Dear Editor,

In his brilliant article previously published and entitled "Anxiety level of first-year medical students from a private university in Peru in times of COVID-19" we are shown that, of 57 first-year medical students, 75.4% suffered from significant levels of anxiety during the pandemic. This result was disturbing, since it is a condition that involves a large part of the population and, therefore, has increased its level of importance within the medical community. Likewise, in the results of the research, a statistically significant correlation was observed between the female gender and the presence of anxiety1, inferring that women have a higher risk of suffering from this condition. It is essential to promptly recognize the signs of this disease in order to provide counseling and adequate management to those who suffer from it, with the aim of improving and preserving their mental health. The consequences do not affect only on a personal level, but can also disrupt people's lives in the family and professional field.

However, there is a very important variable that largely determines the level of affectation that a person's mental health can have and that has not been explored in this study: students’ social isolation. Social isolation is a variable that has been analyzed in other studies that evaluated the mental health of the population during the pandemic; finding that it played an important role in the development of psychological disorders. Therefore, its presence should be considered relevant in these investigations.

Social isolation was a necessary measure applied during the pandemic, especially in quarantine, in which people with or without COVID-19 were forced to comply with it to prevent the spread of the virus. This mandatory isolation on many occasions separated us from our loved ones, family visits and friends, who were a social relief. Thus, there was a great change in the nature of communication that affected most of the population during these circumstances. This situation has brought to light the disagreement of certain social groups towards virtuality and the need for human contact and direct communication. One way of maintaining this communication, was through technological means such as: cell phones, televisions, radios, tablets, laptops, etc.; which for some diminished the feeling of loneliness. However, for others, the use of these instruments was insufficient and ineffective due to the economic restriction that mainly hinders the acquisition of electronic devices and devices, and the lack of training on their correct use.

In Cuba, a study reported that social isolation and quarantine due to COVID-19 have had a negative impact on people's mental health. The most frequent negative psychological manifestations were emotional disorders, depression, stress, apathy, irritability, insomnia, post-traumatic stress disorder (PTSD), anger and emotional exhaustion3. On the other hand, in Switzerland, a study indicated that some students may be at higher risk of social isolation and developing mental health problems during the COVID-19 crisis; particularly, when they live alone they have less direct contact with family and close friends, receive less social support, and have weaker integration into students' social networks. Likewise, the female students who participated in the study were the minority group in the student population and seemed to be at higher risk of facing negative consequences for mental health in the context of COVID-19.4 These observations, as well as those from similar studies, are crucial for developing targeted interventions to support students who are potentially at risk.

Therefore, it is essential to evaluate the impact of social isolation, both physically and virtually, on the appearance of mental disorders such as: depression, stress, and anxiety, during the time of the COVID-19 pandemic. The knowledge of said information will allow a better follow-up and analysis of medical students, who depend on social networks to cope with the load and stress that the career demands, at the same time, the evidence is necessary for the creation of potential solutions for this problem that threatens the health of students.