States and communities around the country are beginning to take steps to reduce human contact to slow the spread of COVID-19. This “social distancing” includes canceling public gatherings such as sports events, restricting or shutting down public transportation, closing schools and other restrictions.
The goal is to make transmission harder for the virus. This will buy time for communities to prepare and will ultimately reduce the peak demand on health care, which has reached catastrophic levels in Wuhan, China, northern Italy and elsewhere, and is beginning to strain places like Seattle.
Many cities undertook just these measures over 100 years ago to blunt the impact of the 1918 influenza pandemic. Those that acted swiftly and decisively were rewarded with fewer cases and a lower peak of cases, relieving the demand for medical care.
Momentum is now building to impose social distancing once again. We strongly support these measures, which will save lives. But it’s critical to be smart about them. Here are some myths about social distancing and the reality as best it can be understood right now.
Myth: Social distancing is only for the elderly and those with high-risk conditions.
Reality: The goal of social distancing is to protect individuals, especially the most vulnerable, but the way to do that is to slow down transmission. All of us can become infected and transmit infection. All of us must contribute to slowing down transmission by staying away from crowded places (especially indoors), reducing the number of contacts we have, avoiding people who are coughing or sneezing, and staying home and really isolating ourselves if we have those symptoms. All of this helps reduce the rate of spread, reduce the number of people who will eventually get infected, and protect those who are most at risk if they do get infected.
Myth: Only people who have tested positive for COVID-19 need to stay home and isolate themselves.
Reality: Unfortunately, the United States has nowhere near the number of tests we need. Until that changes, we can test only the sickest cases (and a fraction of all mild cases for surveillance and public health tracking). As the weather gets warmer, flu and colds will become less common, and COVID-19 will become an increasingly likely cause of respiratory infections. Over the next few months, the best advice will be for those with any respiratory infection to stay home and for employers to make that possible.
Myth: Only really large gatherings have to be stopped.
Reality: Events like the Biogen conference in Boston that sparked an outbreak have rightly focused attention on the potential of mass gatherings to quickly spread coronavirus. Cancellations and postponements of large gatherings like NBA basketball games, Broadway plays, theme parks and the Masters golf tournament are a good first step, but that’s not the end of our responsibility.
From influenza to measles to severe acute respiratory syndrome, we have stark examples of smaller gatherings lighting the spark for larger outbreaks. In fact, the SARS outbreak was seeded in 2003 from a single person in a hotel who transmitted it to 16 others. Remember, this is not about personal risk, which might be relatively low in small social gatherings. This is about population risk. Because of the lack of testing availability to date, we don’t know who has coronavirus. For now, we assume we all might, and we maintain social distancing and avoid indoor gatherings large and small so we are not the spark that generates another outbreak fire.
Myth: All human interaction needs to be stopped.
Reality: Maybe “physical distancing” would be a better phrase than “social distancing,” because the goal is to separate physically, not emotionally. And staying 100% physically separated is not possible for many reasons — keeping food on the table and medicines in the cabinet, keeping the basics of society functioning and maintaining mental health, to name a few. We absolutely should be stopping nonurgent errands, in-home social visits that can be done with a phone call or FaceTime, and nights out at crowded bars (looking at you, millennials).
Instead, head outside during the day. Go for a walk or run with a friend. Meet a neighbor or two or three on the street for a conversation. Send the kids outside for a no-contact game of soccer or a hike in the park or woods with friends. We’ll know a lot more when testing comes online full force in the next few weeks, and then we all can adjust accordingly.
Myth: Coronavirus is spread only from coughing and sneezing.
Reality: The dominant mode of transmission appears to be from large droplets that generate during coughing, sneezing and even just regular breathing and talking. But there are actually three modes of transmission — large droplets, contact with contaminated surfaces, and breathing in airborne virus. The tendency is to treat each mode as distinct, but for many viruses it’s a continuum, novel coronavirus included. When you cough or sneeze and generate large droplets, some fraction lands on surfaces, and some fraction stays airborne as a smaller aerosol that can stay aloft.
Coronavirus: We will be separated. We still have to stick together.
The scientific community will figure out the relative importance of each mode in time, but for now, we should be taking precautions against all of them. That means following the important public health recommendations of covering your cough and frequently washing your hands, but also frequently cleaning surfaces and bringing more air into all of our homes, schools and offices.
Myth: If we do enough social distancing, we will see dramatic results immediately.
Reality: In Chinese cities, the streets have been nearly empty for over a month under an extreme form of social distancing that is just beginning to be lifted. Social distancing in the United States is likely to be less intense, for many reasons. One lesson we can learn from China is that, even with very intense interventions, the demand for hospital beds and intensive care continued to rise for weeks. That’s because once someone is infected, it takes time before they get sick enough to need hospital care. We are social distancing now to reduce the strain on our health care system several weeks from now.
Myth: Social distancing for a period of a month or so may be enough to stop the epidemic permanently.
Reality: Even though the disease can decline in one city or area with very effective social distancing, the virus is still present — in small numbers of mildly ill people, perhaps in very ill patients hospitalized for a long period, and in other parts of the world. History shows that when social distancing works, case numbers go down, and then when controls are relaxed, they can resurge. Unfortunately, we are in this for a long haul. We need to prepare to pull together, help one another and preserve social cohesion while we use social distancing to combat the virus.
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