Exploring the Science of Social Distancing and What it Means for Everyday Life
Feature Story
By Stephanie Miceli
Last update April 3, 2020
As the coronavirus outbreak has spread throughout the United States, social and physical distancing measures have taken many forms — such as business and school closures, stay-at-home orders, and everyone being urged to keep six feet apart.
Recently, the National Academy of Medicine and the American Public Health Association held a pair of webinars on social distancing — or minimizing close contact with others — to slow the spread of coronavirus. These webinars were the first in a planned series that will explore different aspects of the public health response to COVID-19, and had a total audience of more than 18,000 listeners. The next webinar will be held on April 9.
“We may call it social distancing, but it’s really about physical distancing,” said Nancy Messonnier of the Centers for Disease Control and Prevention (CDC), a panelist at the March 25 webinar. Messonnier reminded the online attendees that the term does not imply cutting off ties to loved ones.
During the 1918 flu pandemic (known as the Spanish flu), many U.S. cities used the same social distancing strategies that are currently in place. Generally, the earlier these cities implemented social distancing measures, the more effective they were; evidence shows that they were able to delay the peak of deaths and the death toll overall.
“With the flu, we knew the inflection point in which the virus infected a certain amount of people,” said Howard Markel, distinguished professor and director of the Center for the History of Medicine at the University of Michigan. However, because this is a novel coronavirus, he said, “We’re learning as we go. We’ll have more data to evaluate how well social distancing strategies are working — but it’ll take weeks.”
A top question from attendees was, “How long will social distancing last?” The answer is unclear, but the goal of social distancing is to “buy time” and build the health care system’s capacity to respond to and control the pandemic, said Markel.
Researchers are also examining whether coronavirus cases will decline as summer approaches, the panelists noted. Understanding how changes in temperature and humidity affect coronavirus could help inform which social distancing strategies are used, at what level of intensity, and for how long.
It’s also important to consider the social and economic costs of social distancing, said Mitch Stripling, national director of emergency preparedness and response at Planned Parenthood Federation of America.
“When you put social distancing restrictions in place without support … you push more of that disease to the most marginalized,” said Stripling. He added that this is not likely to be the last pandemic we’ll see, which raises the importance of sustainable social distancing measures.
“Social distancing impacts everyone,” concluded Marc Lipsitch, professor of epidemiology at the Harvard T.H. Chan School of Public Health. “If we don’t do everything we can — ramping up testing, getting more ventilators in hospitals — it will be an even bigger tragedy. We need to use this time wisely.”
How Will We Know Social Distancing Is Working?
More than 100 million Americans have been asked to stay home by state or county authorities as of early April, said Anne Schuchat, principal deputy director at the CDC, and panelist of the second webinar, held on April 2. But there may be some glimmers of hope, she added. Preliminary data from California and Washington — the first states in the nation to mandate residents to stay home and keep physically apart — has shown that social distancing is working.
Webinar Part I Panel
Carlos del Rio (moderator) — professor and chair, Hubert Department of Global Health, Emory University
Nancy Messonnier — director, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention
Howard Markel — George E. Wantz Distinguished Professor of the History of Medicine and director of the Center for the History of Medicine, University of Michigan
Marc Lipsitch — director, Center for Communicable Disease Dynamics, Harvard T. H. Chan School of Public Health
Mitch Stripling — national director, emergency preparedness and response, Planned Parenthood Federation of America, and former
Webinar Part II Panel
Sharon Inouye (moderator) — professor of medicine, Harvard University Medical School
Sandro Galea — dean and Robert A. Knox Professor, Boston University School of Public Health
Jason Karlawish — professor of medicine, University of Pennsylvania Perelman School of Medicine
Jennifer Nuzzo — senior scholar, Johns Hopkins Center for Health Security
Anne Schuchat — principal deputy director, Centers for Disease Control and Prevention
Nonetheless, social distancing is one of many tools, not a single solution to the pandemic, emphasized Jennifer Nuzzo, senior scholar at the Johns Hopkins Center for Health Security.
The eventual end of social distancing measures “will be a question of easing up, not lifting measures overnight, so we don’t find ourselves back to where we started,” said Nuzzo. Pointing to the successes of South Korea, she noted that public health measures like isolation of existing cases, contact tracing and monitoring, and community testing will be an essential next phase of the response in the U.S.
In addition to better disease surveillance data, there is also a need to measure the level of strain on the health care system — including whether and where supply shortages are occurring, and the level of burnout among providers. “If we want to ease social distancing, we also need to have confidence that the number of new cases won’t overwhelm the health system in the U.S.,” Nuzzo added.
“We need Personal Protective Equipment (PPE) and ventilators — but we also need the people behind them.”
We’re Only as Strong as Society’s Most Vulnerable
Sandro Galea, dean of the Boston University School of Public Health, considers the COVID-19 pandemic a traumatic event experienced at the population level.
“We may see anxiety and symptoms of post-traumatic stress disorder (PTSD) on a wide geographic scale,” he cautioned. That may be tied to job loss and economic downturn, or the stressors that may come with caring for an aging parent or someone with a disability — which are already vulnerable populations. Mitigating social and economic stressors can help prevent mental health impacts, Galea noted.
People with physical or cognitive impairment, service industry workers who don’t have health insurance, and health workers are among the most vulnerable, said fellow panelist Jason Karlawish, professor of medicine at the University of Pennsylvania. Expanding access to health insurance, unemployment benefits, and even the Internet (in light of school closures) are just a few considerations, he said, but that list is far from complete.
“The more vulnerable a person is, the further up in the line they should be for testing, vaccine, and treatment,” said Karlawish.
Concluding the webinar, moderator Sharon Inouye, professor of medicine at Harvard University Medical School, emphasized that physical and social distancing measures will likely continue for weeks or even months, which has important implications for caring for people who require hands-on assistance, particularly in nursing homes or settings that people cannot leave. “That’s where we face this dilemma of how we can continue to provide care for people, prevent them from getting the disease, and maintain their well-being and quality of life,” she said.
Resources:
Webinar Part I
Webinar Part II
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