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Author: Holly M.
Fourth Year Medical Student

Introduction:

This is a short introductory article to social distancing. This is a very important topic at the moment, with much debate surrounding it. Policies are changing constantly, and new research is coming out all the time, so make sure you use reliable sources to stay as up to date as you can. As with all articles, this is a topic that could potentially come up in your medical school interviews, so make sure you are well-read up on it, and feel confident discussing it. I would advise taking notes as you read through this article, and reading through the references in your own time too.

 

What is social distancing?

You will already probably have a very good idea about what social distancing is. Social distancing can be specifically referring to staying a certain distance away from people in public and or private spaces, but can also be used as an umbrella term to cover lots of measures currently in place to reduce social contact, and so transmission of COVID-19. These measures include working from home whenever possible, avoiding public transport, and avoiding large gatherings.

Certain people, such as those who have had an organ transplant, are taking drugs called immunosuppressants, are receiving chemotherapy or radiotherapy, have a blood cancer, or those with CF (cystic fibrosis) are more at risk than other people, so need to adhere to stricter measures, and have been ‘shielding’. Shielding is how vulnerable people and their family members have been staying in their houses and not having any physical contact with the outside world in order to reduce the chances of the vulnerable person catching COVID-19.

There have been some calls to call social distancing, physical distancing instead. Social distancing has had hugely negative effects on people’s mental health, and social contacts, and feeling socially connected are more important than ever. It is important to remember that whilst we still may be socially distancing, we don’t have to be distant from our connections with each other.

 

Why does social distancing work?

The main way that the COVID-19 virus can spread is via aerosolization. This is when one person, who has the virus, coughs / sneezes / talks etc. and droplets containing the virus travel from their nose or mouth into the nose or mouth of another person.  As some people may be asymptomatic and never realise they have the virus, or may just be asymptomatic in the early stages of the virus, they could potentially spread the virus to a great deal of people without realising.

It makes sense, that if we are in less close contact with people, it means we are less likely to contract or spread the virus. It also makes sense that if we are in close contact with people, we are for the least amount of time possible, as again this would minimise the chances of contracting or spreading the virus. You can also imagine, that the further away you are from someone, the farther the droplets would have to travel in order to infect someone, so again, social distancing and creating increased space between people, makes it less likely that the virus will be spread.

 

How effective is social distancing?

As I have already mentioned, research is constantly coming out about COVID-19, so don’t just rely on this article, but go search on reliable sites such as PubMed for the most up-to-date research on social distancing and COVID-19. I have included some links to some papers published on social distancing, and I would really recommend reading through them if you truly want an in-depth understanding of the evidence base to social distancing.

Most studies have focused on when social distancing measures were put in place, and lifted in populations, and how this affected the amount and predicted amount of cases of COVID-19. We are not yet completely sure of how long COVID-19 is infectious for, with estimates ranging from 5-20 days, so this can affect how data is generated and interpreted. The infectious period has a really big impact on the speed of the epidemic, so without clearly knowing this, all data must be treated with caution. We also do not yet know if people can develop immunity to COVID-19 (by creating antibodies), how long this immunity may last, and if a convalescing person could still pass on COVID-19 to other people. Without knowing these things, it is again difficult to predict data curves, and also create safe public policies.

As a general overview, social distancing can affect when the peak of the virus happens, as putting it in place can delay the peak, and it can also reduce the amount of cases at the peak of the pandemic. A really early intervention with social distancing can have a much greater delaying effect than a social distancing intervention introduced later on, when cases were already at higher levels. Strategies for social distancing that involve people of all age groups reduce the peak of the curve (so the number of cases) the most, but even reducing contact in adult populations by a quarter can lead to 69% fewer cases at the epidemic peak. Research also suggests that lifting these social distancing measures can result in new epidemic peaks (so more new cases of the virus), especially if an intervention is lifted too soon.

One argument you may have heard, is that the 2m rule is not really based on enough scientific evidence and may not truly be the distance required for effective social distancing. A paper I have linked below explains this really well. In simple terms, a blanket 2 metre rule doesn’t take into account lots of different variable factors such as the difference between indoors and outdoors, how big droplets are, viral load (how much of the virus you have inside of you), and duration of exposure. Small airdrops could travel up to 8 metres from an infected individual, and this is before you factor in fans and other forms of ventilation, which could make droplets travel further. The paper also talks about how ‘droplets’ in themselves are an over simplification. In reality, an infected person has a ‘cloud’ of exhaled air within which you can find droplets visible to the naked eye, and tiny microscopic droplets. The size of this ‘cloud’ and the amount of droplets of different sizes within it is what will really determine how likely an infected person is to transmit the virus. If we were to discover that COVID-19 is only transmitted in large isolated droplets, then we could more safely put in place shorter social distancing measures that were backed by scientific evidence.

This is a constantly evolving situation, and as new evidence continues to come out, we will learn more about the virus, how it is transmitted, and the best social distancing measures we can put in place.

 

References:

https://www.gov.uk/government/publications/covid-19-guidance-on-social-distancing-and-for-vulnerable-people/guidance-on-social-distancing-for-everyone-in-the-uk-and-protecting-older-people-and-vulnerable-adults#:~:text=Social%20distancing%20measures%20are%20steps,COVID%2D19).

https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/social-distancing.html

https://wwwnc.cdc.gov/eid/article/26/8/20-1093_article

https://www.cebm.net/covid-19/what-is-the-evidence-to-support-the-2-metre-social-distancing-rule-to-reduce-covid-19-transmission/

https://www.telegraph.co.uk/global-health/science-and-disease/viral-load-many-health-workers-getting-sick/

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