When the COVID-19 pandemic tore across the planet, the health impacts of the lethal new virus were devastating. But the measures taken to tackle the coronavirus have had dramatic effects in themselves – consequences are being tracked and recorded in real time worldwide thanks to a landmark study led by researchers at ARU.
A population survey launched by ARU on the eve of national national lockdown in 2020 has produced unique insights into how self-isolation has affected the health, behaviour and wellbeing of UK citizens.
The cohort study has examined the impact of social distancing on levels of physical activity, mental health, sexual activity, diet, alcohol consumption and more. Through partnerships with universities overseas, the project has expanded to encompass seven further countries including the USA, Brazil, Spain and Italy, reaching tens of thousands of individuals globally.
"We know that once we have developed a habit it tends to track across the lifespan, and also that if we develop depression or anxiety it reoccurs throughout life. So it’s really important to understand how this isolation has influenced behaviour [and] mental health."
As lockdown eased, the study continued to follow participants to gain an understanding of the longer-term effects of months of isolation, and to highlight which new habits – good or bad – have stuck.
For Dr Lee Smith, Reader in Physical Activity and Public Health at ARU and an epidemiologist by background, the prospect of mass public shielding to try to stop the spread of COVID-19 represented a unique case study that demanded investigation.
“We have never had a scenario before where we have asked people to isolate like this within modern times: we had no idea how this was going to affect anyone’s health and wellbeing.
“We know that once we have developed a habit for a new behaviour it tends to track across the lifespan, and also that if we develop depression or anxiety it reoccurs throughout life. So it’s really important to understand how this isolation has influenced behaviour, mental health and physical health separate from COVID-19 itself, so we can ensure that as people come out of isolation there’s not going to be subsequent detrimental impact on health and wellbeing.”
As the UK Government instructed vulnerable groups to shield but hesitated to extend the policy population-wide, Dr Smith and ARU colleagues Professor Laurie Butler and Dr Daragh McDermott opted to take action. Supported by ARU Deputy Vice Chancellor for Research and Innovation, Professor Yvonne Barnett, they gained ethics approval, designed a 15-minute online survey, launched and publicised it by 15 March, over a week before Prime Minister Boris Johnson announced the national lockdown on 23 March.
“We just cracked on with it,” says Dr Smith, who leads the ARU COVID-19 Research Group – a new interdisciplinary partnership of 36 academic members from across multiple faculties. “With a life event like this, which is affecting the entire population, you need to act quickly. There wasn’t any time to apply for funding – by the time it was reviewed you’d have missed the window of opportunity.”
The team’s speedy response proved invaluable, with almost 1,000 people completing the survey – the majority in the weeks immediately after lockdown. Questions covered levels of anxiety, including a wide range of potential symptoms, physical health, diet in comparison with non-pandemic times, sexual activity, smoking and drinking.
As responses poured in, the ARU team and Professor Mark Tully, a project partner at the University of Ulster, began to analyse and publish their findings, holding a mirror up to a locked-down nation hungry for greater understanding of a strange and stressful shared experience. By mid-July, baseline data from the snapshot cohort study had yielded four papers, with more to come.
One of the first studies examined respondents’ mental health, and found that over one third of people - 36.8 per cent - were experiencing poor mental health, compared with a quarter in normal times.
One of the first studies, examining respondents’ mental health, found that younger people, women, people on lower incomes, smokers and those with poor physical health were likeliest to be experiencing poor mental health – defined as having high levels of anxiety or depression – during lockdown. Over one third of people – 36.8 per cent - fell into this category, compared with a quarter in normal times.
The rise is likely in part to be due to the strain of increased anxiety. But the increase could also be the result of isolation, financial stress and a reduction in social interactions.
In terms of physical activity too, the survey revealed a significant change following the introduction of social distancing regulations. According to the findings, 75% of UK adults met the World Health Organization’s (WHO) physical activity recommendations of 150 minutes of moderate physical activity or 75 minutes of vigorous physical activity per week.
The figure represents an increase on levels before the COVID-19 pandemic, when studies showed only between 58% and 66% of the UK adult population typically met physical activity guidelines.
In another apparent reversal of pre-pandemic trends, the survey found that women, older adults and those with a higher annual household income were significantly more likely to meet the WHO’s guidelines. Prior to the pandemic, in contrast, men and younger adults were found to have higher levels of physical activity.
The unexpected overall activity increase could be down to repeated government references to a daily permitted hour of exercise, according to Dr Smith. “We have never had that message before so frequently. People probably responded to that message and took one of the few opportunities they had to go outside. As well as offering a reason to go out, this may have served as a target for some people.”
Women overtaking men in the activity stakes could be the result of shouldering increased levels of housework and childcare during lockdown, while men working at home spent the day “sitting at a desk”, he added.
While the increase in activity among older adults is positive, consideration should be given to ways to encourage sustained activity levels after the pandemic, the ARU team concluded.
A third paper drawn from the survey results focused on sex during lockdown, finding that only 40 per cent of those responding had engaged in sexual activity at least once a week. While no comparable figures are available for non-pandemic times, researchers “had not expected such a low level of sexual activity”, Dr Smith said.
Men, younger people, married partners and those consuming alcohol were all more likely to be sexually active, and a longer time in social isolation was also associated with more likelihood of sexual activity. Since a regular and trouble-free sex life is associated with a wide range of mental and physical health benefits, positive sexual health messages could help reduce the detrimental consequences of self-isolation, the research team proposed.
The fourth paper drawn from the dataset investigated the relationship between mental health and physical activity, concluding that people who are more physically active enjoy better overall mental health and proposing more analysis over time to better understand how the two features affect one another.
ARU researchers plan to publish more papers from the baseline database covering diet, alcohol, loneliness and more, but are also conducting a three-month follow up to explore how participants’ health and behaviours have changed over the lockdown period.
A further follow-up in autumn 2020 will examine whether those changes have endured post-lockdown, with the team also seeking funding to develop interventions to address the challenges revealed by the study.
Here at ARU we'll also continue to pursue our other coronavirus-linked research, including a high-profile study revealing that countries with low vitamin D levels have suffered higher infection and mortality rates. The ARU team is part of a major international group collating research literature and analysing all aspects of COVID-19.
For Dr Smith, the self-isolation research – widely shared by media all over the world – has more than repaid the effort of its fast-paced launch. He says: “I enjoy doing work which can be applied, which is very topical, and which is of interest to the general public as well as the academic and healthcare communities.”
At present, Lee is leading the COVID-19 research group for ARU which, as well as exploring the effects of lockdown on mental health, is working to develop rapid coronavirus tests and new drug combinations to reduce complications arising from COVID-19.
As an expert on physical activity and sedentary behaviour, Lee is also a member of our Cambridge Centre for Sport and Exercise Sciences, and incorporates his research findings into everyday life – as our feature article Are you sitting comfortably? shows.