOCIAL SUPPORT DURING GLOBAL CATASTROPHES 35
while necessary and supportive variables, will be limited in their long-term efficacy until these
concerns are addressed sociologically and systematically as well. These are all complicating
factors that must be included in the conversation as they are too frequently taken for granted by
those for which scarcity of resources is not a concern. With all this in mind, even the most
comprehensive avenues of communication will be insufficient without the practice of actively
listening and striving to overcome socially normative biases. In order to develop sustainably
effective and equitable solutions amidst the COVID-19 global crisis, the voices of marginalized
and vulnerable people need to be heard, and their experiences and viewpoints need to be more
broadly included in the conversation (Escandón et al., 2021; Maudrie et al., 2021; Kyeremateng
et al., 2022; Schmitz et al., 2022).
While physiological health support is critical during a pandemic, psychological health
must also be considered. Loneliness, social isolation, and alienation may be largely regarded as
inconsequential factors of life that people simply become adapted to. The interviews and studies
conducted throughout the COVID-19 pandemic, such as the isolating and terribly lonely
experiences of COVID ICU survivors, tell a very different story (Piras et al., 2022). It is
imperative to consider the myriad ways these experiences are influenced and how the effects
may be stacked in ways that create seemingly insurmountable and emotionally devastating
barriers for those whom they affect. No matter how entangled or overwhelming the roots of the
issue may appear to be, the resolutions always come back to people supporting people to create
more equitable societies.
THE IMPORTANCE OF SOCIAL SUPPORT DURING GLOBAL CATASTROPHES 36
References
Adelinejad, F., & Alipour, F. (2022). Investigating the relationship between perceived social
support and preventive behaviors in the COVID-19 epidemic mediated by hope and
mental well-being: A case study of women living in Tehran City, Iran. Health in
Emergencies and Disasters Quarterly, 7(2), 87-96. doi:10.32598/hdq.7.2.419.1
Akour, A., AlMuhaissen, S. A., Nusair, M. B., Al-Tammemi, A. B., Mahmoud, N. N., Jalouqa,
S., & Alrawashdeh, M. N. (2021). The untold story of the COVID-19 pandemic:
Perceptions and views towards social stigma and bullying in the shadow of COVID-19
illness in Jordan. SN Social Sciences, 1(9) doi:10.1007/s43545-021-00252-0
Astell-Burt, T., Hartig, T., Eckermann, S., Nieuwenhuijsen, M., McMunn, A., Frumkin, H., &
Feng, X. (2021). More green, less lonely? A longitudinal cohort study. International
Journal of Epidemiology, 51(1), 99-110. doi:10.1093/ije/dyab089
Basch, C. H., Basch, C. E., Hillyer, G. C., & Meleo-Erwin, Z. C. (2022). Social media, public
health, and community mitigation of COVID-19: Challenges, risks, and benefits. Journal
of Medical Internet Research, 24(4), e36804. doi:10.2196/36804
Bertram, F., Heinrich, F., Fröb, D., Wulff, B., Ondruschka, B., Püschel, K., . . . Hajek, A. (2021).
Loneliness among homeless individuals during the first wave of the COVID-19
pandemic. International Journal of Environmental Research and Public Health, 18(6)
doi:10.3390/ijerph18063035
Brooks, S. K., Webster, R. K., Smith, L. E., Woodland, L., Wessely, S., Greenberg, N., & Rubin,
G. J. (2020). The psychological impact of quarantine and how to reduce it: Rapid review
THE IMPORTANCE OF SOCIAL SUPPORT DURING GLOBAL CATASTROPHES 37
of the evidence. Lancet (London, England), 395(10227), 912-920. doi:10.1016/S0140-
6736(20)30460-8
Buecker, S., & Horstmann, K. T. (2021). Loneliness and social isolation during the COVID-19
pandemic: A systematic review enriched with empirical evidence from a large-scale diary
study. European Psychologist, 26, 272-284. doi:10.1027/1016-9040/a000453
COVID-19 dashboard: The center for systems science and engineering (CSSE) at Johns Hopkins
University (JHU). (2022). Johns Hopkins Coronavirus Resource Center, Retrieved
from https://coronavirus.jhu.edu/map.html
Charron, N., Lapuente, V., & Rodríguez-Pose, A. (2022). Uncooperative society, uncooperative
politics or both? Trust, polarization, populism and COVID-19 deaths across European
regions. European Journal of Political Research, n/a(n/a) doi:10.1111/1475-6765.12529
Cooper, F., & Jones, C. (2022). Co-production for or against the university: Student loneliness
and the commodification of impact in COVID-19. Qualitative Research Journal, 22(1),
81-95. doi:10.1108/QRJ-02-2021-0016
Dahl, U. (2022). Open forum: The politics of gender (research) in a global pandemic. European
Journal of Women's Studies, , 13505068211065138. doi:10.1177/13505068211065138
D'cruz, M., & Banerjee, D. (2020). ‘An invisible human rights crisis’: The marginalization of
older adults during the COVID-19 pandemic – an advocacy review. Psychiatry
Research, 292, 113369. doi:10.1016/j.psychres.2020.113369
THE IMPORTANCE OF SOCIAL SUPPORT DURING GLOBAL CATASTROPHES 38
de la Fuente-Núñez, V., Cohn-Schwartz, E., Roy, S., & Ayalon, L. (2021). Scoping review on
ageism against younger populations. International Journal of Environmental Research
and Public Health, 18(8), 3988. doi:10.3390/ijerph18083988
DeLuca, S., Papageorge, N. & Kalish, E. (2022). The unequal cost of social distancing.
Retrieved from https://coronavirus.jhu.edu/from-our-experts/the-unequal-cost-of-social-
distancing
Dionne, K. Y., & Turkmen, F. F. (2020). The politics of pandemic othering: Putting COVID-19
in global and historical context. International Organization, 74(S1), E213-E230.
doi:10.1017/S0020818320000405
Emerson, E., Fortune, N., Llewellyn, G., & Stancliffe, R. (2021). Loneliness, social support,
social isolation and well-being among working age adults with and without disability:
Cross-sectional study. Disability and Health Journal, 14(1), 100965.
doi:10.1016/j.dhjo.2020.100965
Escandón, K., Rasmussen, A. L., Bogoch, I. I., Murray, E. J., Escandón, K., Popescu, S. V., &
Kindrachuk, J. (2021). COVID-19 false dichotomies and a comprehensive review of the
evidence regarding public health, COVID-19 symptomatology, SARS-CoV-2
transmission, mask wearing, and reinfection. BMC Infectious Diseases, 21(1), 710.
doi:10.1186/s12879-021-06357-4
Gardiner, C., Geldenhuys, G., & Gott, M. (2018). Interventions to reduce social isolation and
loneliness among older people: An integrative review. Health & Social Care in the
Community, 26(2), 147-157. doi:10.1111/hsc.12367
THE IMPORTANCE OF SOCIAL SUPPORT DURING GLOBAL CATASTROPHES 39
Goode, J. P., Stroup, D. R., & Gaufman, E. (2020). Everyday nationalism in unsettled times: In
search of normality during pandemic. Nationalities Papers, , 1-25.
doi:10.1017/nps.2020.40
Hawkins, M., Clermont, M., Wells, D., Alston, M., McClave, R., & Snelling, A. (2022). Food
security challenges and resilience during the COVID-19 pandemic: Corner store
communities in washington, D.C. Nutrients, 14(15) doi:10.3390/nu14153028
Hwang, T., Rabheru, K., Peisah, C., Reichman, W., & Ikeda, M. (2020). Loneliness and social
isolation during the COVID-19 pandemic. International Psychogeriatrics, , 1-4.
doi:10.1017/S1041610220000988
Imran, N., Aamer, I., Sharif, M. I., Bodla, Z. H., & Naveed, S. (2020). Psychological burden of
quarantine in children and adolescents: A rapid systematic review and proposed
solutions. Pakistan Journal of Medical Sciences, 36(5), 1106-1116.
doi:10.12669/pjms.36.5.3088
Irvine, K. N., Fisher, D., Marselle, M. R., Currie, M., Colley, K., & Warber, S. L. (2022). Social
isolation in older adults: A qualitative study on the social dimensions of group outdoor
health walks. International Journal of Environmental Research and Public Health, 19(9)
doi:10.3390/ijerph19095353
Kang, Y., Kim, H., Hossain, M. I., Biswas, J. P., Lee, E., Ruel-Bergeron, J., & Cho, Y. (2022).
Adaptive implementation of a community nutrition and asset transfer program during the
COVID-19 pandemic in rural Bangladesh. Current Developments in Nutrition, 6(5)
doi:10.1093/cdn/nzac041
THE IMPORTANCE OF SOCIAL SUPPORT DURING GLOBAL CATASTROPHES 40
Kia, H., Rutherford, L., Jackson, R., Grigorovich, A., Ricote, C. L., Scheim, A. I., & Bauer, G.
R. (2022). Impacts of COVID-19 on trans and non-binary people in Canada: A
qualitative analysis of responses to a national survey. BMC Public Health, 22, 1284.
doi:10.1186/s12889-022-13684-x
Kou, H., Zhang, S., Li, W., & Liu, Y. (2021). Participatory action research on the impact of
community gardening in the context of the COVID-19 pandemic: Investigating the
seeding plan in Shanghai, China. International Journal of Environmental Research and
Public Health, 18(12) doi:10.3390/ijerph18126243
Krekula, C., Nikander, P., & Wilińska, M. (2018). Multiple marginalizations based on age:
Gendered ageism and beyond. In L. Ayalon, & C. Tesch-Römer (Eds.), Contemporary
perspectives on ageism (pp. 33-50). Cham: Springer International Publishing.
doi:10.1007/978-3-319-73820-8_3 Retrieved from https://doi.org/10.1007/978-3-319-
73820-8_3
Kyeremateng, R., Lynch, M. A., Pinzón-Segura, M. C., Osei-Bonsu, A., Fortmann, J., & Wood,
D. (2022). What the children tell us: The COVID-19 pandemic and how the world should
respond. BMJ Paediatrics Open, 6(1), e001481. doi:10.1136/bmjpo-2022-001481
Mak, H. W., Fluharty, M., & Fancourt, D. (2021). Predictors and impact of arts engagement
during the COVID-19 pandemic: Analyses of data from 19,384 adults in the COVID-19
social study. Frontiers in Psychology, 12 doi:10.3389/fpsyg.2021.626263
Manera, K. E., Smith, B. J., Owen, K. B., Phongsavan, P., & Lim, M. H. (2022). Psychometric
assessment of scales for measuring loneliness and social isolation: An analysis of the
THE IMPORTANCE OF SOCIAL SUPPORT DURING GLOBAL CATASTROPHES 41
household, income and labour dynamics in Australia (HILDA) survey. Health and
Quality of Life Outcomes, 20(1), 40. doi:10.1186/s12955-022-01946-6
Maudrie, T. L., Lessard, K. H., Dickerson, J., Aulandez, K. M. W., Barlow, A., & O’Keefe, V.
M. (2021). Our collective needs and strengths: Urban AI/ANs and the COVID-19
pandemic. Frontiers in Sociology, 6, 611775. doi:10.3389/fsoc.2021.611775
Moak, S. C., Leban, L., & Reuter, T. K. (2022). Reentry during a pandemic: A pilot study of
access to peer support through technology to reduce social isolation. American Journal of
Criminal Justice, , 1-20. doi:10.1007/s12103-022-09690-9
Normandin, L., Wong, C., Dumez, V., Malas, K., Grégoire, A., Grégoire, J., . . . Pomey, M.
(2022). Reducing social isolation during the COVID-19 pandemic: Assessing the
contribution of courtesy phone calls by volunteers. PloS One, 17(5), e0266328.
doi:10.1371/journal.pone.0266328
O'Keefe, V. M., Maudrie, T. L., Ingalls, A., Kee, C., Masten, K. L., Barlow, A., & Haroz, E. E.
(2021). Development and dissemination of a strengths-based Indigenous children's
storybook: “Our smallest warriors, our strongest medicine: Overcoming COVID-
19”. Frontiers in Sociology, 6 doi:10.3389/fsoc.2021.611356
O’Sullivan, R., Burns, A., Leavey, G., Leroi, I., Burholt, V., Lubben, J., . . . Prohaska, T. R.
(2021). Impact of the COVID-19 pandemic on loneliness and social isolation: A multi-
country study. International Journal of Environmental Research and Public
Health, 18(19) doi:10.3390/ijerph18199982
THE IMPORTANCE OF SOCIAL SUPPORT DURING GLOBAL CATASTROPHES 42
Patulny, R., & Bower, M. (2022). Beware the “loneliness gap”? examining emerging inequalities
and long-term risks of loneliness and isolation emerging from COVID-19. Australian
Journal of Social Issues, 57(3), 562-583. doi:10.1002/ajs4.223
Perkins, R., Kaye, S. L., Zammit, B. B., Mason-Bertrand, A., Spiro, N., & Williamon, A. (2022).
How arts engagement supported social connectedness during the first year of the COVID-
19 pandemic in the United Kingdom: Findings from the HEartS survey. Public
Health, 207, 1-6. doi:10.1016/j.puhe.2022.03.002
Perry, B. L., Aronson, B., & Pescosolido, B. A. (2021). Pandemic precarity: COVID-19 is
exposing and exacerbating inequalities in the American heartland. Proceedings of the
National Academy of Sciences, 118(8), e2020685118. doi:10.1073/pnas.2020685118
Piras, I., Piazza, M. F., Piccolo, C., Azara, A., Piana, A., Finco, G., & Galletta, M. (2022).
Experiences, emotions, and health consequences among COVID-19 survivors after
intensive care unit hospitalization. International Journal of Environmental Research and
Public Health, 19(10) doi:10.3390/ijerph19106263
Power, T., Wilson, D., Best, O., Brockie, T., Bourque Bearskin, L., Millender, E., & Lowe, J.
(2020). COVID‐19 and Indigenous peoples: An imperative for action. Journal of Clinical
Nursing, 29(15-16), 2737-2741. doi:10.1111/jocn.15320
Preusting, L. C., Raadsen, M. P., Abourashed, A., Voeten, H. A. C. M., Wagener, M. N., de Wit,
E., . . . Doornekamp, L. (2021). COVID-19 related stigma and health-protective
behaviours among adolescents in the Netherlands: An explorative study. PLoS
ONE, 16(6) doi:10.1371/journal.pone.0253342
THE IMPORTANCE OF SOCIAL SUPPORT DURING GLOBAL CATASTROPHES 43
Rui, J. R., & Guo, J. (2022). Differentiating the stress buffering functions of perceived versus
received social support. Current Psychology, doi:10.1007/s12144-021-02606-6
Sánchez-Izquierdo, M., García-Sánchez, R., & Fernández-Ballesteros, R. (2022). Anti-ageism
social actions: Lights and shadows. Land, 11(2) doi:10.3390/land11020195
Shakespeare, T., Ndagire, F., & Seketi, Q. E. (2021). Triple jeopardy: Disabled people and the
COVID-19 pandemic. The Lancet, 397(10282), 1331-1333. doi:10.1016/S0140-
6736(21)00625-5
Schluter, P. J., Généreux, M., Landaverde, E., Chan, E. Y. Y., Hung, K. K. C., Law, R., . . . Roy,
M. (2022). An eight country cross-sectional study of the psychosocial effects of COVID-
19 induced quarantine and/or isolation during the pandemic. Scientific
Reports, 12 doi:10.1038/s41598-022-16254-8
Schmitz, R. M., Gomez, G., Propst, A., Tabler, J., & Charak, R. (2022). Queer politics of a
pandemic: LGBTQ + People’s conceptions of COVID-19’s politicization. Sexuality
Research & Social Policy, , 1-15. doi:10.1007/s13178-022-00719-6
Vandrevala, T., Alidu, L., Hendy, J., Shafi, S., & Ala, A. (2022). ‘It’s possibly made us feel a
little more alienated’: How people from ethnic minority communities conceptualise
COVID-19 and its influence on engagement with testing. Journal of Health Services
Research & Policy, 27(2), 141-150. doi:10.1177/13558196211054961
Veazie, S., Gilbert, J., Winchell, K., Paynter, R., & Guise, J. (2019). Addressing social isolation
to improve the health of older adults: A rapid review. Addressing Social Isolation to
THE IMPORTANCE OF SOCIAL SUPPORT DURING GLOBAL CATASTROPHES 44
Improve the Health of Older Adults: A Rapid Review [Internet], Retrieved
from https://www.ncbi.nlm.nih.gov/books/NBK537909/pdf/Bookshelf_NBK537909.pdf
Wang, Y. (2022). Every day matters: Using daily methods to understand oppression and BIPOC
youth development in context. Journal of Research on Adolescence, 32(2), 666-672.
doi:10.1111/jora.12763
Ward, M., May, P., Normand, C., Kenny, R. A., & Nolan, A. (2021). Mortality risk associated
with combinations of loneliness and social isolation. Findings from the Irish longitudinal
study on ageing (TILDA). Age and Ageing, 50(4), 1329-1335.
doi:10.1093/ageing/afab004
Wickenden, M., Shaw, J., Thompson, S., & Rohwerder, B. (2021). Lives turned upside down in
COVID-19 times: Exploring disabled people's experiences in 5 low-and-middle income
countries using narrative interviews. Disability Studies Quarterly, 41(3)
Yanguas, J., Pinazo-Henandis, S., & Tarazona-Santabalbina, F. J. (2018). The complexity of
loneliness. Acta Bio Medica : Atenei Parmensis, 89(2), 302-314.
doi:10.23750/abm.v89i2.7404
Zhu, Y., Zhang, L., Zhou, X., Li, C., & Yang, D. (2021). The impact of social distancing during
COVID-19: A conditional process model of negative emotions, alienation, affective
disorders, and post-traumatic stress disorder. Journal of Affective Disorders, 281, 131-
137. doi:10.1016/j.jad.2020.12.004
