Just as we judge trends of the disease by what happens in other countries, those in relationships should be concerned that following quarantine for coronavirus, an unprecedented number of couples requested divorce appointments in districts of Xi’an, capital of Northwest China’s Shaanxi Province.

According to The Global Times, the surge in divorce appointments was the result of the pandemic causing couples to be “bound with each other at home for over a month” and it created conflict and the desire for impulsive divorces.

But how do self-isolation and quarantine affect marital relations?

“Quarantine is stressful—a review of the evidence published in The Lancet indicates that quarantine can have negative psychological effects including anger, confusion and in some cases, post-traumatic stress symptoms,” David Cates, Ph.D., a licensed psychologist and director of behavioral health at the University of Nebraska Medical Center, told Newsweek.

“Factors that increase the stress of quarantine include a longer quarantine duration, fear of infection, boredom, inadequate supplies, inadequate information and financial loss,” Cates said.

The rise in panic buying and uncertainty over paid sick leave for Americans will likely contribute to this stress, meaning that American couples could be susceptible to impulsive divorce requests.

“Being together in a small space for a much longer period than usual under stressful conditions means more opportunities to amplify both positive and negative dynamics,” Cates told Newsweek. “My guess is that relationships with a strong foundation will survive and may even flourish, whereas those characterized by poor negotiation skills, destructive communication and lack of appreciation are more likely to buckle under the stress.”

Cates said that research by John Gottman shows that the ratio of positive to negative interactions during a conflict is critical—couples with at least five positive comments or gestures for every negative interaction tend to be happy.

“So, to survive and thrive during quarantine, couples should look for opportunities to show interest, find areas of agreement, express affection and appreciation and demonstrate empathy. And they need to do this during times of conflict. They should also recognize that worry, fear, stress and guilt are expected and normal reactions during quarantine and not criticize one another for expressing these feelings.”

In addition to relationship-focused strategies, Cates recommends couples reduce their own individual stresses to lessen the toll on the relationship. Recommended strategies for managing stress during quarantine include:

Get the facts and understand the actual risk—media coverage with dramatic lead-ins and bold headlines might make your personal risk seem worse than it is. Get facts from a reliable source such as the Centers for Disease Control and Prevention (CDC), a local health department or a medical provider. Limit media consumption such as 30 minutes in the morning and evening rather than reading headlines or keeping cable news on all day. Connect with others who can provide social support—reach out via telephone, email, social media, text message. Create and follow a daily routine. Ideally, this would include time for work, exercise, hobbies, learning and eating. Stay busy; this might be a good time to catch up on books or movies, fix things around the house you’ve been meaning to get to, learn a language and try out new recipes. These might be things a couple can do together, but can also be separate activities. Eat well. Get sufficient sleep. Get physical exercise. Learn formal skills for managing stress, such as deep breathing, muscle relaxation or mindfulness meditation.

Currently, there are over 5,000 confirmed cases of COVID-19 in the U.S., according to Johns Hopkins University. Those who have symptoms of the coronavirus disease (COVID-19) are recommended to home isolate. According to the CDC, Americans who are sick should do the following to help prevent the spread of COVID-19:

Do not leave the home except to get medical care and do not visit public areas. Stay in touch with doctors and health professionals where appropriate—Call before you get medical care and be sure to get care if you feel worse or you think it is an emergency. Avoid public transportation—Avoid using public transportation, ride-sharing, or taxis. Stay away from others as much as possible—you should stay in a specific “sick room” and away from other people in your home. Use a separate bathroom, if available.

For couples worried about when they can return to normal, the CDC provides the following guidance:

If you will be tested to determine if you are still contagious, you can leave home after these three things have happened:You no longer have a fever (without the use of medicine that reduces fevers). Other symptoms have improved (for example, when your cough or shortness of breath have improved). You received two negative tests in a row, 24 hours apart; your doctor will follow CDC guidelines.

Hygiene advice

Clean hands frequently with soap and water, or alcohol-based hand rub. Wash hands after coughing or sneezing; when caring for the sick; before; during and after food preparation; before eating; after using the toilet; when hands are visibly dirty; and after handling animals or waste. Maintain at least 1 meter (3 feet) distance from anyone who is coughing or sneezing. Avoid touching your hands, nose and mouth. Do not spit in public. Cover your mouth and nose with a tissue or bent elbow when coughing or sneezing. Discard the tissue immediately and clean your hands.

Medical advice

If you feel unwell (fever, cough, difficulty breathing) seek medical care early and call local health authorities in advance. Stay up to date on COVID-19 developments issued by health authorities and follow their guidance.

Mask usage

Healthy individuals only need to wear a mask if taking care of a sick person. Wear a mask if you are coughing or sneezing. Masks are effective when used in combination with frequent hand cleaning. Do not touch the mask while wearing it. Clean hands if you touch the mask. Learn how to properly put on, remove and dispose of masks. Clean hands after disposing of mask. Do not reuse single-use masks.