What is social distancing and why is it needed?

This series of articles is about the COVID-19 pandemic, but specifically deals with  social distancing: what is it, why do we need it, how to do it right.  It is written by Edison Liu and Jill Goldthwait who are both medical professionals who have broad governmental, scientific, and management experience.  Goldthwait is an R.N. who has served in the Maine State Senate for 8 years and is currently serving in local government, Liu is an M.D. and is the President and CEO of The Jackson Laboratory. He previously led the scientific response for the country of Singapore for the SARS crisis in 2003. The opinions expressed are those of the authors and do not reflect policies or positions of The Jackson Laboratory or the Town of Bar Harbor.   

Social distancing

This animation explains how social distance slows the spread of diseases like SARS and COVID-19.

The COVID-19 pandemic is unlike any other experienced by Americans since the great 1918 influenza epidemic which killed 675,000 Americans. COVID-19 is a coronavirus similar to viruses that cause not only the common cold but also serious epidemics like SARS (2003) and MERS (2015). Both emerged from animal coronaviruses that “jumped” into human populations and mutated to facilitate human-to-human transmission.

COVID-19’s name comes from Corona Virus Disease 20 19 and causes symptoms nearly indistinguishable from seasonal influenza (the flu). This usually means cough, fever, sore throat, and shortness of breath. But unlike the flu, COVID-19 is about 10 times more dangerous (as measured by the proportion of people dying), and perhaps about 1.5 times more infectious. Those individuals over 70 and with medical conditions such as cardiovascular disease, diabetes, and whose immune system is compromised are at much higher risk of dying than other individuals. Younger healthy persons may just experience mild symptoms and therefore, as a population, may act as “carriers” of COVID-19 as they feel well enough to be out and about but will spread the virus.

The major concern of all medical and governmental health experts is that COVID-19 is not only more infectious and more dangerous than the flu virus but is also a completely new virus to human populations. This means no one has proper immunity against COVID-19. Even with influenza vaccines, it has been estimated that 29 million Americans may have been affected by the flu in 2019 through 2020. Many more would have been affected if we did not have vaccines. If we assume the same number of infected individuals, we can calculate that 435,000 Americans may die of COVID-19.

Others, using mathematical models of pandemic spread, have suggested that, in the worst case, as many as 1.1 million Americans may die. With approximately 1 in ten infected COVID19 cases requiring hospitalization, this means that 2.9 million Americans may require hospitalization. Both numbers are staggering and will have a huge impact on the health care system.

It is estimated that there are 929,000 staffed hospital beds in all of The U.S. This means that if the pandemic is unchecked, there will be insufficient acute hospital beds for COVID-19 cases let alone other diseases. In addition, healthcare professionals are much more likely to be infected than other people, which will result in a simultaneous reduction in the medical workforce to care for patients.

This is why the country is finally mobilizing – to prevent a disaster.

Since vaccines and anti-virals are still being developed, we currently have only one tool to work with: social distancing. The concept of social distancing is to increase the space between individuals so as to reduce the probability that the virus can transfer between human beings. This distancing can be accomplished by physically keeping away from others or, in the case of COVID-19, to stay greater than 6 feet from the next person. Distancing can also be accomplished by blocking viral transfer by wearing gloves, proper handwashing and cleaning surfaces.

Social distancing helps protect you from getting the virus and becoming sick, but some feel that COVID-19 is not that serious and question the need for any constraints. This impression is further confused by the fact that mortality rates range from 1-4% depending on the region and the ability to test the virus in populations. The WHO officially estimated a 3.4% mortality rate as of March 3 ranging from 1.6% in the US to as high as 7.9% in Italy.

Let’s match comparable activities for the risk of death. A 2% mortality rate for COVID-19 infection is a 1 in 50 chance of dying. Sky diving has a 1 in 101,000 risk of death, boxing has a 1 in 2,200 chance, and airline travel is barely even registerable. Only climbing mountains in Nepal (1 in 167) and base jumping (jumping off high rise buildings at 1 in 60) come close.

How many would take a plane ride with a one in fifty chance of dying on that flight? Even if those odds do not scare you, there is a one in ten chance of being hospitalized with a serious enough condition to be in an ICU. This now approaches the odds of Russian roulette for a serious but non-fatal case.

The impact of social distancing is greater than personal safety alone. It protects your loved ones and your community. Once someone catches COVID-19, they are a danger to everyone else. By taking precautions to not catch COVID-19 and not to spread the virus, you are protecting your friends and family. Similarly, just as you would refuse to ride with a friend who is drunk, you should tell your friend who is sick to go home.

Finally, social distancing is a proven means of reducing deaths in a pandemic. This was shown in the 1918 influenza pandemic. When Philadelphia experienced the first cases of the disease, the authorities downplayed their significance and permitted large social gatherings. St. Louis imposed social distancing by closing schools and theaters. The outcome was that Philadelphia had a much greater death rate than St. Louis. Social distancing interventions do work.

Except for individuals with medical conditions, the young (including children) appear to have much milder symptoms. One could argue that social distancing is not necessary for this age group. However, because COVID-19 is very infectious, the young will bring the virus into homes where more vulnerable family members may live – those with illnesses, and elderly parents or grandparents. This is the reason why child care facilities and schools are closed. This is also why large parties and summer breaks to crowded beaches should be discouraged.

 What is the science behind the social distancing recommendations?Implementing social distancing can be done at the individual level which is focused on a person not catching COVID-19 or at a population level to slow the spread of the pandemic across large groups of people. social-distance-ed-liu-part-2

 Why testing for COVID-19 is so importantSocial distancing, travel restrictions, shelter-in-place, and lockdowns are all blunt instruments in fighting a pandemic. But what if doctors could pinpoint who among the people with cough and fever have COVID-19, and even identify who are asymptomatic carriers of the virus? social-distance-ed-liu-part-3

 The surge: When is it coming and how do we prepare?What is the difference between an epidemic and a pandemic? It’s all about scale. social-distance-ed-liu-part-4

 The new normal after the COVID-19 surgeNow that we have social distancing policies and protocols in place, how long will it be before they can be relaxed? social-distance-ed-liu-part-5