Hard to imagine that it was only a month ago that the first cases of COVID19 started to strike home here in the U.S. Those of us in travel health were still advising our travelers about their future itineraries, counseling companies about “business essential” travel, and working with administrators coordinating spring study abroad programming.
Hard to believe…But in that short period of time the Coronavirus has spread rapidly around the world and in this country and now we find ourselves trying to prevent an infection for which we have insufficient tests, no preventive or treatment drugs, and no vaccine.
Elbow bumps are out and social distancing is the new imperative.
Our public health authorities and evidence from previous epidemics support the fact that if we all work together and really commit to social distancing, we can start to see a time when this pandemic will cease.
In this blog I want to address the following:
- What is the definition of social distancing- it is more than just trying to stay 6 feet apart from each other
- What is the evidence that social distancing works in pandemics like this one
- And why is everyone’s commitment to social distancing critical right now
So first, what exactly is Social Distancing?
Social distancing is defined as a public health technique to mitigate transmission of an infection, in this case the respiratory infection of coronavirus. Social distancing is deliberately increasing the physical space between people to avoid spreading illness. COVID19 is primarily transmitted by small respiratory droplets of the virus spreading from one person to another. If persons are carrying the virus- with or without symptoms- and they cough or sneeze they can spread the virus to nearby persons. Separation by a distance of 6 feet or more can help prevent the virus droplets from reaching another person and entering their mouth, nose or eyes.
Is Social Distancing a new technique?
Not at all. It isn’t a term or concept that only appeared with this novel coronavirus. From historical accounts we know social distancing was practiced during 19th century pandemics in Europe.
Does it really work?
It was shown to have a benefit during the infamous Spanish Flu of 1918-19. Philadelphia went ahead with a parade for returning WWI soldiers despite early signs of a flu epidemic; some 4500 citizens died within one week. By contrast, St Louis took heed of the flu, cancelled its parade, quickly shut down the city, and reduced its deaths by more than half. San Francisco did much the same. So we know social distancing can have benefit. Until such time as we have drugs to prevent the virus, drugs to cure the virus, and a vaccine it is our best public health approach. A study published recently online in the Journal Emerging Infectious Diseases (Fong MW, Gao H, Wong JY, Xiao J, Shiu EYC, Ryu S, et al. Nonpharmaceutical measures for pandemic influenza in nonhealthcare settings—social distancing measures. Emerg Infect Dis. 2020 May) presents the evidence for the value of this preventive measure against COVID19. And the NYTimes has an article also supporting its benefit in its March 31 edition https://www.nytimes.com/2020/03/30/health/coronavirus-restrictions-fevers.html
So how do we practice social distancing?
Social distancing isn’t just one behavior. It is a combination of prevention measures that include isolation, quarantine and community containment.
First: Protect vulnerable persons for COVID19 by isolation. Persons at high risk- including seniors, persons with chronic heart or lung disease, those with diabetes, or who are immunocompromised should stay at home. Not expose themselves to someone who may have the virus. Don’t visit nursing homes, for example. Shelter them at home. Avoid the virus.
Second: Identify and quarantine sick persons. This is where testing becomes so important. We need more testing and as we start to test more widely we will identify more cases. Persons who are symptomatic (coughing, sneezing, short of breath, fever) absolutely need to quarantine at home. Persons who test positive but still feel fine also must quarantine and persons in direct contact with sick or positive cases need to quarantine as well. Stay home, Stop the spread.
- If someone exhibits COVID19 symptoms-cough, short of breath, fever- they should be told to quarantine at home, to call their health care provider and follow their professional guidance.
- If someone tests positive for COVID19, whether they feel sick or not, they should quarantine at home and follow the guidance of their health care provider or local health department. Don’t leave the household unless absolutely necessary.
- If anyone in a household has been exposed to a person who tests positive all persons within the household may need to be quarantined. (Guidance for workers has been evolving.**)
Third: Fully cooperate with all community containment efforts. Adhere to government actions to close gathering places, reduce congestion and reduce virus density. Public health authorities want to reduce the frequency of contact with persons who might be infected with the virus, whether they show symptoms or not. Therefore municipalities are adopting distance learning, telecommuting, curbside pick-up… Community containment incorporates a host of actions: working from home, closing schools and switching to online classes, closing museums, theaters, and sports stadiums, visiting loved ones via electronic devices instead of in person, cancelling or postponing conferences, meetings, and family gatherings. Right now these restrictions are voluntary. Compliance can prevent the necessity for more stringent police enforcement.
Social distancing asks that everyone stay home as much as possible. If you must go out for essentials such as food or to visit a pharmacy make every effort to keep 6 feet or more away from others. Follow cough and sneeze etiquette, try hard not to touch your face, and disinfect surfaces (counter tops, doorknobs, cell phones, etc.) to keep the virus from spreading. And wash your hands often and properly- it may seem rather simple, but it is most important.
Remember: despite what you may hear on TV or read on social media we have no proven pharmaceutical approaches as yet to prevent or stop this pandemic. Social distancing is what we have and if we try to commit 100% we are giving this prevention mechanism a good opportunity to succeed. We all know this is not easy. It is actually very hard and asking a great deal from all of us. And as the weeks go by it will become even harder, but right now social distancing is what we have for prevention.
So why are public health authorities asking all of us to change our behavior so drastically? Why does it matter so much? Simply put-to save lives and to save our healthcare system.
Here are three reasons social distancing is so important right now in America:
First: Social distancing can reduce the rate of viral transmission now- stopping the spread, keeping the number of new cases down.
Second: Social distancing can reduce the pressure on our health care system. We all have heard that we don’t have enough beds, ventilators, or health care personnel if the number of COVID19 cases keeps rising rapidly. As per Johns Hopkins, “A large number of people becoming very sick over the course of a few days could overwhelm a hospital or care facility. Too many people becoming severely ill with COVID-19 at roughly the same time could result in a shortage of hospital beds, equipment or doctors.” Social distancing can “flatten the curve,” reduce pressure on our health care system, and save lives (including the lives of health care professionals).
Third: If our health care system isn’t overwhelmed with new cases, then social distancing gives us the valuable, needed time to accomplish critical goals: really ramp up testing and accomplish the necessary research to find pharmaceuticals that work for treatment and for prevention. Social distancing can help us END this pandemic.
If you find the term social distancing rather strange and awkward, you are not alone. Many of us do. As humans we are social by nature and this measure asks us to avoid the kinds of contact we all crave, especially during times of fear and uncertainty. But social distancing is important and it works, so let’s remember why we are doing this and then commit fully.
Recently NY Governor Andrew Cuomo started calling social distancing by a new name, Matilda’s Law. Matilda is Cuomo’s 88 year old mother and he realized that right now social distancing is a way to keep her and all of our vulnerable loved ones- of any age- safe from this virus. He put a name and face to his daily efforts to practice social distancing in every way he can.
As a nation we have to see social distancing as an act of compassion for the least among us and a way past this pandemic. As nurses we need to model this behavior and encourage everyone to adopt social distancing for as long as it takes to defeat this virus.
We can all beat this together, just by staying apart.
Apart, but Not Alone
And here are some PSAs on social distancing and handwashing created by the Mailman School of Public Health at Columbia University and featuring actors who starred in the movie Contagion. https://www.publichealth.columbia.edu/controlthecontagion?utm_medium=press_release&utm_source=press_release&utm_campaign=control_the_contagion
March 29, 2020
**For example, workers who cannot work from home and can wear a mask while at work, and self-monitor temp & symptoms twice daily may be permitted to return to the workplace. HCPs who are symptomatic or test + must be quarantined for 7 days, plus be afebrile the last 3 days prior to their return. See these references for more details:
CDC. Criteria for Return to Work for Healthcare Personnel with Confirmed or Suspected COVID-19 (Interim Guidance), Mar 16, 2020. Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/healthcare-facilities/hcp-return-work.html
NYSDOH. Health Advisory: Protocols for Personnel to Return to Work Following COVID-19 Exposure, Mar 16, 2020.