Dear Doctor:

I live alone, and stay-at-home orders have been hard. I've heard people say that being lonely is really bad for your health, and now I believe them. What problems can it cause? Also, I'm going to start seeing friends and family again. What can we do to stay safe?

Dear Reader:

While it's easy to understand the link between loneliness and depression, anxiety and other psychological ills, the connection to physical effects on the human body can seem like a bit of a stretch. However, ongoing research has shown that loneliness, as well as the social isolation we have all been asked to practice for several months now, do, indeed, take a physical toll.

Individuals who experience chronic loneliness have been found to be more vulnerable to a number of diseases and conditions than are people who enjoy strong emotional connections. These include an increased risk of developing heart disease, metastatic cancers and having a stroke. Older adults who are socially isolated are also more likely to become cognitively impaired or to develop dementia, including Alzheimer's disease. Researchers have even tied loneliness to an increased risk of premature death. Adults in midlife who are chronically lonely are 25% more likely to die prematurely. Older adults, whose social connections have shrunk due to factors such as retirement, have double the risk of premature death as those who are socially connected.

You're not alone in being determined to rekindle your social contacts. We've all seen an increase in the number of people returning to a semblance of normal life. The challenge is that each and every contact with someone outside of your quarantine circle becomes a calculated risk. This is because of the highly transmissible nature of the novel coronavirus and the existence of asymptomatic carriers, who can unknowingly pass along the virus. Still, several months into the pandemic, the medical community has gained a clearer understanding of mitigation measures. As a result, the focus has begun to shift from strict quarantine behavior to risk management and mitigation.

Before we go any further, we have to repeat that any contact with people outside your quarantine circle puts you at risk of infection. The best way to lessen that risk is to stick to small gatherings that are held only outside -- never indoors. And it's crucial to maintain the social distancing guidelines we are all now familiar with. That means tables or chairs or picnic blankets spaced at least 6 feet apart. No handshakes or hugging, no matter how tempting it may be. Everything about the gathering should be BYO -- bring your own. That includes food, drink, condiments, disposable plates, cups and utensils, and a large garbage bin for safe disposal. Wear masks except while eating or drinking. No sharing of food or drink or condiments. If things get lax and you become uncomfortable, make a polite excuse and leave. This is all a far cry from the way we visited with each other in the pre-COVID-19 world, but the potential consequences of skipping or relaxing even one of these steps are too grave.

Elizabeth Ko is an internist and primary care physician at UCLA Health. Ko earned her medical degree from the University of Miami School of Medicine. She then moved to Providence, Rhode Island, where she completed her residency and chief residency in internal medicine with a focus on primary care. Ko lives in Los Angeles with her husband and their daughter.

Eve Glazier, M.D., MBA, is an internist and an assistant professor of internal medicine at UCLA Health. Glazier earned her medical degree from Columbia University College of Physicians and Surgeons. She completed her internal medicine residency and chief residency at UCLA. Glazier lives in Los Angeles with her three daughters.

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