Written by Gira Patel, Mental Health Counsellor
Many folk in Hong Kong have spent months waiting for the news that online learning is permanently over, or the news that travel without multiple periods of long quarantine just to visit your family for a week is possible.
There is ONE thing that all of us are definitely not eagerly awaiting.
None of us wants that call from the Centre for Health Protection. The call that tells you are a suspected close contact of a positive COVID-19 case and that you are required to be admitted to a government facility or hotel to complete a 21-day Quarantine Order. No one, not even the vaccinated, is immune from that affliction.
That Phone Call
Unfortunately, I received ‘that phone call’ out of the left-field just over 2 weeks ago so I am writing this from my room in Penny’s Bay Quarantine Centre. When I have finished my quarantine, I will have spent almost 3 weeks living as a ‘suspected close contact’ of a positive COVID-19 case. Suspected, but couldn't be factually confirmed. Three weeks of negative saliva testing on four separate occasions. Three weeks of knowing I was never infected nor infectious. I had not even been a ‘close contact’ according to the official definition of unmasked contact with an infected individual for over 15 minutes. Most importantly, I had already received my second vaccination in the two weeks prior to ‘that call’.
Anyway, no point crying over uninfected saliva. I had no choice but to gather my things, say my goodbyes and be dropped off in Penny’s Bay Quarantine Centre. I have to say, the helpful quarantine essentials packing lists available online from previous quarantine survivors (quarantine heroes, in my opinion) were a saviour. After ‘that phone call’, one’s mind can turn into a confused unthinking mess and the ready-made list was spot on with its advice. So do use the essential packing lists. Perhaps even keep things aside and ready to pack in case of short notice.
I was also aware that whilst there is no baggage limit for quarantine, any comparison to Business Class travel stops right there. You are not given any physical assistance to carry any of your things into or out of the centre or hotel. As a result, I had to quickly think about which extra essentials and home comfort items I could pack easily into my bags. I have heard about people taking coffee machines and barbells into quarantine – whatever works for you. What were my small but highest comfort items? The most comfort bang for buck? What snacks would give me nourishment but dopamine-boosts of pleasure too? What supplements and medicines can multi-task to boost strength, abate a headache and aid sleep? I decided my small comforts were a mini speaker and tiny bedside lamp for music and reading, an extravagantly perfumed bar of soap I received for Christmas, a bottle of my favourite gin (with ample tonic and a bottle opener, of course!) and my usual chipped breakfast mug I’ve had since I was at university for my daily drip coffee. A skipping rope, 6-10 metal coat hangers and a socket extension are also smart items.
Like many people who have never been in government quarantine, I had always dreaded it and imagined it would be awful, unthinkable, intolerable. I had watched friends’ Facebook posts showing themselves hilariously demarcating zones of their hotel rooms with folded bath towels into ‘work space’ and ‘Netflix in bed space’ but the videos of the quarantine camps were always more upsetting. Perhaps in a biased way, showing apparently prison-like conditions, lack of basic amenities and minimal comfort. Whether it’s a camp room or a hotel room, self-isolation in any room for 21 days away from the outside world and human touch is abnormal and has negative health impacts. We are social beings and our brains need daily social stimulation for our general wellbeing. The requirement until recently for prolonged hotel quarantine for 3 weeks after returning to Hong Kong from the UK was one of the reasons I had chosen not to travel to see my family there, all of whom I have now not seen in person for close to 2 years. I know myself. I could not deal with 21 days enclosed in a room. I love my daily walks outside. I go at least twice a day and no, I don’t have a dog. I’ve always loved walking and I go as a source of exercise, personal wellbeing, connection with nature and given the type of work I do, it’s my time for thinking, debriefing with Mother Nature (she always listens) and engaging in personal reflection. I enjoy walking too much for it to be worth losing to be locked up indoors for 3 weeks in a row. Only for those I most love in exceptional circumstances, would I do it. Otherwise, I would go insane, surely? I also know that I am an adaptable person though. I have mettle. I have been through personal hardships before and so, how bad could this be?
Arriving in Penny's Bay
And here I am.
Penny’s Bay is certainly not the most welcoming place in the world when you arrive on the bus at 10 pm to see all the rows of candy colour ‘units’ floodlit like a prison motel. But initial impressions fade. Now I have spent some time here, I can say it’s not as bad as everyone made out. Isn’t that always the case? You don’t know what something is like until you have actually tried it yourself? The room is sparsely furnished, but it is clean and functional – there is a desk, 2 foldaway chairs, a small bedside table and 2 single beds - one of those beds can be used to put things on if not used as a bed. If you bring your own pillow, duvet cover, some fabric spray and your own towels (all I strongly advise!), it can actually feel more like a minimalist 3* hotel room. The best thing I realised, to my surprise, was its purpose-built features. In many ways then, it is better than being in a hotel where you may not have opening windows and there is a closed air circuit system (which we now think may be a factor in the quarantine-acquired transmission of COVID-19). A purpose-built facility is made for people to be kept clinically separate, not pampered and relaxed. As it lowers your expectations of massive comfort, you can adjust to having just the basics. So no pampering at Penny’s Bay, but at least there are windows that open out to fresh air - three of them in fact, if you count the bathroom window. Some rooms will have direct sunlight falling in so it’s worth asking at the entry point, if you have the presence of mind, to get one of these rooms with an open view or facing the mountain. A green view is good for our mental wellbeing, after all.
Your rubbish is collected daily from outside your door. You can choose your meals and I would strongly advise people to opt for the Indian food menu if you can handle mild spices daily – it is far more palatable than the standard fare. You can also get food delivered, but it’s easier in a hotel than at Penny’s Bay. Penny’s Bay doesn’t have the luxury carpet and marble finishings of a hotel, but the wood laminate floor is easy to keep clean and for a non-technical person like me, there are no complicated switches and panels to put the AC or lights on. My biggest complaint however is the lack of Wi-Fi and a fridge. There's also a lack of laundry facilities. For a 21-day stay, this is really tough. It sounds spoilt, but when you need a Wi-Fi to maintain your income stream online or you have a health condition and need to store medication in a fridge, it IS a problem. I brought small cartons of UHT milk in with me but I have to consume them every day after opening to avoid spoiling. I’m not used to drinking so much dairy. I don’t mind occasionally washing smalls in the bathroom sink using the liquid detergent I thankfully packed …. but this sink is also where I wash my hands, brush my teeth and do my dishes. By week 3, it’s feeling stale, routine is becoming a chore and I feel ‘icky’, as my son would say.
Physically, I am usually reasonably fit but I have not walked outside for 16 days in a row, not even once a day let alone my beloved twice a day routine. This has thankfully not rendered me insane as I feared, although a feeling of nervous agitation, pallor and physical weakness from lack of daily sunlight exposure has persisted. I make sure therefore to engage in morning ‘self-care’, including making a nice pot of drip coffee after I have done some yoga stretches, a few rounds of skipping rope and some mat exercises such as lunges and squats to keep my legs active. I have lost a bit of weight from stress – not necessarily a bad thing to lose some ‘COVID lockdown podge’. Morning exercise first thing on waking, I’ve found, has kept me grounded and slightly more energized to face yet another day of confinement. I brought a vitamin D/iodine supplement with me for immunity along with zinc (“no zinc, no think”) and magnesium to ease stress, tension and aid sleep – all of which would be naturally prevented with my usual daily walking. In hindsight, some vitamin B complex would have been useful to boost my concentration and memory which seem to be suffering. I sent an email by mistake last week, which, although nothing serious happened is a mistake I don’t usually make. It dented my confidence slightly more than it should and I notice I am now being rather more careful to check my work before hitting ‘send’. I also make sure I don’t spend too long seated or reclining at a time and I try to take phone calls standing and pacing around. Last night, I had cramps in my legs and realized I am dehydrated. It’s easy to drink less water than normal when you don’t have the usual routine and social cues - e.g. water bottle for gym class or meal times with colleagues or family, so I have set some reminders on my phone. So that’s the physical side.
Emotionally, it’s another story. There is no rulebook for how you will (or healthily should) respond emotionally to this situation – it just depends on your personality. And I realise that however you emotionally respond and just try to cope and get through another day is ok and normal. We know that our personality can work against us under stress and this is a seriously stressful situation. My stress response is to internalize feelings of irritation and so I recognized this and wrote down how I felt or I called a good friend and had a good moan and then a laugh over a glass of gin & tonic.
How can I describe this experience in emotional terms? It is a type of trauma. Maybe in years to come, it will be given a clinical definition. But it ticks all the boxes for ‘acute stress reaction’ and possibly, for those who come out of quarantine, there is a degree of post-traumatic stress. I can imagine people with pre-existing mental health issues will find this experience triggering and in these cases, it's essential to reach out to your health professionals to be adequately supported. Although a quarantiner knows how much time they have left before release, processing the anger and shock of being here against your will (and against medical facts!) takes a while. It also isn’t helped by the Quarantine Order stating your stay is ‘until 6th May’ and then realizing that actually, this doesn’t mean, “until 5th May ends and 6th May begins” (as my native English language tells me), rather it means ‘until the whole of 6th May is over, ie. 23:59pm on the 6th May, right before 7th May’). Small semantics and grammar error with huge psychological implication – it essentially means, an extra day. I felt stupid and then cheated when I realized this. Note to self to write to the CHP and advise that Quarantine Orders should state the date and time of release, not just ‘until’.
Sadness and despair come and go – again, of course they would. A feeling of missing out also, not quite FOMO but an awareness that friends are getting on with their lives and I know they feel hesitant to tell me any details in case it upsets me or sounds like gloating. I was very frank with my friends and just said, “It’s ok, life goes on and I will be joining you again soon”. I did have some distressing dreams and again, this is normal – it’s just my brain trying to process something it’s not had to deal with before. It doesn’t make sense and it triggers underlying fears of being helpless and powerless - this is ok. I will talk it through and know I am not going mad. Helplessness and fear, maybe even dread of how to cope once this is over, have been things I noticed in myself during waking hours too.
I have talked that through with fellow quarantiners on the Penny’s Bay Whatsapp group chat. This is another good idea for social connection whilst in isolation – join the Whatsapp chat group to check in on each other, have a virtual happy hour and compare your dinner choices. At Penny’s Bay, we even took photos of ourselves holding up a cocktail at the window with sunset in the background. We ended up calling it ‘Upper Level, Sunset End’ to laugh at how tropical luxury holiday it sounded, but the reality was quite different.
Unless you have actually been in prolonged quarantine yourself, it’s probably not a good idea to tell someone going into quarantine, “Think of it as a 3-week yoga holiday” or “Now you get to relax a bit and watch Netflix all day – lucky you!” Because, whilst some may choose to do some yoga or watch Netflix while in quarantine, it’s not the same as being forced to have to do that because your choice to do pretty much anything else, has been removed. That’s the key issue for me – it’s not the loss of control I grieve, because I accept that loss of control and freedom to some extent as it is also what makes Hong Kong a safe place to live and work. For me, it’s the removal of personal choice and agency. I don’t actually care that I cannot travel overseas at the moment – but I grieve the loss of choice to travel when I want. I grieve the loss of choice of how many people I can eat dinner with, without a plastic separation screen. In terms of agency, I have no problem speaking up for myself or getting help from other people, but having to be completely dependent on the ‘outside world’ for something as simple as a data SIM card (because there is no Wi-Fi here and I still have online Zoom consults to do with my patients) is frustrating and humiliating. This place was purpose-built for people in quarantine, but perhaps with the assumption that people disconnect from their daily lives and just sit and quarantine quietly here. We don’t. We still feel, we still need, we still have to maintain a sense of dignity and purpose and by having a complicated approval/ authorization system to get even the most basic items sent in, you reduce human beings to ‘request from room 130 11 approved’.
Managing my mental health
So, how did I, a mental health professional, manage my emotional experiences? It’s been tough – and I’ve been trained over 20 years in how to deal with healthy and unhealthy psyche in myself and those I treat. But I am also human. I react. I feel. I found that having a routine does help me stay more grounded and calm – just as it does in normal life. I have been able to continue working online and seeing my patients, but if I wasn’t working, I would make sure I was doing something cognitively stimulating, not just watching TV or Netflix all day. I would want to come out of quarantine with some kind of personal achievement. So I brought a couple of books that I can realistically finish and I have signed up for online classes (e.g. Masterclass) and some of my old university alumni webinars in the evenings. I already learn Japanese for fun and I have been able to keep attending my weekly lesson online – my fellow students found it fascinating to see my quarantine room and it was useful language immersion for me to describe my room details in Japanese! Lots of ‘wabi sabi’ in Penny’s Bay, there is. I keep a journal in my normal life and a paper diary for my daily schedule and to-do’s and I continued this in quarantine. It made me feel ‘normal’ and with purpose, even if my Saturday schedule was, ‘Exercise, coffee, read, Japanese homework, rest’, it’s ok to be a bit loose on the timing. I treated myself to a couple of online purchases and had them sent to my home so I have something to look forward to when I am out. I try to meditate for brief periods when I feel a surge in emotions – usually something like anxiety or dread. I breathe it away and know it’s a completely normal fight-or-flight response to a situation where I feel uncertain and lacking control and my brain is just wanting me to be safe from what it thinks is a dangerous situation. My counselling work of others during quarantine has reminded me how resilient I must be to keep offering guidance and comfort to others even though I am currently facing this personal challenge. And I know I am not alone, I am missed and loved - this helps enormously.
My release is in sight. I made it this far and I know this experience won’t define me. It will be a psychological injury that I will heal from over time, bit by bit and my experience has been testing yet enlightening. For this reason, I decided I can put myself forward as a quarantine counsellor because although I am not an expert in this, I can at least relate to people in distress during and after quarantine. I expect I will emerge feeling jaded and unsure, perhaps mistrustful and needing to cocoon again just until my sympathetic nervous system calms down and I feel ok. I know this is normal. After an acute stress, you will naturally continue to feel fearful, indecisive and hypersensitive including angry, maybe even vengeful. My colleagues, family and friends are aware and will be guided by me as to what I want from them or myself. I know I want to return to work but I also feel a longing to just spend time in my home, touching my things and re-integrating back into ‘my’ normal. I will take my time. I am also acutely aware that for my loved ones, my incarceration has been traumatic and I want them to feel able to tell me about their distress seeing me go through this, feeling helpless to protect me and I want them to know that it’s not all about me and my prolonged quarantine story; they have a quarantine story too. They might not be ok too. They are survivors too.
“This too shall pass” as the quote says. How true that is. One day, I hope this will be a bizarre, funny story I share over dinner … “Hey, remember the night the lady in a Hazmat suit knocked on the door to drop me off behind Disneyland? It gets better, the address was ‘Fantasy Road’!”