I’ve been banging my drum about wearing face masks for the last few weeks, but let’s not forget the other simple steps that we all need to take to control the COVID-19 pandemic: social distancing, hand washing, and cleaning high-touch surfaces. This week, I’m focusing on social distancing.
What is social distancing? At its simplest, social distancing means staying at least 6 feet away from anyone who might be sick, and anyone who doesn’t live in your household. It can mean staying home (either by choice, because of an isolation or quarantine order or a stay-at-home order), or it could mean going out in public or to work but keeping 6 feet away from the nearest people. For example, many workplaces have either changed their layouts so that all work stations are at least 6 feet apart or started alternating schedules so that staff can be spaced out at least 6 feet apart. If schools do reopen in the fall, then desks will need to be at least 6 feet apart.
Social distancing also applies to trips to the store, doctors’ offices, or, well, socializing. Unless you’ve stayed at home for the last few months, you’ve probably seen stickers on the floor indicating 6 foot distances between people and directing the flow of foot-traffic. These stickers visually remind us how far apart we need to stay to protect ourselves and others from people who might be contagious even before they know that they are sick. Following the directed flow of traffic means you don’t unexpectedly come face-to-face with someone sick.
As far as socializing, nowadays we have so many great ways to communicate and spend time with each other without being in close physical contact. Video messaging, texting, social media and good old fashioned phone calls work great to keep us in touch with our friends and loved ones.
I miss my friends too, but in some ways I feel even closer with them now. For example, my friends and I have regular game nights. Before COVID-19, they were always a big production involving rotating hosts, potluck meals and (local) travel that we could only pull off once a month or so. Nowadays, we play online games together every weekend. It’s been a great way to stay in touch, share our stresses and frustrations, and just have some fun.
Why six feet? Coughs can spread germs up to 6 feet away, sometimes farther depending on the force of the cough and wind conditions. Most droplets start to drop down after a few feet, but airborne viruses travel farther and stay suspended in the air for longer. That means that 6 feet is the minimum; if COVID-19 truly is airborne then we might need to stay even further apart.
What’s the difference between social distancing and physical distancing? They’re just two different terms to describe the same thing. The term “social distancing” is relatively old, by modern standards. It’s been traced back to around 2004, which might not seem like that long ago, but keep in mind that the iPhone was first introduced in 2007. Our world has changed a lot in the last 16 years, and we’re much more connected than we used to be. The term “physical distancing” helps to clarify its true purpose: we need to stay physically apart from each other to stop the spread of this virus, but we don’t need to be socially isolated.
I do like the term “physical distancing”, but “social distancing” is such a longstanding and engrained term, and so many people have adopted it in the last few months, that it’s difficult to change that vocabulary. Either term is fine, really.
Is social distancing something new? As I mentioned above, the term has been around for about 16 years. However, the practice has been around for centuries. Quarantine was first used to control the spread of plague in the 14th century. Isolation of sick people, quarantine of people who might be sick, school closures and cancellation of public gatherings were used to varying degrees in the United States during the 1918 flu pandemic.
Why do I have to social distance now if I didn’t in other outbreaks? Most of the recent outbreaks in the United States have either been vaccine-preventable (measles, hepatitis A) or relatively contained to international travelers and their close contacts (Ebola, Zika). We are very fortunate that unlike some other countries, the majority of U.S. Americans are vaccinated, and therefore most of us aren’t directly impacted by outbreaks of measles and other vaccine-preventable diseases. However, people who are not vaccinated are regularly excluded from school or work or even quarantined during outbreaks of measles, mumps and other vaccine-preventable diseases. Likewise, if either Ebola or Zika had been more widespread within the U.S. then it is likely that we would have used more social distancing during those outbreaks. Unfortunately for us, there isn’t (yet) a vaccine against COVID-19, and it spreads very, very easily, so social distancing is necessary to control this outbreak.
Does social distancing even work? Yes! Let’s go back to the 1918 flu pandemic. Cities that started social distancing earlier had 50% lower fatality (death) rates during that pandemic than cities that delayed them or never started them at all. Cities that stopped social distancing too early had late peaks of disease – something we’ve seen in many U.S. states this summer.
We’ve seen this in the current pandemic. A study published this week in the British Medical Journal (BMJ) found that countries that used at least one physical distancing measure (which the researchers defined as school closures, workplace closures, public transportation closures, limits on large gatherings and/or lockdowns) statistically significantly reduced new cases of COVID-19. Overall, countries that at least closed schools and workplaces and put limits on large gatherings had the largest reductions in new cases. On the other hand, countries that did not put limits on large gatherings did not significantly reduce new cases of COVID-19, regardless of other measures used (although it should be noted that there were not very many countries in this category). Additionally, countries that shut down schools but not workplaces reduced cases less than countries that shut down both.
Finally, look to Sweden for an example of what happens when we don’t social distance. Sweden did not close businesses nor most schools, nor put other restrictions on movement. They banked on the hope that citizens would act responsibly to slow the spread of disease without impacting the country’s economy.
Unsurprisingly, it didn’t work. Sweden has had a higher death rate than the United States. Despite businesses staying open, the rate of unemployment in Sweden is now higher than in surrounding countries that did use social distancing, and the Swedish economy is expected to be harder-hit than its neighbors.
As a public health physician, I find the idea that loss of life is an acceptable trade-off for economic benefits to be abhorrent, but it clearly has resonated for many policy-makers. However, we are now seeing exactly what happens when we try that: not only did more people die, but the economy was even worse hit than countries that used social distancing. Why should we continue to take risks with peoples’ lives, trying an experiment that already failed in Sweden out of the misguided hope that it would be different here?
If I’m wearing a mask, then does that mean I don’t need to social distance? Not unless you don’t have any other choice. In some situations (doctor appointments, public transportation, some jobs), you can’t avoid coming within 6 feet of other people. If you’re in that unenviable position then wearing a mask will help reduce – but not eliminate – your risks. But if, like most of us, you do have a choice about how far apart you are from others, then wear your mask and stay 6 feet away from other people who don’t live in your household.
Masks work to reduce the spread of COVID-19, but they aren’t perfect. Cloth face coverings reduce the spread of droplets during speech or coughing from 6 or more feet to anywhere from a few inches to 4 feet. Even if you are both wearing masks, the farther you can stay away from other people, the better.
If I’m social distancing, then do I still need to wear a mask? Yes, you do!
All right, I’ll back that up a bit. It depends on where you are. If you’re at home either by yourself or with household members who don’t have any symptoms of COVID-19, then you can leave your mask off. If you work in a single-worker office with either a door that shuts or a desk that’s more than 6 feet away from the entrance, then you can most likely safely take it off so long as you have it within easy reach and could quickly put it on if someone came in your office.
The big question I get asked a lot is why people need to wear face masks when they’re in an elevator alone or walking down a seemingly-empty hall. My answer is that you don’t know for sure that you will be alone for your whole trip. That elevator could stop on the next floor and someone else could get on. Someone could step out of a doorway into the hallway just in front of you. Why take that risk for a short elevator ride or walk down the hall?
Until next time, please stay well, stay home, stay 6 feet apart and wear your masks!
😷 Dr. B