State responsibilities to protect us from loneliness during lockdown

: One consequence of the lockdowns that many countries have introduced in response to the COVID-19 pandemic is that people have become more vulnerable to loneliness. In this contribution, I argue that even if this does not render lockdowns unjustified, it is morally incumbent upon states to make reasonable efforts to protect their residents from loneliness for as long as their social confinement measures remain in place. Without attempting to provide an exhaustive list of ways in which this might be done, I identify four broad measures that I believe many, if not most, states ought to take. These require states to (i) help ensure that people have affordable access to the internet, as well as opportunities for learning how to use this medium so as that they can digitally connect to others; (ii) help people to have harmonious and rewarding intimate relationships; and try to make (iii) non-human companionship as well as (iv) various non-social solutions to loneliness widely available. ABSTRACT. One consequence of the lockdowns that many countries have introduced in response to the COVID-19 pandemic is that people have become more vulnerable to loneliness. In this contribution, I argue that even if this does not render lockdowns unjustiﬁed, it is morally incumbent upon states to make reasonable efforts to protect their residents from loneliness for as long as their social conﬁnement measures remain in place. Without attempting to provide an exhaustive list of ways in which this might be done, I identify four broad measures that I believe many, if not most, states ought to take. These require states to (i) help ensure that people have affordable access to the internet, as well as opportunities for learning how to use this medium so as that they can digitally connect to others; (ii) help people to have harmonious and rewarding intimate relationships; and try to make (iii) non-human companionship as well as (iv) various non-social solutions to loneliness widely available.


INTRODUCTION
H umans, like many other mammals, are social creature through and through. Whilst many us will have been at least implicitly aware of this, especially those who suffer from occasional if not chronic loneliness, the lockdowns that various countries have introduced in response to the COVID-19 pandemic have made it vividly clear to almost everyone within these societies. Whether it is because people are not allowed to meet up with close friends and relatives, or perhaps because they are missing face-to-face interactions with colleagues at work or with acquaintances and strangers in shops and bars that have been forced to close, the social costs of lockdowns are widely and intensely felt.
[ 2 ] For many, this is a price worth paying in order to protect vulnerable populations from a virus as contagious and deadly as COVID-19 including the elderly, heart-patients, and those with respiratory diseases. In this contribution, I will not seek to evaluate this claim even though I am sympathetic to it. What I want to do instead is argue that even if lockdowns are justified in order to reduce the spread of viruses such as COVID-19, it is morally incumbent upon states to make reasonable efforts to prevent and alleviate any feelings of loneliness that this type of confinement might cause or amplify among their residents. Without attempting to provide an exhaustive list of ways in which this might be done, I identify four broad measures that I believe many, if not most, states ought to take. These require states to (i) help ensure that people have affordable access to the internet, as well as opportunities for learning how to use this medium so as that they can digitally connect to others; (ii) help people to have harmonious and rewarding intimate relationships; and try to make (iii) non-human companionship as well as (iv) various non-social solutions to loneliness widely available.
Before vindicating these claims, it is important to ask: Given that many countries have recently started easing their lockdowns (Zurcher 2020), should we still be concerned about how any (heightened) feelings of loneliness that people might suffer under them ought to be addressed? I think so for two reasons. First, many scientists are expecting new waves of COVID-19 infections until populations have either achieved herd immunity or until a vaccine has been developed and been made widely available (Cyranoski 2020), which is likely to result in a reintroduction or a re-strengthening of social confinement measures. Second, even if this particular virus will soon be eradicated, similar infectious diseases might emerge in the future that will cause states to take similar measures (Brulliard 2020). To be prepared for these eventualities, it is important to know what states are morally required to do in order to protect their residents from loneliness during lockdown.

LONELINESS PROTECTION DURING LOCKDOWN AS A STATE RESPONSIBILITY
Why think that states have moral duties to protect their residents from loneliness during lockdown at all? Some critics might maintain that even if some of the harmful effects of lockdowns ought to be addressed, states should focus entirely on addressing the economic damage that is being caused by this type of confinement given that, within many countries, a [ 3 ] large proportion of firms and shops are struggling to survive and thousands if not millions of workers have either already been laid off or are at risk of losing their job (BBC 2020). The answer, I believe, is that although protecting the economy ought to be a policy priority, our interests in being free from loneliness are weighty enough to impose a moral duty upon states to spend part 1 of their budget on offering loneliness protection, especially when we consider that such protection has indirect economic benefits (more on this below). The reason for this lies in the fact that loneliness, or the unpleasant feelings that people have when the number of social relationships that they desire is not realized and/or when the specific types of social relationships that they desire do not exist (cf. de Jong-Gierveld 1987, 120), can have a host of serious consequences for a person's mental and physical health. To be sure, in many cases where people feel lonely -as most of us will at certain points in our lives, such as after a romantic break-up or after a relocation to a different town or city -they manage to overcome these feelings after a while and suffer no significant harm (De Jong Gierveld and Fokkema 2015). Much like feelings of thirst and hunger, problems start to arise only once people's loneliness becomes persistent, as chronic loneliness has been found to contribute to e.g. depression (Cacioppo, Hawkley, and Thisted 2010); dementia (Holwerda et al. 2012); and poor physical health (Aanes, Mittelmark, and Hetland 2010), with some medical experts arguing that its health effects can be compared to those of smoking 15 cigarettes a day (Novotney 2019).
These outcomes are clearly very serious and, it seems, serious enough to deprive people of a minimally decent life, which has led Kimberley Brownlee (2013) to argue that we have a human right against social deprivation understood as a fundamental moral right that all of us possess and that is necessary for the realization of a minimally decent human life. On Brownlee's account, this right entitles us to adequate opportunities for cultivating social relationships when we are still capable of this and, to the extent that this capacity is temporarily or permanently lost, the provision of minimally decent companionship by private individuals and, if necessary, the state. As she goes on to explain, these entitlements are violated when, for instance, inmates are put in long-term solitary confinement, as well as when people are held in long-term quarantine when this is not strictly necessary, and when those who cannot leave their homes due to illness or disability do not receive regular visits (Brownlee 2013, 207-8).
[ 4 ] It is not my aim here to assess Brownlee's claim that our social interests are weighty enough to ground a human right against social deprivation as opposed to an ordinary moral right (which is how those who believe that recognizing additional human rights would unduly weaken the human rights-currency might argue such a right ought to be seen). Neither will I assess her contention that our social interests can potentially give us a moral claim against the state to provide us with decent human companionship when we are temporary or permanently unable to address our own social needs as opposed to simply a negative right not to be interfered with in most cases 2 where we try to socialize or associate with others, or where others try to do so with us (which for those who are more libertarianminded may be all that we can be morally entitled to within this area). All I assume for the remainder of this contribution is that, even if the lockdown requirements that many states have introduced in response to the COVID-19 pandemic are justified, our psychological and physical interests in being free from loneliness (see the penultimate paragraph) are strong enough to impose a moral duty upon states to make reasonable efforts to prevent and alleviate any loneliness that their residents might suffer under these requirements given that they are responsible for having introduced them. On this view, even when such duties would not have existed had people's opportunities to socialize not been compromised by their state-or simply not in such a far-reaching way-the fact that their state has chosen to implement a lockdown and, in so doing, to interfere with their ability to maintain existing social relationships and forge new ones, means that the relevant state can be morally expected to offer loneliness protection when this is possible at reasonable cost. (An analogy might be drawn here with incarcerating people; even if incarceration can be justified for those who have committed serious crimes for which they can be held responsible, and even if states lack duties to facilitate visits between friend and relatives outside of prison, once they put someone behind bars for a significant amount of time, they acquire a moral duty to make accommodations that allow the prisoner to be visited by any friends and relatives that she might have.) So far, I have suggested that, although implementing policies that protect people from loneliness during lockdown leaves fewer resources for (directly) addressing the negative economic effects of this type of confinement, states should spend part of their budget on offering loneliness protection nonetheless. What I want to add here is that this is especially plausible once we take into account that low levels of loneliness have DE VRIES • STATE RESPONSIBILITIES TO PROTECT US [ 5 ] indirect economic benefits. In the UK, for instance, it is estimated that ill health associated with loneliness costs employers £2.5 billion every year (HM Government 2018), whereas in the US, Medicare is estimated to spend annually approximately $134 more for each socially isolated older adult compared to an older adult who is not socially isolated (AARP Foundation 2018).

FOUR ANTI-LONELINESS MEASURES
Of course, in order for states to have moral duties to protect their residents from loneliness under lockdown, it must be possible for them to do so, assuming that ought implies can. My aim in this section is to show that providing loneliness protection under lockdown is possible, and to identify four broad measures that I believe many, if not most, states ought to take in order to do so (which are not meant to be exhaustive).

Providing affordable internet access and raising internet literacy
The internet has become one of the main communication platforms over the past decades and its use in maintaining social relationships has been found to be capable of reducing loneliness among various groups of users, including elderly populations (Nowland, Necka, and Cacioppo 2018;Cotten, Anderson, and McCullough 2013;Sum et al. 2008). Under a lockdown, having access to the internet is especially valuable because it allows people to see one another using a webcam, which may not be possible otherwise without violating the requirements of the lockdown. However, there remain many, predominantly rural, areas where local residents have no, or only poor, internet access, which is a problem that affects even comparatively wealthy countries such as Germany (Mitsis 2019). Another common problem is that people simply cannot afford to use the internet. Apart from the fact that they require a device with internet access to do so, such as a computer or smart phone, the fees for using the internet might be prohibitive (Reglitz forthcoming,(10)(11). Still another problem is that some people lack the skills to use the internet or to do so comfortably, which is an issue that mostly affects elderly individuals (Hunsaker and Hargittai 2018). In order to protect these groups from loneliness during lockdown, it is imperative that, resources permitting, states improve internet coverage within any (populated) 'WIFI-deserts' within their territory, as well as that they subsidize internet access for those who cannot afford it, and that they teach internet literacy and broader computer skills to those who lack them (e.g. by sending accessible information brochures to elderly populations and by opening special helplines for those who struggle to use the internet or to connect to it) (cf. Hunsaker and Hargittai 2018, 3944).
Some might say that the mere fact that people are at greater risk of (intense) loneliness during lockdown does not justify the price tag of these measures given that lockdowns are temporary. My rejoinder is twofold. First, given the potential psychological and physical harms of loneliness as detailed within the previous section, and given that lockdowns can take a long time especially for at-risk groups-within many countries, for instance, care homes residents have been denied visits from friends and relatives for weeks if not months during this first COVID-19 wave-it is doubtful whether the temporariness of lockdowns provides sufficient reason against state attempts to facilitate online contact. This is so especially when we consider that future of waves of COVID-19 infections are expected to take place that are likely to be accompanied by a reintroduction or a retightening of lockdown requirements (see the introduction).
But even when our interests in being protected from loneliness during lockdown are not in and of themselves sufficiently strong to impose moral duties upon states to provide their residents with affordable internet access and to offer guidance on how to use it, and this brings me to the second rejoinder, there are further reasons for introducing these measures that together with the ones just mentioned appear to be decisive. These include, but are not necessarily limited to, the fact that the internet is an increasingly important tool for providing health care services to elderly populations as well as those with chronic illnesses (Yin et al. 2016); the fact that its availability throughout a country helps to reduce economic inequalities between urban and rural areas (Prieger 2013); and, as Merten Reglitz (forthcoming) has recently argued, the fact that internet access has become indispensable in our day and age for making our voices heard to fellow citizens and to policy makers. Now, the extent to which states can be expected to provide their residents with (affordable) internet access and support on how to use this medium will vary across societies depending on, among other things, the level of wealth within society. Whereas it might be prohibitively expensive for third-world countries and developing countries to provide affordable internet access to all residents and to teach internet skills on a large scale, other countries such as those in Western-Europe, Scandinavia, and North-America may be able to do so as long as there is the political will. I just want to add here that when states have the wherewithal to realize affordable internet access for all along with high levels of internet literacy, it might be incumbent upon them to go beyond these goals by helping to make more immersive social experiences available to internet-users insofar as these offer better loneliness protection. One way of doing so may be to give (some) residents free or discounted access to so-called 'telehaptics'. These are internet-operated devices (e.g. pillows) with sensors and effectors that mimic the sensation of interpersonal physical contact or what is sometimes referred to as 'social-touch' by allowing a person to cause the device of someone in a different physical location to warm up and exert pressure (Huisman 2017). Another option may be to offer free or discounted access to VR-technology that allows people to interact with their loved ones within online virtual environments, possibly with facsimile avatars of themselves that can be created these days through the use of 3D printers (Coburn, Freeman, and Salmon 2017). By providing users with three-dimensional experiences and instantly copying their movements including their facial expressions, this type of technology not only improves the social quality of people's interactions but also offers them new opportunities for socializing, for example by allowing them to play immersive virtual versions of board-games such as chess and Settlers of Catan (Webster 2017).

Helping couples have harmonious and rewarding relationships
Another measure that I believe many, if not most, states ought to take in order to protect their residents from loneliness under lockdown is to help their residents have harmonious and rewarding intimate relationships. Even when people are living with a partner, research suggests that they will often feel lonely nonetheless when the quality of their intimate relationship is poor (Tilburg, 2007, 33). This is especially problematic during a lockdown as the social restrictions that apply during lockdowns might make it illegal for people to meet with friends and relatives. Apart from the fact that this may render it difficult for them to fill (part of) the social void that is left by their dysfunctional intimate relationships, it might prevent them from discussing their relationship sorrows with others insofar as they are unable to call their friends or relatives at home without being overheard by their partner or running the risk thereof.
In order to address this problem, governments could help to familiarize their residents with some of the insights that social psychologists have gathered into how dysfunctional relationships can be avoided and, insofar as such relationships have already materialized, healed. 3 For example, they might spread this information by launching social media campaigns and by creating websites, none of which needs to be particularly expensive. Another important measure is for them to offer affordable online relationship counselling services to couples. Besides helping people to improve the quality of their intimate relationships, such measures may help some couples to prevent their dysfunctional relationships from degenerating into abusive ones. (Whilst preventing domestic abuse is always important given the impact of such abuse upon the victims, notice that this is so even more under lockdown because of the already mentioned restrictions that people suffer on their freedom of movement and freedom of association, apart from the fact that the stress of lockdowns combined with the increased time that couples spend together have been found to raise the prevalence, frequency, and severity of intimate partner violence within various countries.) 4

Making non-human companionship more widely available
Both measures discussed so far are concerned with human social interaction. However, there are good grounds for thinking that many, if not most, states should also try to prevent and alleviate loneliness during a lockdown by making social interaction with non-humans more widely available. One way of doing this is for them to encourage people to have pets, which have been found to reduce feelings of loneliness (e.g. (Satoshi Iwaki et al. 2008;Powell et al. 2019). In addition, they might require care homes to allow their residents to have pets insofar as they are able to look after them, or simply encourage these places to allow pet ownership, possibly in exchange for financial benefits. Still another option would be to require, or simply encourage, care homes to have communal pets (insofar as domesticated animals do not contribute to the spread of the COVID-19 virus). The advantage of such pets is that all residents would have access to them including those who are incapable or unwilling to look after a pet personally.
Admittedly, because of allergies, financial constraints, or simply an indifference to (if not a positive dislike of) pets, interacting with pets is not for everyone. To cater to these individuals, it looks like, resources permitting, there are strong reasons for states to subsidize the purchasing of social robots, which are already widely used within Japan to provide companionship to elderly people (Sone 2017) and which have been shown to reduce loneliness among this group as well as among individuals with dementia specifically (Banks, Willoughby, and Banks 2008;Kanamori, [ 9 ] Suzuki, and Tanaka 2002; Mordoch et al. 2013;Barrett et al. 2017). Such robots may take the form of animals such as the therapeutic seal Paro which has been a global best-seller (Dapin 2019). However, they might also take the form of humanoids whose appearance and behavior is becoming increasingly life-like; for example, the robot Nadine that is being developed at Singapore's Nanyang Technological University is not only largely indistinguishable from a real human but can read stories, play games, and adapts automatically to people's emotions (Mulligan 2017). Now, it is true that the use of social robots raises certain challenges. Ones that are often mentioned include the fact that this type of technology might undermine people's privacy (Sharkey and Sharkey 2012;Sparrow and Sparrow 2006), and the fact that people with dementia might not realize that they are interacting with an entity that is not a real human or a real non-human animal (Vandemeulebroucke, Dierckx de Casterlé, and Gastmans 2018, 19). Whereas a detailed discussion of these objections is beyond this article's scope, I want to make two observations about them.
The first is that even when they identify genuine problems, there are ways in which states can address these, for example by imposing stringent privacy requirements upon the design of social robots and by requiring care workers to (try to) make clear to people with advanced dementia that their social robots are not real humans or non-human animals. Another measure that they might take is to encourage people to specify in an advance care directive whether they wish to be protected from loneliness with social robots should they reach a stage of cognitive impairment where they can no longer competently decide about this and, if so, whether they want their companionship even if they were to lose the ability to recognize them as robots. Whilst this measure would not prevent individuals from mistaking their social robot for a real human or a real non-human animal, it does seem to reduce any moral problems with such misrecognition. The second observation is that, even if measures like the ones just mentioned do not entirely eliminate the problems under consideration, there is a strong case to be made that this is an acceptable price to pay given our strong psychological and physical interests in being protected from loneliness as discussed within the previous section.

Making non-social solutions to loneliness more widely available
Which brings us to a fourth measure that I believe many, if not most, states ought to take in order to protect their residents from loneliness under lockdown. This measure does not seek to prevent or alleviate feelings [ 10 ] of loneliness through social means as the measures discussed within the previous subsections do, but rather through non-social means. To see how this works, it needs to be recalled that loneliness does not consist of social isolation or the objective state of having few social contacts. What it consists of instead is a subjective state that exists when there is a disutilityinducing misalignment between people's realized social relationships and the number and/or types of social relationships that they desire, which explains, among other things, why it is possible for some of us to live a highly seclude life without feeling lonely, as well as why some of us feel lonely despite having many social contacts of varying degrees of closeness (Wenger et al. 1996, 333).
As this widely-used definition suggests, one way in which people can be protected from loneliness that does not involve helping them change any objective features of their social network is to help them appraise their existing relationships more positively so that they become more satisfied with the relationships that they already have. States might do this, for instance, by subsidizing the production of gratefulness workshops for television and online media that help people to feel (more) grateful towards their friends and relatives (cf. Caputo 2015). Admittedly, it would be problematic for someone to feel grateful towards a person who is persistently abusive towards her given that she will often be best off by leaving such a relationship, and states should help their residents to recognize abusive relationships through the education system and possible media campaigns. However, as far as decent human relationships are concerned, it looks like there can be considerable value in positive re-appraising such relationships, especially under lockdown given that lockdowns greatly constrain our opportunities for meeting new people in person and, consequently, our opportunities for establishing new relationships.
Another non-social way in which states may protect their residents from loneliness during lockdown involves helping them address the negative feelings that are an inherent part of feeling lonely (were someone to believe that her social relationships are deficient in terms of their quantity, quality, and/or depth whilst being completely undisturbed by this, it would be difficult to recognize this as an experience of loneliness.) For example, states might fund the production of mindfulness workshops for television and online outlets, as there are studies that suggest that mindfulness can reduce negativity and, in so doing, help to mitigate feelings of loneliness (Creswell et al. 2012;Cacioppo et al. 2006).
[ 11 ] CONCLUSION I have identified four broad measures that I believe many, if not most, states ought to take in order to protect their residents from loneliness during lockdown. These measures require them to (i) help ensure that people have affordable access to the internet, as well as opportunities for learning how to use this medium so as that they can digitally connect to others; (ii) help people to have harmonious and rewarding intimate relationships; and try to make (iii) non-human companionship as well as (iv) various non-social solutions to loneliness widely available. Some readers might find these measures under-and/or over-inclusive and/or reject some of the more specific policy proposals that I have made. Even when this is the case, I hope to have shown that there are ways in which states can protect their residents from loneliness during lockdown, and that there are good grounds for thinking that they have moral duties to implement at least some anti-loneliness measures. NOTES 1. How large this part is will vary among societies and depends on, inter alia, how well a country's national health care sector can deal with the COVID-19 outbreak; how much its economy is suffering; and how affluent the relevant country is. 2. I say 'most cases', because there are cases where it does seem appropriate to constrain people's freedom to socialize or associate with others. One might think ones where people have sexually assaulted or stalked someone and states impose a restraining order on them to come near the victim. 3. For an helpful introduction to this field, see Bradbury and Karney (2019). 4. See Taub (2020).