Social Distancing

Introduction

One way of limiting the spread of an infectious disease, for instance, Covid-19, is to practice social distancing. This is not a new concept, as most societies have been aware of the value of keeping away from people who are suffering from an infection for many generations.

The objective is to reduce transmission, delaying the epidemic peak, reducing the size of the epidemic peak, and spreading cases over a longer time to relieve pressure on the healthcare system[1].

What Does Social Distancing Involve?

It is an action taken to minimise contact with other individuals.

It has been suggested that maintaining a distance of approximately 2 metres from another individual result in a marked reduction in transmission of most flu virus strains, including COVID-19.

In practice, this means that avoiding close proximity to other people will aid in slowing the spread of infectious diseases. Social distancing is one of the non-pharmaceutical infection control actions that can stop or slow down the spread of a highly contagious disease[2].

How Does It Work?

The virus that causes COVID-19 is currently spreading easily from person-to-person. When a healthy person comes into contact with respiratory droplets from coughs or sneezes of an infected person, they are can catch the infection[3][4].

The World Health Organisation (WHO) states that "COVID-19 is transmitted via droplets and fomites during close unprotected contact between an infector and infectee"[5]. A fomite is an object or material which is likely to carry infection, such as clothes, utensils, and furniture. Therefore, transmission of the infection can be avoided by staying away from other people as well as from touching infected fomites.

Social distancing aims to decrease or interrupt transmission of COVID-19 in a population[1] by minimising contact between potentially infected individuals and healthy individuals, or between population groups with high rates of transmission and population groups with no or low levels of transmission.

[6]

How Effective Is It?

Studies on outbreaks of infectious diseases, such as the flu, suggest that social distancing is an effective way to reduce the number of people infected provided that the measures are thorough and that they are continued for a suitable length of time[7]. Studies on the 1918 influenza epidemic, comparing different states in the USA, demonstrated the benefits of applying social distancing[8][9].

A recent, systematic review by Fong et al., (2020) "found some evidence from observational and simulation studies to support the effectiveness of social distancing measures during influenza pandemics. Timely implementation and high compliance in the community would be useful factors for the success of these interventions."[10]

Covid-19-curves-graphic-social-v3.gif

Methods of Social Distancing

Prohibition of Mass Gatherings

Cancellation of events which involve large numbers of people gathering together, such as:

  • Sports games
  • Work conferences
  • Theatre productions
  • Cinemas

Closure of Community Facilities

These facilities can include:

  • Swimming pools
  • Gyms
  • Youth clubs
  • Community centres

Workplace Closure

  • Closure of non-essential workplaces
  • Closure of schools
  • Closure of colleges and universities

Self-Shielding

  • Individuals limit face-to-face contacts
  • Individuals avoid public places
  • Individuals avoid public transport

Shut Down/Reduce Public Transport

Difference Between Social Distancing and Shielding

Shielding like social distancing is recommended to prevent the spread of infection but is particularly aimed at protecting vulnerable people like the elderly and those with an underlying condition[11]. It involves minimising interaction by staying at home but also minimising all non-essential contact with other members of the household. a measure to protect extremely vulnerable people by minimising interaction between those who are extremely vulnerable and others. This means that those who are extremely vulnerable should not leave their homes, and within their homes should minimise all non-essential contact with other members of their household. These measures include[11]:

  1. Strictly avoid contact with someone who has signs and symptoms of the infection.
  2. Stay at home.
  3. Do not attend any social gatherings. This includes socialising with friends and families not just at official functions (including religious gatherings) but also in your home or theirs.
  4. Do not go out for shopping, leisure or travel. Where possible arrange for food and medications to be delivered and left on the doorstep to minimise contact.
  5. Make use of remote technology to stay in touch. This is much easier in a world that now has mobile phones, the internet and social media.
  6. If contact needs to be made with medical or other essential services make use of the telephone or online services.

The key message is to avoid (or at least minimise) contact with ALL people!

Is Social Distancing a New Concept?

No, it has been around for many generations and in many different regions of the world.

Resources

References

  1. 1.0 1.1 Wilder-Smith A, Freedman DO Isolation, quarantine, social distancing and community containment: pivotal role for old-style public health measures in the novel coronavirus (2019-nCoV) outbreak. J Travel Med. 2020 Feb 13. pii: taaa020. doi: 10.1093/jtm/taaa020. [Epub ahead of print]
  2. Ahmed F, Zviedrite N, Uzicanin A Effectiveness of workplace social distancing measures in reducing influenza transmission: a systematic review. BMC Public Health. 2018 Apr 18;18(1):518. doi: 10.1186/s12889-018-5446-1.
  3. "Q&A on coronaviruses"World Health Organization (WHO). 11 February 2020. Retrieved 13 March 2020
  4. Rothan HA, Byrareddy SN (February 2020). "The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak"Journal of Autoimmunity: 102433.
  5. World Health Organisation. Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19). https://www.who.int/docs/default-source/coronaviruse/who-china-joint-mission-on-covid-19-final-report.pdf. Accessed 16 March 2020.
  6. World Health Organisation. Why is it recommended to avoid close contact with anyone who has fever and cough? Published on 5 February 2020. Available from https://www.youtube.com/watch?v=6Ooz1GZsQ70. [last accessed 16 March 2020]
  7. Maharaj S, Kleczkowski A (2012). "Controlling epidemic spread by social distancing: Do it well or not at all"BMC Public Health12 (1): 679.
  8. Hatchett RJ, Mecher CE, Lipsitch M (2007). "Public health interventions and epidemic intensity during the 1918 influenza pandemic"Proc Natl Acad Sci U S A104 (18): 7582–7587
  9. Bootsma MC, Ferguson NM (2007). "The effect of public health measures on the 1918 influenza pandemic in U.S. cities"Proc Natl Acad Sci U S A104 (18): 7588–7593
  10. Fong MW, Gao H, Wong JY, Xiao J, Shiu EY, Ryu S, Cowling BJ. Early Release-Nonpharmaceutical Measures for Pandemic Influenza in Nonhealthcare Settings—Social Distancing Measures. Emerging Infectious Diseases. 2020; 26(5).
  11. 11.0 11.1 Public Health England 2020. Guidance on shielding and protecting people defined on medical grounds as extremely vulnerable from COVID-19 - What is Shielding. Accessed 24 March 2020