Most Americans are struggling right now with some level of fear, anxiety, and stress.
Human beings thrive on interaction, and our cities and public spaces are designed to facilitate social connection. But with the places at the center of shared life — schools, churches, restaurants, small businesses — closed, people are cut off from the usual outlets for coping in crisis.
History warns us that mental health is at risk for decline in the midst of a pandemic, especially given the anticipated vast negative economic consequences. For example, the Great Recession led to increased psychological distress, depression, and anxiety, while multiple recent outbreaks including SARS, H1N1, and Ebola were associated with stress and PTSD. When isolated and lonely for any reason, people are more likely to develop depression and anxiety, and even have a higher risk of premature death. Promoting well-being during the COVID-19 pandemic, then, should be a priority.
Spending time outdoors, with adjustments to how space is used, is a sustainable, proven approach to preserving mental health. Congregating in groups is no longer allowed, but spending time outside can still be a safe, practical way to buffer the loneliness, stress, and anxiety of new extreme social distancing measures.
Even places with the most comprehensive restrictions include provisions to spend time outside. California was the first state to order residents in seven counties to stay home except for essential reasons, which includes going outdoors for “walking, hiking, or running.” France allows people to leave for exercise, but only if they are alone.
When spending time outside, there is more space to spread out and maintain a safe distance from one another. COVID-19 survives up to 24 hours on cardboard and 72 hours on plastic. Compared with being inside, there are fewer man-made surfaces for the virus to survive on outside. Further, the virus quickly dissipates in open air.
Perhaps the greatest benefit of being outside is contact with nature. Trees, parks, greened vacant lots, trails, and woods are associated with definitive mental health benefits such as reduced feelings of depression and anxiety, improved mood, and increased general well-being. These links are thought to be due, in part, to lower stress, attention restoration, and physical activity. Even seeing other people outside — at a distance — may help foster a needed sense of social connection.
Enjoying nature may entail walking around a neighborhood gazing at the trees, sitting in a backyard, gardening, or visiting parks. Most national parks remain open, while many state parks have closed to protect employee health. In Philadelphia, public parks and playgrounds are open. While nature is everywhere, it is not evenly distributed, with lower-resourced neighborhoods often having less tree cover and fewer well-maintained parks. COVID-19 has highlighted many long-standing social and economic inequities, and nature is no exception.
In order to safely leverage public outdoor space and nature during COVID-19, social distancing must be maintained. First, if people are sick with fever, cough, or difficulty breathing, or if they are under quarantine for any reason, they should not go outside and should follow CDC guidelines regarding staying indoors. Second, people who are able to go outside safely must do so only with those they live with, in order to maintain silos of physical contact.
While outside, people should maintain the recommended six feet of space between their small group and others, and not touch anything, for risk of rendering playground equipment unusable. Finally, hand washing for 20 seconds before and immediately after going outside, while taking care to avoid touching the face, remains important.
In addition to going outside, and for those who are unable to do so, there are other ways to preserve mental health, including connecting virtually with friends and family via FaceTime, Google Hangouts, and GroupMe. Journaling may be a way to process emotions and stress. And, of course, anyone with feelings of depression, anxiety, or self-harm should seek professional help.
In the short term, people who can safely get outside should aim to do so daily to help manage the overwhelming uncertainty of this time. Then once the pandemic is over, let’s not forget how nature helped us cope. Health care, government, education, business, and criminal justice can incorporate nature into policies and practices aimed at healing individuals and communities.
Several estimates suggest that extreme social distancing measures may be in place until July or August. As the initial shock of disruption settles into the new, albeit temporary, normal, nature may emerge as a vital, accessible, and safe tool to improve well-being and promote mental health.
Eugenia C. South is an assistant professor of emergency medicine at the Perelman School of Medicine at the University of Pennsylvania. @Eugenia_South. Raina M. Merchant is an associate professor of emergency medicine at Perelman. @RainaMerchant