Ah, look at all the lonely people.
John Lennon and Paul McCartney could not have predicted how accurately the lyrics to “Eleanor Rigby” would describe the list of my primary-care patients requesting a call. Before the pandemic, clinic days were a mix of patients with severe chronic diseases and those who I would describe as terminally lonely. These are people who, through life circumstances, spend most days without the benefit of meaningful human contact. They depend on brief social exchanges and relationships that might otherwise go unnoticed — getting cash from a bank teller when the ATM would do, buying a pack of gum for a chance of a quick conversation with a supermarket checker, becoming a regular at the coffee shop in hopes of becoming friendly with the barista.
Any primary-care physician will tell you, our daily victories often consist of knowing that we provided kindness and dignity — and the power of human touch — to individuals who might not otherwise have experienced it. This raises a key question: In the COVID-19 era, what becomes of all the lonely people?
The human experience of loneliness may have evolved to warn us of the threat of isolation and abandonment. Loneliness is also a risk factor for depression, Alzheimer’s dementia, coronary heart disease and stroke. Indeed, the odds of dying are 50% higher for lonely people, which are similar to the odds of dying from smoking and greater than the odds dying of high blood pressure and obesity.
For primary-care physicians, knowing our patients — their interests, their social contexts, their fears — is critical to maintaining their health. Since early March, my virtual clinic visits have included troubleshooting flares of chronic low-back pain, adjusting insulin, brief cognitive-behavioral techniques for anxiety, examining rashes and fine-tuning heart failure medications. Perhaps more importantly, these visits have centered on topics that are nonmedical but at the same time vital for health. We have discussed books, travel, Bob Barker versus Drew Carey on “The Price is Right,” the merits of having a dog during the pandemic and where to get the best takeout in Seattle.
One patient simply wanted to commiserate about how unsatisfying a telephone call is compared to a clinic visit. Several have made appointments to make sure that I am OK and ask after my family. One shared an exhaustive list of every meal he had eaten for the past week. He admitted he was so lonely he had driven to the beach to eat in his car while watching pairs of people strolling on the sand. We all agree that our encounters would be richer if we could truly see the sparks in each other’s eyes. The loss of photon exchange between patients and providers is truly felt.
To be sure, social distancing has flattened the curve of COVID-19 transmission and saved countless lives. Appropriate attention is being dedicated to the economic and educational consequences of the pandemic and our collective response. However, as a society we must also be cognizant of the invisible health costs.
After the COVID-19 surge passes, I anticipate a different kind of surge: Waves of people returning to primary-care clinics who were avoiding or delaying care during the outbreak. While staying home to protect themselves and their neighbors, they suffered from profound loneliness — and the related health consequences. I doubt there will be daily White House briefings or a federal task force to address the pandemic of loneliness. However, the primary-care doctors on the front lines will be ready to take up the charge, and I, for one, cannot wait to share a smile, a touch, a room with my lonely people.