Loneliness didn’t start with the coronavirus pandemic. Even before COVID-19 became part of our reality, with stay-at-home orders and fear of being close to other people, there was a dawning realization that America was seeing a huge increase in lonely people.

In 2018, the healthcare insurer Cigna released a study that said 54 percent of the 20,000 Americans surveyed reported feeling lonely. In just over a year, that number jumped to 61 percent. It’s thought that Generation Z adults, those now aged 18-22, are the loneliest people, with higher numbers than Boomers, Gen X, and Millennials, even though they’re more connected to the world and their communities than ever before, says Eric Carson for cnet.

Doug Nemecek is Cigna’s chief medical officer, and he says that loneliness is a whole new epidemic. 

What’s most troubling about this is that sustained periods of loneliness can take a big toll on both our mental and our physical wellbeing. According to the same Cigna study, the health risks that come along with loneliness are as serious as those for smoking and obesity.

A 2018 article in The Lancet described the situation like this: “Imagine a condition that makes a person irritable, depressed and self-centered, and is associated with a 26% increase in the risk of premature mortality.” 

Yet, we are living in the times of a global pandemic and social distancing from others. Being the safest way to stay healthy, keeping distance may also provoke a feeling of isolation. With that said, it is just about the right time to reflect on the impact loneliness has on our health, including our brain, heart, and immune system. 

What is loneliness?

As we think of loneliness, we may imagine being separated from family and friends or not having a companion for a Friday night out. Yet, this feeling roots much deeper than that, and has a lot to do with being a part of a group, such as being a part of a tribe in the past. Evolutionarily, it meant increased chances of survival, getting some sort of protection, and sharing the workload. Times have changed but we still need to have our tribes. 

“It’s very distressing when we are not a part of a group,” said Julianne Holt-Lundstad, professor of psychology and neuroscience at Brigham Young University. “We have to deal with our environment entirely on our own, without the help of others, which puts our brain in a state of alert, but that also signals the rest of our body to be in a state of alert.”

According to the Mayo Clinic, it can be really harmful to the body to stay in that high state of alertness and stress for a long period of time. People may experience insomnia and anxiety, or even gain extra weight due to the increasing amount of stress hormones, such as cortisol and norepinephrine.

Holt-Lundstad also noted that the pandemic is probably the most stressful experience of most people’s lives. Our daily life and routine has been shattered, millions of people have found themselves unemployed, and over 8 million people have been infected with COVID-19 across the globe. In such turbulent times, you’d normally be reaching out to friends and family for comfort and reassurance. But because of how the virus spreads, physical loneliness is much more prevalent than ever before, increasing the challenges to cope.

Almost every one of us has experienced loneliness at some point in our lives. Yet, it’s still unclear for the scientists what impact loneliness has on our health. The most complicated part of the research is about loneliness being a personal, subjective feeling, that can’t really be measured. No matter how big a person’s social circle is, they may still feel lonely and there is no guarantee they wouldn`t experience the feeling.

Surveys focus on asking people how they feel, said Holt-Lundstad, with direct questions like “how often would you say you were lonely?” and indirect ones like “do you feel like you lack companionship?”  

NASA has had a keen interest in studying how isolation and being confined affects astronauts and has been looking into for years. Their conclusions have been broadly the same as other studies that have been conducted; isolation leads to issues with cognition and behavior. There are also biological elements to loneliness that have been investigated by other researchers, too.

To do this, they need to look at our brains. 

The Rush Alzheimer’s Disease Center in Chicago did research, studying 823 elderly people over four years. The researchers used questionnaires to assess how lonely they were, and where they were with a dementia or Alzheimer’s diagnosis, as well as testing their thinking, memory, and learning skills and were assigned a score of 1-5 for loneliness. The study found that for every point increase on the scale, the chance of Alzheimer’s increased 51 percent.

When autopsies were done on those who died in the trial period, there weren’t any “hallmark brain changes associated with Alzheimer’s disease, including nerve plaques and tangles, or tissue damaged by lack of blood flow.” Robert S. Wilson, one of the study researchers noted that there was an increased vulnerability to “deleterious effects of age-related neuropathology.”

“Loneliness [can] be a good predictor of accelerated cognitive decline,” said Turhan Canli, professor of integrative neuroscience at Stony Brook University. 

Scientists haven’t yet discovered the mechanism of how loneliness and health issues interact. Canli suggested one idea, that when you’re lonely and down you’re more likely to neglect your health and general needs. You don’t eat properly, consume more alcohol, get disrupted sleep patterns. All these things can have a big impact on your long-term health

Canli also discussed his work with another researcher at the Rush Alzheimer’s Disease Center. His work with David Bennett looks at the expression of genes across different people who say they are or aren’t lonely.

30-odd years ago, Bennett began a longitudinal study in which those taking part did annual psychological and physical check-ups and then agreed to donate their brains to be looked at when they eventually died. The study looked at two areas of the brain that work with cognition and emotion. Genes that are associated with cardiovascular and inflammatory diseases, as well as cancer, were all expressed in the lonelier participants.

“There’s actually a network of connections between these different genes by which they can affect each other,” Canli said, “that might be an underlying genetic reason why these diseases might show up as a function of loneliness.”

It’s not right to conclude that being lonely means you’ll get heart disease. More research is needed in areas like heritability and gene expression. In early studies at UCLA, a researcher called Steve Cole put forward one idea – the stress hormones associated with long-term loneliness could interact with some genes that cause these health issues.

“The subjective experience has to be translated somehow in the brain into biology, and so that’s that’s we’re looking at now,” Canli said. 

As we learn more about how these issues all interact, we can get better therapies that will be able to successfully treat patients.

A lonely future

Lockdowns and restrictions are slowly being lifted or relaxed across states, with bars, restaurants, and other public spaces beginning to open up. How these changes will work with social distancing is yet to be seen. Harvard researchers suggested back in April that regular orders to increase social distancing until 2022 could be needed to curb the virus’ spread. 

In the New York Times in March, Scott Kelly, the NASA astronaut who spent 340 days on the ISS, gave some advice by drawing on his experience. His recommendations include to keep a journal, build a routine and schedule, and find a new hobby. 

Meanwhile, Cigna’s Nemeck said that we need to be checking up on our friends and family more than ever at the moment. We need to be open to talking about feelings and our difficulties to try and rid the stigma associated with loneliness.

“We need to reach out to some friends and make sure we maintain those connections and have meaningful conversations,” he said. “It’s important for all of us to be comfortable asking other people how they feel.”