“Fold down the what?”

She lives 2 miles away in a very nice senior living community, and until four weeks ago, had rarely been away from my father. My dad did everything from run their dishwasher to change channels on the TV. But on February 23, he suddenly collapsed and went from the ER to a nursing home, 2 miles in the other direction. He suffers from a still-undiagnosed condition that's most likely Parkinson’s disease.

In a previous world—like two weeks ago—I would have run over and quickly rebooted her phone. She just wanted to talk to my father—her husband of 60 years. Both my parents have been isolated since March 12 when the Centers for Disease Control and Prevention issued guidelines urging people to restrict visits to long-term care facilities. Since then, my mom has been navigating the TV remote, laptop, and iPhone mostly on her own. But she needs social connections—particularly with family—like she needs oxygen. If anything goes awry with email or her iPhone, it feels like an emergency.

“Take your iPhone to the lobby,” I texted, and then got in the car. I guess I was thinking that the senior care facility staff would let me fix my mom’s iPhone. From a safe distance. Of course, what I should have done is call and ask a staff member to fix her phone instead. But it didn’t occur to me. It’s been a crazy time, and none of us are thinking clearly. So I was brought up short, however foolishly, when I reached the facility and saw a bright red “Stop” sign on the door.

This has become life for many of us with elderly parents and grandparents in this no-visitor, keep-your-distance world. It makes sense in our collective effort to slow the spread of the coronavirus pandemic and protect the people most vulnerable from the disease. In China, almost 15 percent of people 80 and older and 8 percent of people 70 to 79 died from Covid-19. No one wants this virus to infest senior care facilities in the U.S. Or anywhere else.

But at what cost? Social isolation and loneliness can also lead to health problems. It’s entirely possible—even probable—that over time, the forced isolation would keep her safe from the coronavirus at the price of a deterioration in other aspects of her health.

“Loneliness and weak social connections are associated with a reduction in lifespan similar to that caused by smoking 15 cigarettes a day,” Vivek Murthy, a physician and former U.S. Surgeon General, wrote recently. “Loneliness is also associated with a greater risk of cardiovascular disease, dementia, depression, and anxiety.”

When it comes to the coronavirus pandemic, geriatrician and epidemiologist XinQi Dong told me, we really should be focusing on “the unintended consequences of social distancing” as much as the disease itself.

I called Murthy to discuss the topic more. The 19th surgeon general, Murthy has turned his focus recently to the health implications of isolation. (His book, Together: The Healing Power of Human Connection in a Sometimes Lonely World, is scheduled for publication next month).

Loneliness can affect the elderly on three levels, Murthy said. First, it can compound physical issues that they might already be dealing with by causing chronic stress, which “may significantly tax their bodies physically.” Second, isolation can have practical health implications: they may not have anyone to help them get to doctor’s appointments or remind them to take their medication. And third, it can affect them emotionally, especially if close friends have passed away or if they are physically limited by, say, arthritis, and cannot get out easily to visit people.

Like all of us, the elderly need a variety of relationships to ward off loneliness. They need deep connections to people who know them well (a spouse/partner, family member, or very close friend), connections to friends on a social level (e.g., friends with whom they dine regularly), and a connection to a community (church or groups with shared interests such as knitting or crafting). All three types of relationships are important, and even if a person has two of these connections but not the third, Murthy said, he or she will experience loneliness.

My parents—and other elderly in lockdown because of the coronavirus pandemic—are now missing at least one of these connections, and probably more.

Until the lockdown on March 12, my mom visited my dad daily in the nursing home. Both my parents are still lucid, so they fully feel the pain of separation and isolation. Luckily, I was able to show them both how to use FaceTime before I left. I assured my mom that I would bring necessities and encouraged her to socialize with the other residents. And to FaceTime us. “Just push the green button with the movie camera icon,” I said.

“The what?”

They would be OK, I reasoned. My dad was scheduled for release to the retirement community in less than two weeks. He had worked hard in physical therapy at the nursing home’s rehab center to regain strength to help overcome some of his Parkinson’s-like symptoms. Still, he would transition home through the assisted living facility (attached to the retirement community). At that point, I thought my mom would be able to visit him daily there—without even going outdoors.

A few days later, the senior living facility had to prohibit residents from socializing among themselves for their safety. They also closed the dining room. Meals would be delivered to their apartments, where they would eat alone.

My mom FaceTimed me. “It’s hard,” she said, sounding resigned, “but probably for the best.”

I had to remind myself of that, too.

I also reminded myself that my parents are lucky. Although they are unable to physically see me or anyone else in the family, their respective facilities are staffed by caring aides, and my mother has lived in the retirement community long enough to have formed bonds with many of them.

After I dropped my father off at the assisted living facility (and sobbed as I said goodbye), a friend whose husband is an ER doctor in a Virginia hospital tried to cheer me up. She pointed out that by accepting isolation, the elderly and their caregivers are actually performing a heroic act. By remaining healthy (hopefully), they are keeping hospital ICUs from inundation. The bravest generation is, in essence, making one final sacrifice.

“Anyone who can stay out of the hospital is making a true contribution,” she said, “and there’s value in that.”

So how long must they perform this heroic act? And really, how long must any of us remain isolated, waking up each day to more of the same, like Bill Murray’s character in the movie Groundhog Day?

I’m reminded of an aphorism: We can live through hell if we know what day it ends on. But with coronavirus, when is that day?

These days, that’s the question that is increasingly being asked. David Katz—a public health physician and the founding director of the Yale-Griffin Prevention Research Center—stirred controversy last week when he proposed gradually loosening restrictions on low-risk individuals while still protecting higher-risk individuals in an effort to build herd immunity to the virus. In an interview, he told me that he was driven to develop his plan in part by concern for his parents, who are in their 80s. He said his mother’s greatest fear is that she will die from something—coronavirus or really anything—before she can hug her grandchildren again.

So in the meantime, the challenge facing all of us is to retain emotional connectedness while remaining physically separated.

“Really it’s about communication,” Dong said. “It comes down to basics. The elderly are no different from other people who are isolated. They want to feel loved and appreciated and cherished. Sometimes a small gesture really is a wonderful thing. Kind words can go a long way to insure that emotional connectedness. Really focus on their needs and be able to meet those needs.”

Phone calls are good but can be confusing for those with cognitive loss and next-to-impossible for those with hearing loss, like my mother. FaceTime, Skype and Zoom video calls are good too because they bring a sense of visual connectedness, but only if the elderly are tech savvy or have help when technology goes awry.

“We don’t focus enough on just how important and powerful connection is for the health and well-being of the elderly,” Murthy said. “If we recognize how powerful it is, then I think we would prioritize enabling social connection in these kinds of facilities.”

This means ensuring that seniors in isolation have access to technology (smartphones, iPads, computers, internet access) as well as staff who can teach, help and troubleshoot.

Beth Baker, a journalist and author of two books on aging, suggests reverting to old-fashioned lines of communication—letter-writing and sending pictures, which can be particularly important to loved ones who suffer from dementia. Sending homemade cookies or flowers is good too, if senior living facilities allow them in this age of coronavirus.

“An advantage to using non-digital and non-electronic ways of communication is that the person can keep the letter and go back and read it again and again,” she pointed out.

Baker is herself now restricted from seeing her 6-year-old granddaughter, who lives 2 miles away. So the two have become pen pals.