COVID-19: Why is social distancing so important?

Hugs, handshakes and high fives are a distant memory for most of us now. If you’ve been practicing social distancing -- and let’s hope you have -- these cordial signs of greeting used around the world are now under lock-and-key in an effort to block coronavirus (SARS-CoV-2), the virus that leads to COVID-19.

As the planet awaits new treatments and a vaccine, public health experts declare that social distancing is our best tool to slow the spread of COVID-19.

What is social distancing?

Social or physical distancing is just that -- keep a minimum space between yourself and others. To effectively implement social distancing, you should:

• Keep at least 6 feet (~2 meters) between yourself and other people outside your household at all times.
• Stay out of crowded places and avoid mass gatherings: this includes mass transit, large church groups, conferences, festivals, parades, concerts, sporting events, weddings, and other types of assemblies.

It seems harsh, as by nature humans are social creatures. However, right now every action, every movement you take will affect how this virus affects you and many others.

COVID-19 is highly contagious. The latest research suggests that even those who exhibit few or no symptoms, possibly 25% to 50%, can spread the disease, according to Anthony Fauci, MD, Director of the US National Institute of Allergy and Infectious Diseases (NIAID). In other words, you cannot identify those who have COVID-19 and are contagious just by taking their temperature or looking for a cough. This also applies to children who often have no symptoms and could easily infect older adults and seniors.

The virus is thought to spread mainly from person-to-person, for example:

• between people who are within about 6 feet) of each other.
• through respiratory droplets produced when an infected person coughs, sneezes or talks.
• these droplets can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs.

Community spread is occurring in the US in most places now. Especially hard hit areas include New York City, Seattle and New Orleans. But downwards trends are starting to show in some areas, as cautiously noted by public health experts. This does not mean it's time to start easing on social distancing rules.

Why should I practice social distancing?

Besides protecting yourself and those in your family, social distancing can have wide-reaching outcomes.

Symptoms of COVID-19 usually result in mild or moderate illness, such as a fever, dry cough, body aches, and fatigue that resolves over a few weeks. In older adults and people with existing health problems, it can cause a more severe outcome, which can include pneumonia, acute respiratory distress syndrome and death.

Adhering to social distancing norms can:

• protect health care workers, limit overcrowding of hospitals and ICUs, help to slow a shortage of protective personal equipment (PPE) and life-saving ventilators.
• protect groups at higher risk, for example:
  • older people
  • those with heart disease or high blood pressure
  • groups who have lung disease, such as asthma or chronic obstructive pulmonary disease (COPD).
• help keep surfaces clean in your home by not bringing in the coronavirus in and out during the day. Studies have shown the coronavirus can stay active on surfaces for days.
• Keep you and your family healthy while science catches up with COVID-19: there are currently no approved drug treatments or vaccines, although research is active. Scientists are hopeful for a vaccine with 12 to 18 months, antigen tests are now approved, multiple drug treatments are under study and emergency use, and convalescent plasma therapy is a promising option.

Does social distancing work?

A new study published by the National Institutes of Health (NIH) in the journal Science suggests that yes, social distancing does work and may be our best bet to flatten the COVID-19 curve. Based on mathematical models, researchers found that:

• for every confirmed case in China, there were roughly five to 10 people with undetected infections.
• individuals with undetected infections may have been a source of infection for 86% of confirmed cases.
• the spread of COVID-19 slowed considerably after travel restrictions and social distancing rules were established.

And in the US, downwards trends are encouraging, too. Kinsa Health, a technology company from San Francisco, followed body temperature trends across the country in mid-March to track for patterns. According to the New York Times, Kinsa “adapted its software to detect spikes of “atypical fever” that do not correlate with historical flu patterns and are likely attributable to the coronavirus.”

Data from their thermometers and connected via the internet to one million users revealed that fever counts dropped after social distancing was instituted in hard-hit places like New York. Some cities that had delayed social distancing did not see trends initially; however with wider adoption of stay-at-home policies, counties throughout the country are seeing a fall in fever trends.

Experts note that we all must take social distancing seriously if it is to work to control the pandemic. Healthy young people need to be prudent in adhering to guidelines. Even though their risk from the disease is lower, but they can spread the disease to older, high risk groups, such as parents, grandparents and the community at-large.

When will social distancing for COVID-19 end?

A pandemic of this proportion has never happened in modern times, so predicting when we can all get back to hugs and handshakes is a calculated guess, often fueled by mathematical models. Many around the world are anxious to get back to work, to their friends and family, and to their “normal” life. But will a normal life ever be possible again?

A study from Wuhan, China, the epicenter of the worldwide outbreak, suggests there may be additional waves of social isolation needed.

• Researchers, publishing in Lancet Public Health, found that prematurely lifting physical-distancing could lead to an early second peak of COVID-19 cases.

• By lifting school and workplace closures in March instead of April, peaks could occur in August instead of October.

• Exact numbers of those at risk are hard to predict, the experts noted, because it’s hard to know the actual number of people who may be infected or how long people are actually contagious.

• Results would be different for different countries. However, holding back waves is crucial to prevent the health care systems from becoming overwhelmed, as reported by scientists.

In the US, former President Barack Obama recently tweeted that “social distancing bends the curve and relieves some pressure on our heroic medical professionals. But in order to shift off current policies, the key will be a robust system of testing and monitoring — something we have yet to put in place nationwide.”

However, on Thursday, April 9 the federal government issued guidelines to allow “critical infrastructure workers”, such as energy, transportation, hazardous material and emergency responders, who had previously been exposed to COVID-19, to return to their jobs.

The new guidelines from the CDC include recommendations on how to prevent new infections, such as pre-screening employees for fever, having employees self-monitor for symptoms, wearing a cloth face covering, and maintaining six feet of social distancing at work, and disinfecting the workplace, among other rules. Reserve surgical masks and N-95 respirators for health care providers and emergencies workers on the front-line.

Bottom Line

• Social distancing for COVID-19 disease can protect health care workers, limit overcrowding of hospitals and ICUs, help to slow a shortage of much needed health care equipment.
• As many people are asymptomatic or pre-symptomatic, social distancing can protect the high-risk groups, such as the elderly, and those with heart and lung disease.
• Most important, social distancing can protect you, and your family, from a virus that has no approved treatment or vaccines, yet. Social distancing can buy time for the development of an effective preventive and treatment for this novel virus.

Anthony Fauci, MD, the nation's top infectious disease expert and NIAID Director, stated on NBC on Thursday, April 9 that the US appears to be starting its initial signs of flattening of the COVID-19 curve.

• Deaths, he said, could be around 60,000 instead of the dire 100,000 to 240,000 previously predicted.
• However, he emphasized that when the US starts to ease social isolation, the virus won’t suddenly disappear. He stated a plan needs to be in place to “suppress it by identification, isolation, contact tracing.”
• Most importantly, he emphasized that a plan for a future pandemic outbreak needs to be put in place in the US.