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\begin{document}


\def\RunningAuthor{Kumar Gaurav Chhabra et al.}
\firstPage{1469}
\articleType{Review Article}
\receivedDate{10 Nov 2020}
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\title{Impact of COVID- 19 and Social Distancing on Mental Health}
\author{Kajal~Gandhi,  
            Kumar~Gaurav~Chhabra\textsuperscript{*},  
            Revati~More,  
            Ankita~Rathi,  
            Gargi~Nimbulkar, 
            Amit~Reche~\\[5pt]{Department of Public Health Dentistry, Sharad Pawar Dental College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Sawangi (Meghe), Wardha, Maharashtra, India}}

\begin{abstract}
The Coronavirus Disease 2019 started in Wuhan Province, China and which spread to half a dozen countries between 2019 and 2020 and was declared a pandemic. This resulted in the implementation of a lockdown in different parts of the world, explaining it was an effective and essential way to break the cycle of infection. Physical distancing is the most important measure to break this infection cycle which affected many people's lives in different aspects. Mental health is considered to be one of the important components of the overall health as the definition given by the World Health Organization. It says that the person should be well-adjusted with the environment and should not be easily upset. He should know his needs, problems and goals properly; moreover, if he faces problems, he tries to solve them intelligently for which he tries to cope up with stress and anxiety. Along with all these things, he has good self-control balances between rationality and emotionality. It has likewise set off a wide variety of mental issues, for example, anxiety, panic disorder and depression. Most of the studies have reported negative impacts, including anger, stress symptoms and confusion. Education and training on pandemic should be provided by the authorities and health care workers.
\end{abstract}\def\keywordstitle{Keywords}

\begin{keywords}Mental Health,\newline Social Distancing,\newline COVID 19
\end{keywords}
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\makeatletter{\raggedright\textsuperscript{*}Corresponding Author\par Name:\ Kumar~Gaurav~Chhabra~\\ Phone:\ +91 79768 40339~\\  Email:\ rajsushil.chhabra@gmail.com
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\section{Introduction}
Coronavirus 2019 pandemic first appeared in Wuhan Province, China and started spreading countrywide between December 2019 and early 2020. During this period it spread to half a dozen countries worldwide and was declared as a pandemic \unskip~\citep{948710:20906703}. The seriousness of coronavirus disease has been related to clinical and demographic characteristics, for example, diabetes, immunosuppression, chronic respiratory diseases and hypertension; which intentionally increase the fatality hazard for COVID-19 \unskip~\citep{948710:20906701}. The route of transmission predominantly has been identified through droplet as stated by WHO. In the absence of a vaccine, social distance is the most widely adopted strategy for its control and mitigation \unskip~\citep{948710:20906694}.

\textbf{But what is social distancing?}

According to the Centers for Disease Control and Prevention, social distancing, also known as "Physical distancing" means keeping space between you and other people outside. According to the WHO it is important to maintain at least 1 metre (3 feet) distance between yourself and others because when someone coughs, sneezes, or speaks they spray small liquid droplets from their nose or mouth which may contain the virus. If you are standing too close, you can breathe in the droplets, including the COVID-19 virus if the person has the disease \unskip~\citep{948710:20906700}.

The implementation of strict social distancing and quarantine in and around the world has forced a lot of people into isolation. It triggered a large number of psychotic disorders, anxiety, stress and depression \unskip~\citep{948710:20906703}. Mental stability and health are the vital aspects that should be maintained in this lockdown as all means of communication spin around the virus. The loss due to social distancing has been subdivided into loss of income, loss of interaction, loss of routine and structure.

\textbf{Mode of transmission}

In spite of the fact that the viral infection is zoonotic in origin, the ongoing outbreak has exhibited its solid empathy for a human to human communication. The infection basically escalates through the respiratory driblet from breathed in through cough air or sneeze of a diseased individual, which settles down in the nasal mucosa, mouth and lungs of individuals. It likewise is assumed to be transmitted by touching the nose, mouth or eyes and by touching infected things. Asymptomatic carriers are suspected to cause the transmission as well \unskip~\citep{948710:20906705,948710:20906699}.\textit{}

\textbf{Importance of social distancing during this pandemic}

In this cutting edge, world connection's technology is used on a regular basis, but major activities are carried out on by social interaction. Social cooperation and contact are essential as a practical point of view for the nation as laborers need to work all the time to generate income in their particular organizations, it is likewise a fundamental piece of consumers and shoppers to produce income. Social distancing permits people to maintain distance from each other for a while to ensure the spread of the infection is limited. This would diminish the basic production rate (R0) of the virus, which would limit the infection spread. Studies show that social distancing when followed a reduction in 92\% of cases appropriately, can be seen till the end of 2020. An individual infected with COVID-19 has the capacity to spread it to 2-3 individuals who will go on until they are distanced each other. There are some regular implementations followed using social distancing, one of them is physical distancing and maintaining a distance of almost 1m within the individuals and the other being staying inside at home. This implementation has been successful in the past and as well as in the present. Wuhan was able to reduce the infection spread by implementing these practices \unskip~\citep{948710:20906704}.

\textbf{Stressors during social distancing are}

The utilization of forceful isolation measures is likewise known to have genuine financial, mental, and social consequences. Isolation methods, as a rule, results in causing multiple times to post-traumatic and psychotic stress in isolated people in contrast with non-isolated people \unskip~\citep{948710:20906705}.

\textbf{Inadequate supply}

Having inadequate supplies of basic necessities was one of the factors that caused frustration and anxiety during this period. The shortage of medical prescriptions and being unable to get regular medical services is also a problem for many people.

\textbf{Finances}

Budgetary imbalance can be an issue during the lockdown, with individuals incapable of working and interfering with their professional work with no timely arrangement. In several studies, it was found that financial loss during this lockdown created some serious socioeconomic crisis and was known to be a major threat for psychotic disorders such as stress and anxiety. Many got dependent on their families to accommodate them during this lockdown which was frequently difficult for them to accept and causes conflicts. Individuals who are isolated and have lower family unit earnings may need extra degrees of help, alongside the individuals who lose income during this lockdown. These factors can cause stress in such individuals \unskip~\citep{948710:20906696}.

\textbf{Duration of lockdown}

One of the biggest stress-causing factors for people is the fact that they are not acquainted with the duration of the lockdown and how long it will last. Some individuals are worried about Socializing for some till lockdown gets over. Studies show that the longer duration of lockdown and physical distancing is related to poor mental health, specifically stress \unskip~\citep{948710:20906702}.

\textbf{Impact of social distancing on the geriatric population}

Elderly individuals are more probable to develop some serious psychological disorders than individuals of other ages if they get infected with the coronavirus. Because of their high risk to the infection, it is particularly significant for them to maintain physical distancing, amid all the other protective measures. These protective measures can restrain them from having connections with their friends, caretakers and family, which could prompt expanded feeling of nervousness and loneliness, in addition, the overall feeling of vulnerability and threat because of a pandemic. Older individuals have a high chance of depression, which is frequently misidentified and untreated in this populace. The frequency of sadness and stress increases among individuals who need home health care or those who require emergency hospital treatments. Self-destruction is a related emotional risk among the geriatric population \unskip~\citep{948710:20906695}.

\textbf{Impact of social distancing on children}

To reduce the spread of infections, most of the schools are closed across the country, affecting students, their guardians and parents. It has interrupted the children's education and has affected families beyond it. According to the Centers for Disease Control and Prevention (CDC), students that depend on the school services for meal programs and social, physical and mental health services will be affected because of the prolonged closure of schools. Mental health issues may also increase among children due to decreased opportunities to engage with peers. Already existent dysfunctional behavior seen in adolescents might be aggravated in the pandemic, and with the closure of schools, students won't have a similar approach to the mental health administrations. Studies show that adolescents from the age of 12 to 17 have been diagnosed with anxiety or depression. Self-destruction is one of the major risk factors among adolescents \unskip~\citep{948710:20906695}.

\textbf{Impact of social distancing on overall population}

Social distancing will most likely increase anxiety, fear, depression and loneliness. Humans are social creatures, free of nationality and maintaining distance for a very long time may generate significant mental stress. The financial burden during the pandemic, with a huge number of unemployment, increment in penury, imbalance may emphasize such feelings. Effects are intense in developed countries for {\textemdash} the individuals who are in healthcare facilities, the vagrants and individuals with psychotic issues. A US-based study researched in excess of 10 million Google searches and evaluated the changes in psychological wellness questions after the lockdown orders. Topics associated with negative believes, stress, sleep disruption and self-destructive thoughts have significantly increased before stay-at-home requests leveling with graph after usage \unskip~\citep{948710:20906698}.

A British based quantitative online research with 27 members surveyed five groups throughout the beginning phases of the physical distancing and isolation measures (5{\textendash}12 days post lockdown). Insulation brought about notable negative effects on mental health within a short period of strategy application, predominantly in those with low-income workers. Decreased social interaction, financial losses, and transformation have brought about mental and emotional effect, such as demoralization, reduced self-importance and reduced self-confidence \unskip~\citep{948710:20906697}.

\textbf{Impact of social distancing on substance users}

People with substance use disorders (SUD) have a high possibility of getting infected because of numerous factors attributable from their mental, clinical and psychotic conditions. In addition, social and financial changes brought about by the pandemic, alongside the difficulties with respect to treatment approach and adherence- which will unquestionably increase during this time, henceforth further disturbing their condition. So as to quantify the effect of coronavirus on substance users and to recommend particular systems, it is essential to think about the characteristics of these subdivisions, for example, a) people with mild SUD versus moderate to severe SUD; b) those currently into abstinence versus active substance use; c) those with comorbid mental issues (including utilization of various substances). People with moderate to severe SUD are now significant risk group, could agonize severe effects, since they have recently been related to every one of these diseases. Moreover, previous some studies have announced that tobacco and liquor ingestion can provoke flu.

The way that substance users often misuse the substances in a mix with different drugs can cause added risk. While substance use can widen the risks related to COVID contamination, social and mental possibility of the pandemic can escalate substance use, in a destructive cycle. Physical distance, quarantine or isolation are basic procedures to put a stop to disease transmission {\textemdash} nonetheless, the procedures, and the pandemic, has been related with negative antipathy, for example, nervousness, irritability, misery, outrage, anxiety or fatigue. Withdrawal signs inspired during isolation could likewise endanger these safety techniques, as people could step out looking for drugs. Likewise, clinical help for signs will be restricted, since the significant clinical endeavours outfitted towards the coronavirus pandemic. Moreover, these individuals can be potential transmitters for infection. Explicit techniques for prevention and treatment must be talked about. Healthcare workers managing SUD should know about the difficulties they will have to face during and after the coronavirus outbreak \unskip~\citep{948710:20906701}.

\textbf{Strain among the frontline health workers}

The crucial job of health care workers during the pandemic as front line workers is indispensable and huge, making them more vulnerable to stress and anxiety because of overpowering health care facilities in addition to getting infected with their main concern of transmitting the infection to their families. Previous episodes and pandemics of different infectious diseases for example H1N1 flu, SARS-CoV-1 and Ebola infections have demonstrated to cause critical short and long term mental effect on health care workers in the frontline \unskip~\citep{948710:20906693}. Research shows that mental exhaustion in hospitals especially has increased for nurses and medical attendants attending emergency clinics with the decreased caregiver to patient ratios. Doctors have experienced mental exhaustion and have therefore experienced the effects on psychological wellness, including stress, anxiety and substance abuse. Risk of self-destruction is likewise high among doctors.

Recent studies have investigated the psychological health results of front line workers in China throughout the COVID-19 pandemic, finding that workers have reported sentiments of anxiety, stress, and psychological health. This was especially intense among medical workers, nurses, and workers associated with diagnosing and treating patients with coronavirus \unskip~\citep{948710:20906695}. Even in the dental field also while examining the patient, additional aspects of precautionary measures to perform various procedures and to disinfect the surgical field were discussed and a safe distance should be maintained with correct posture while examining and treating the patient with all the necessary precautions including personal protective equipment \unskip~\citep{948710:20906707}.
    
\section{Conclusion}
How you react to stress during the Coronavirus pandemic can rely upon your experience, your social help from family or companions, your related financial circumstances, your well being and enthusiastic foundation, the network you live in, and numerous different components. The progressions that can happen due to the Coronavirus pandemic and the manners in which we attempt to contain the spread of the infection can influence anybody.

\textbf{Funding Support}

The authors declare that they have no funding support for this study.

\textbf{Conflict of Interest}

The authors declare that they have no conflict of interest for this study.
    

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