There’s an alarming connection between illness and isolation.

Loneliness kills.

This is not hyperbole. There’s a ton of research out there that shows how being isolated from others can lead to physical and mental illnesses like depression, anxiety, insomnia, heart disease, and respiratory difficulties.

As you can imagine, one group particularly at risk of loneliness is older adults. Sequestered in nursing homes, incapacitated by physical and mental vulnerabilities, and confronted with the limited mobility that vulnerability brings, they often feel an acute lack of social support. Unsurprisingly, elders who identify as immigrants and/or LGBTQ+ — two groups that can have increased difficulty finding support networks — are even more vulnerable.

Even before the pandemic hit, loneliness was considered an epidemic amongst the elderly. And since the elderly are more at risk of developing severe COVID-19 symptoms, it makes sense that they are also being put under the most stringent physical distancing protocols.

But there is a reason that we colloquially interchange the phrases “social distancing” and “self-isolation”: for many people, there doesn’t seem to be much difference between the two. The pandemic has turned many of us into housebound homebodies, forced to forgo normal social interactions for SNS chats and Skype calls. After nearly a year of this, plenty of people are feeling disconnected from the world. Social media is awash with posts describing previously healthy people experiencing symptoms of depression, anxiety, and other mental illnesses.

The isolation has gotten so bad that it’s being compared to solitary confinement or being an astronaut adrift in space.

At the moment, there is an unfortunate gap in research on the mental health consequences of prolonged pandemics, but there is a lot of research on the effects of prolonged loneliness on mental health.

And the results? Not good.

Social support is important to human health. Loneliness and social isolation are associated with poorer cardiovascular, respiratory, neurological and immunological health. Particularly for patients hospitalized with heart failure, loneliness resulted in an almost 4x higher risk of death. Most doctors attribute this to multiple mechanisms, with an overworked inflammatory response as one of the most widely discussed theories.

People who self-report more loneliness have higher levels of blood cortisol, a stress hormone that can lead to high blood pressure and inflammation if present in elevated levels for a long time. Emerging research seems to indicate that such inflammation damages cells, overtaxes the circulatory system, and can result in plaque-related coronary artery disease, detracting from the body’s ability to protect and preserve itself.

It seems that being heartsick is an actual medical condition.

And with people having to stay cooped up in the confined quarters of their homes for months on end, it is not unsurprising that many are having difficulties with maintaining the levels of activity (physical or social) necessary to protect the health of their hearts, brains and immune systems.

Disturbingly, COVID-19 infections also lead to poorer cardiovascular, respiratory and immunological health. So the chances of isolation-related illness being exacerbated by COVID-19 infection or vice-versa is sobering. Especially when you realize that loneliness is associated with increased susceptibility to viral infections.

There’s more. Feelings of loneliness have repeatedly been correlated with increased mortality, meaning that people who feel more lonely are more likely to die earlier. There are multiple reasons behind this. For one, people might feel lonely and isolated because of pre-existing health conditions that keep them from participating in social activities. Or they might not have the support networks necessary to call for help in case of emergencies. Or they might have less people checking up on them who could spot a problem or malady before it became life-threatening — it is well-documented that lonely and isolated people are at increased risk of abuse, a risk that is only likely to be exacerbated by the pandemic. Loneliness is also linked to poor mental health and suicidality in a terrifying causal triangle — one that shows up across the world.

But saying that loneliness alone kills would be irresponsible. Loneliness is different from social isolation. While social isolation is an objective, literal lack of other people to socialize with, loneliness is a subjective feeling that comes with feeling isolated. But the directionality is a bit unclear. Are people who are already ill more likely to become isolated and lonely, or does feeling lonely itself cause sickness? Is loneliness like a virus or toxin, creating tangible physical disruptions to our body’s carefully calibrated homeostasis all by its lonesome? After all, when researchers accounted for smoking habits, pre-existing conditions, and economic status, the association between social isolation and poor heart health was reduced.

Furthermore, while some studies seem to suggest that social isolation is a better predictor of poor health outcomes than self-reported loneliness, others suggest the opposite. And some say both are true, but when associated with different pre-existing conditions.

Physical distancing can exacerbate existing loneliness by keeping people from their family, friends and community. But physical distancing is also essential to stopping the spread of the virus and keeping those same loved ones safe.

So what can we do?

We can reach out to each other. Send video call invites or emails to friends and family who we might not be able to keep in touch with, literally.

Telephone-based “befriending” programs have visibly improved the quality of life for elderly and isolated people. Even ordinary conversations boosted their self-confidence and gave them a future to look forward to. And if talking over the phone feels too difficult, there are also digital penpal programs. A few simple words can make a huge difference in someone’s day.

Zoom calls and digital messaging are nowhere near the same as warm hugs and sharing meals at the same table, but they can help bridge the gap and bring people together. Most health experts are preaching solidarity, pleading with people to not relax their physical distancing measures and mask-wearing. They instead offer other suggestions, noting that voice-based communications (video chats, phone calls) are better at reducing feelings of loneliness than less interactive mediums like text or email. Granted, not everyone feels comfortable with talking on the phone, but it’s scientifically shown to be better than nothing.

And volunteering isn’t just for young people! I have met seniors who, through their active involvement in local advocacy groups, got out into the community and built connections even when their family members lived entire states or even countries away. There is plenty of evidence demonstrating that participating in fulfilling, enjoyable activities improves cognitive functioning and reduces feelings of loneliness. If you are stuck at the start, the CDC has a list of organizations that older people can try and get involved with. If there aren’t any local chapters in your area, try looking for groups that share your interest in poetry, nature, or movies. Local libraries are great places to start, and social media also makes it easy to search for like-minded folks to while away the otherwise lonely hours with.

The Cleveland clinic has a list of further suggestions to help people form connections and find fulfillment in these fraught, fear-ridden times. Random acts of kindness and webcam brunches might sound like pithy stopgaps for serious suffering, but there is evidence that videoconferencing programs improve emotional and psychological well-being in participants.

Though ZOOM calls and messaging platforms might make it easier to weather isolation, economically disadvantaged people who lack access to preventative medicine are also more likely to lack access to the stable internet connection needed to utilize these resources. Structural factors can impede the chances of people in high-crime neighborhoods who want to become more engaged with the community. And while using social media to message friends and family can help, endlessly scrolling through anxiety-inducing feeds filled with morbid news and painful trauma are not going to help. In fact, it can hurt you mentally.

Researchers recommend that policy-makers at the local level work with mutual aid groups and volunteer organizations that aim to improve people’s quality of life through community service. Such community-based cooperatives have demonstrable benefits on the health outcomes of participating residents. The health of residents should be just as much of a priority as infrastructure and the environment, as it is just as essential to long-term, sustained economic prosperity.

We need more research looking at how digital platforms can reduce feelings of loneliness and help foster connection. We also need more social advocacy and informed policy to help realize the recommendations based on that research. Now more than ever, it is essential that we come up with creative, emotionally resonant alternatives to the social practices we have been relying on for millenia. We need to work together to find ways for grandparents to see their beloved grandchildren meet life milestones, for grieving adults coping with the losses brought about by the pandemic to find comfort in the arms of family and friends and for people who are celebrating graduations, weddings, and births to be able to share their happiness with those they care about. The world does not stop turning just because a virus is tearing through it. Life goes on, and we must find ways to maintain the connections we cherish.

Hopefully, the alternatives that emerge in these trying times will continue to help remedy the growing problem of loneliness long after the pandemic has ended. Because we know that for some people, “normal” wasn’t all that great of a place to begin with.