The COVID-19 social connectivity paradox

Humans are social beings, and our social relationships—both in quality and quantity—have a large impact on our health and well-being. Social support has long been recognized as a key social determinant of health (SDOH); however, social isolation and loneliness have only recently been recognized as SDOH and can be equated with negative health risks such as obesity, physical inactivity, high blood pressure or smoking 15 cigarettes a day. Although some progress has been made across health care, aging services and public health to combat social isolation, the movement is young and has been recently compounded by the COVID-19 pandemic.

A paper led by Matthew Lee Smith, PhD, MPH, CHES, co-director of the Texas A&M Center for Population Health and Aging and associate professor in the Department of Environmental and Occupational Health at the Texas A&M University School of Public Health, introduces the COVID-19 Connectivity Paradox and describes strategies to improve and maintain social connectedness during the pandemic that promotes physical distancing for safety.

The paper, “Combatting Social Isolation Among Older Adults in a Time of Physical Distancing: The COVID-19 Social Connectivity Paradox,” was recently published in Frontiers in Public Health with co-authors Lesley E. Steinman from the Health Promotion Research Center at the University of Washington School of Public Health and E.A. Casey with the AARP Foundation.

“Many questions arise when society is faced with the rapid and widespread onset of challenges deterring in-person human interaction. How do we quickly and effectively modify our existing strategies to improve connectivity in a time of recommended and required physical distancing?” Smith said. “How do we introduce and implement opportunities for meaningful connectivity without physical interactions?”

Smith and his co-authors define the COVID-19 Social Connectivity Paradox as an instance when one set of actions meant to protect older adults (i.e. physical distancing measures) can simultaneously both protect and harm that group. For example, the authors posit that if an older adult increases their physical interactions with others, they can protect themselves against social isolation, loneliness and disconnectedness; however, they are simultaneously increasing their risk of COVID-19 exposure, and vice versa.

The researchers also note that although screenings for preventable public health risk factors like smoking and high blood pressure are a staple of routine clinical care, social isolation risk has not been widely incorporated as a routine screening.

“At present, clinical-community integration for social isolation screening and referral is disjointed and at times fragmented,” the authors write. “Continuity in screening methods, frequent communication mechanisms and seamless referral systems are needed to ensure the older adult is identified, monitored and supported throughout their journey to connectivity.”

So, what can be done?

According to Smith and his co-authors, traditional gerontological health care practices must be “rapidly altered and translated” so that older adults are engaged and connected. They define this concept as “distanced connectivity,” which attempts to maintain the positive aspects of physical social connections through communication outlets like the telephone, computer or smart devices. This can include methods like telephone and virtual video calls where older adults are able to engage with family, friends and community navigators while getting information and accessing health-related resources, services and programs.

“Social isolation is becoming intensified and complicated during the COVID-19 pandemic. While the newly-required physical isolation provides protection against the virus, social isolation has a range of negative consequences that may be amplified by the stress and uncertainty of the contemporary reality,” Smith said. “Distanced connectivity can be a central solution to serve older adults most vulnerable to both COVID-19 and the devastating effects of social isolation.”

The authors also note that these interventions offer opportunities to learn best practices for distanced connectivity that lessen the effects of social isolation, but caution that these technologies are not always available to rural and marginalized communities, and that user accessibility also must be taken into account.

“For many older persons, access to reliable internet is limited, and former sources of connectivity such as libraries and senior centers are unavailable during the COVID-19 pandemic,” Smith said. “Even if access is available, barriers exist to older adults using technology, including limited technological literacy and negative attitudes about ease of use and security issues.”

The authors posit that reaching the state of ideal “distanced connectivity” requires clinical and community organizations to work together in partnerships to identify how risk screenings and assessments can become purposeful tools to connect older adults with services during this pandemic.

“Screening for risk in clinical and community settings is essential, but screening and assessments become more powerful if they are linked to specific and purposeful action,” Smith said. “Effective interventions are those that help with improvement of social skills, enhance social support, increase opportunities for social interactions and address maladaptive social cognition. Multidimensional screening for low social connectedness can be helpful to identify what aspects of social relationships are missing in the lives of older adults, which can then guide intervention selection appropriate for each older person.”