Feature

Social distancing ‘is all we have’ to prevent spread of COVID-19

Millions of Americans have been ordered by state health officials to stay home until further notice except for essential needs, such as food and health care.

The recommendation to avoid gatherings and maintain a distance of approximately 6 feet from others when possible is part of a broader effort to slow the spread of disease and flatten the curve of the pandemic.

However, people who ignore health officials only exacerbate an already difficult situation, physicians and epidemiologists told Healio Primary Care. They also explained the rationale for social distancing and ways that physicians can explain the concept to people — both in and out of health care settings — without causing further alarm.

Danger of ignoring social distancing

 

The reason for social distancing largely stems from health officials’ inability to know exactly who has COVID-19, Jennifer A. Horney, PhD, MPH, CPH, founding director of the epidemiology program and core faculty in the Disaster Research Center at the University of Delaware, said in an interview.

Jen Horney
Jennifer A. Horney

“Data from China show that 85% of COVID-19 infections were undetected due to having no or only mild symptoms. If these individuals continued social interactions but never know that they were infected, then many more people were at risk,” she added.

Similarly, a recent Pediatrics study showed that of 2,143 children in China, 731 were laboratory confirmed for COVID-19. More than 90% of all pediatric patients had no symptoms or experienced only mild or moderate disease, which provides further support for the recent actions like school closures, Horney added.

Catherine Troisi, PhD, an infectious disease epidemiologist at The University of Texas Health Science Center, said people who refuse or ignore social distancing orders can only make the pandemic worse.

“The current estimate is that between 40% and 70% of the population could be infected and that we’re going to see more deaths if we don’t socially distance ourselves,” she told Healio Primary Care. “Ignoring social distancing is particularly dangerous for those over 65 years old and especially dangerous for those over 85 years old.”

David Holtgrave, PhD, the dean of the University at Albany School of Public Health, said social distancing is part of a larger societal responsibility.

With a “very contagious” virus like COVID-19, which is stretching the capacity of our health care system, everyone’s participation is crucial, Troisi added.

“One person will not stop the COVID-19 virus. But that person can significantly slow it down and will go a long way toward making our capacity function,” she said. “It’s hoped that social distancing can put off large numbers of infection until we get the antivirals, the vaccine, in place.”

According to Holtgrave, lessons can be learned from the responses to the pandemic in China and South Korea, particularly the combination of aggressive testing, contact tracing and social distancing. He added that China has done more physical distancing of large geographic areas, while South Korea has conducted more narrowly-focused physical distancing based on results of aggressive testing, intensive contact tracing data, and extensive health screening.

David Holtgrave
David Holtgrave

“If we are very intensive and roll out similar interventions at the right scale, we could make a difference in several weeks’ time,” Holtgrave said. “If we can keep the given number of new COVID-19 cases down somewhat or at least spread them out over time, we can do a better job of keeping the number of cases either below or not too much above the number of hospital beds and ICU and ventilator facilities that we have available.”

Helping patients understand

Individuals who fail to see the rationale for social distancing may benefit from the lessons of recent history, Mark Cameron, PhD, an associate professor in the department of population and quantitative health sciences at Case Western Reserve University, told Healio Primary Care.

Mark Cameron
Mark Cameron

”For example, after close contact and personal protective equipment precautions were relaxed following the first wave of the 2003 SARS epidemic in Toronto, transmission flared up again. The second wave lasted just as long as the first with new cases breaking mainly out of hospitals and affecting health care workers, patients and their visitors.

Horney said it is important to put COVID-19 into context. The U.S. frequently experiences outbreaks of diseases like pertussis and mumps.

But with those, we have pharmaceutical interventions like vaccines or antivirals that we can give to either shorten the length of the illness or lessen the symptoms,” she said. “With COVID-19, social distancing is all we have at this time.”

Doing it for your grandmother and grandfather

Troisi said physicians should explain to patients that social distancing is not just for their own benefit.

“Emphasize that you’re not just social distancing for yourself, but you’re doing it for your grandmother and your grandfather,” she said. “By socially isolating, or distancing yourself, you are helping prevent those in the community who could not fight off the infection as well as others could. Public health is looking out for your society, not just yourself.”

Cameron said physicians also should give patients positive reinforcement.

“Tell individuals that every time they practice social distancing, they are saving lives and that they are saving somebody who’s truly vulnerable,” he said. “Tell individuals that social distancing is a heroic act that also provides researchers time to identify treatments and roll out a vaccine.”

Holtgrave, who also led the CDC’s Division of HIV/AIDS Prevention-Intervention Research and Support for about 4 years before assuming his current position, said physicians need to “dispel some of the myths that just because you’re younger — maybe in your 20s or 30s or 40s — you won’t become ill.”

“The chances are less that you’ll become ill, but it’s certainly possible for people [in that age group] to become sick and even be hospitalized,” Holtgrave said. “Even the very young can, theoretically, become infected.” – by Janel Miller

References:

CDC. Coronavirus disease 2019 (COVID-19) Risk assessment and management.

https://www.cdc.gov/coronavirus/2019-ncov/php/risk-assessment.html. Accessed March 23, 2020.

CDC. Coronavirus disease 2019 (COVID-19) Schools, workplaces and community locations. https://www.cdc.gov/coronavirus/2019-ncov/community/index.html. Accessed March 23, 2020.

COVID19 California. Stay home except for essential needs. https://covid19.ca.gov/stay-home-except-for-essential-needs/. Accessed March 20, 2020.

State of Illinois. Gov. Pritzker announces statewide stay at home order to maximize COVID-19 containment, ensure health care system remains fully operational. https://www2.illinois.gov/Pages/news-item.aspx?ReleaseID=21288, Accessed March 21, 2020.
Governor Cuomo signs the 'New York State on PAUSE' executive order. https://www.governor.ny.gov/news/governor-cuomo-signs-new-york-state-pause-executive-order. Accessed March 21, 2020.

UTHealthNews. What is social distancing and should we be doing it? https://www.uth.edu/news/story.htm?id=329ef39d-5022-491b-9196-49c39a734670. Accessed March 19, 2020.

Disclosures: Cameron, Holtgrave, Horney and Troisi all report no relevant financial disclosures.

Millions of Americans have been ordered by state health officials to stay home until further notice except for essential needs, such as food and health care.

The recommendation to avoid gatherings and maintain a distance of approximately 6 feet from others when possible is part of a broader effort to slow the spread of disease and flatten the curve of the pandemic.

However, people who ignore health officials only exacerbate an already difficult situation, physicians and epidemiologists told Healio Primary Care. They also explained the rationale for social distancing and ways that physicians can explain the concept to people — both in and out of health care settings — without causing further alarm.

Danger of ignoring social distancing

 

The reason for social distancing largely stems from health officials’ inability to know exactly who has COVID-19, Jennifer A. Horney, PhD, MPH, CPH, founding director of the epidemiology program and core faculty in the Disaster Research Center at the University of Delaware, said in an interview.

Jen Horney
Jennifer A. Horney

“Data from China show that 85% of COVID-19 infections were undetected due to having no or only mild symptoms. If these individuals continued social interactions but never know that they were infected, then many more people were at risk,” she added.

Similarly, a recent Pediatrics study showed that of 2,143 children in China, 731 were laboratory confirmed for COVID-19. More than 90% of all pediatric patients had no symptoms or experienced only mild or moderate disease, which provides further support for the recent actions like school closures, Horney added.

Catherine Troisi, PhD, an infectious disease epidemiologist at The University of Texas Health Science Center, said people who refuse or ignore social distancing orders can only make the pandemic worse.

“The current estimate is that between 40% and 70% of the population could be infected and that we’re going to see more deaths if we don’t socially distance ourselves,” she told Healio Primary Care. “Ignoring social distancing is particularly dangerous for those over 65 years old and especially dangerous for those over 85 years old.”

David Holtgrave, PhD, the dean of the University at Albany School of Public Health, said social distancing is part of a larger societal responsibility.

With a “very contagious” virus like COVID-19, which is stretching the capacity of our health care system, everyone’s participation is crucial, Troisi added.

“One person will not stop the COVID-19 virus. But that person can significantly slow it down and will go a long way toward making our capacity function,” she said. “It’s hoped that social distancing can put off large numbers of infection until we get the antivirals, the vaccine, in place.”

According to Holtgrave, lessons can be learned from the responses to the pandemic in China and South Korea, particularly the combination of aggressive testing, contact tracing and social distancing. He added that China has done more physical distancing of large geographic areas, while South Korea has conducted more narrowly-focused physical distancing based on results of aggressive testing, intensive contact tracing data, and extensive health screening.

David Holtgrave
David Holtgrave

“If we are very intensive and roll out similar interventions at the right scale, we could make a difference in several weeks’ time,” Holtgrave said. “If we can keep the given number of new COVID-19 cases down somewhat or at least spread them out over time, we can do a better job of keeping the number of cases either below or not too much above the number of hospital beds and ICU and ventilator facilities that we have available.”

Helping patients understand

Individuals who fail to see the rationale for social distancing may benefit from the lessons of recent history, Mark Cameron, PhD, an associate professor in the department of population and quantitative health sciences at Case Western Reserve University, told Healio Primary Care.

Mark Cameron
Mark Cameron

”For example, after close contact and personal protective equipment precautions were relaxed following the first wave of the 2003 SARS epidemic in Toronto, transmission flared up again. The second wave lasted just as long as the first with new cases breaking mainly out of hospitals and affecting health care workers, patients and their visitors.

Horney said it is important to put COVID-19 into context. The U.S. frequently experiences outbreaks of diseases like pertussis and mumps.

But with those, we have pharmaceutical interventions like vaccines or antivirals that we can give to either shorten the length of the illness or lessen the symptoms,” she said. “With COVID-19, social distancing is all we have at this time.”

Doing it for your grandmother and grandfather

Troisi said physicians should explain to patients that social distancing is not just for their own benefit.

“Emphasize that you’re not just social distancing for yourself, but you’re doing it for your grandmother and your grandfather,” she said. “By socially isolating, or distancing yourself, you are helping prevent those in the community who could not fight off the infection as well as others could. Public health is looking out for your society, not just yourself.”

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Cameron said physicians also should give patients positive reinforcement.

“Tell individuals that every time they practice social distancing, they are saving lives and that they are saving somebody who’s truly vulnerable,” he said. “Tell individuals that social distancing is a heroic act that also provides researchers time to identify treatments and roll out a vaccine.”

Holtgrave, who also led the CDC’s Division of HIV/AIDS Prevention-Intervention Research and Support for about 4 years before assuming his current position, said physicians need to “dispel some of the myths that just because you’re younger — maybe in your 20s or 30s or 40s — you won’t become ill.”

“The chances are less that you’ll become ill, but it’s certainly possible for people [in that age group] to become sick and even be hospitalized,” Holtgrave said. “Even the very young can, theoretically, become infected.” – by Janel Miller

References:

CDC. Coronavirus disease 2019 (COVID-19) Risk assessment and management.

https://www.cdc.gov/coronavirus/2019-ncov/php/risk-assessment.html. Accessed March 23, 2020.

CDC. Coronavirus disease 2019 (COVID-19) Schools, workplaces and community locations. https://www.cdc.gov/coronavirus/2019-ncov/community/index.html. Accessed March 23, 2020.

COVID19 California. Stay home except for essential needs. https://covid19.ca.gov/stay-home-except-for-essential-needs/. Accessed March 20, 2020.

State of Illinois. Gov. Pritzker announces statewide stay at home order to maximize COVID-19 containment, ensure health care system remains fully operational. https://www2.illinois.gov/Pages/news-item.aspx?ReleaseID=21288, Accessed March 21, 2020.
Governor Cuomo signs the 'New York State on PAUSE' executive order. https://www.governor.ny.gov/news/governor-cuomo-signs-new-york-state-pause-executive-order. Accessed March 21, 2020.

UTHealthNews. What is social distancing and should we be doing it? https://www.uth.edu/news/story.htm?id=329ef39d-5022-491b-9196-49c39a734670. Accessed March 19, 2020.

Disclosures: Cameron, Holtgrave, Horney and Troisi all report no relevant financial disclosures.

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