October 26, 2020

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Social Distancing

Social Distancing | COVID-19 South Africa | Social Distancing of at least 2 meters will help flatten the curve and prevent the spread of COVID-19.

In the battle against the highly infectious COVID-19 virus, social distancing is extremely important to help curb the spread of this disease across the country.

The term “social distancing” basically means one needs to keep their distance from others. This includes avoiding public spaces such as malls, the work place, and of course, social events as well as recreational areas where others usually gather.

One needs to avoid handshakes, hugs and other forms of direct contact as well as keeping a distance of at least two metres from others.

This practice is particularly important while we are in the midst of the Coronavirus epidemic where the virus spreads from person to person via an infected person passing droplets through sneezing or coughing or by coming into contact with surfaces where the virus has been transmitted.

There are various examples of social distancing that worked in curbing the rate of disease transmission, with one of the earliest and most notable examples going as far back as 350 years ago during the Black Plague.

The plague ended up killing around 100,000 people in total. However, there is a little town in the United Kingdom that was praised for its commitment to social distancing and quarantine and has been credited with keeping the disease from spreading to larger surrounding towns.

According to an article from Historic UK by Victoria Masson, written in 2016, the small British village isolated itself from the rest of the country for 14 months and through this, was able to contain the spread of the disease.

A boundary wall was set up around the outskirts of the village and it was guarded by watchmen to ensure no one ventured outside the town’s limits. Watchmen also ensured people stayed in their own homes whilst food and water was left by some   neighboring villages near the outskirts of the town when the villagers ran short of supplies.

One only has to look up the village online to see how effective they were in containing the spread of the disease without the use of modern medicine and protective equipment and the village’s decision has been said to have made a significant impact on the medical understanding of social distancing and quarantining.

The implementation of social distancing and quarantine in South Africa is essential in flattening the curve, which is indicated by the number of infectious people dropping.

We can learn many lessons from past pandemics and how they were handled. While many people may be frustrated by the current lockdown, it is vital in keeping South Africans, especially our more vulnerable communities, safe.

Staying indoors, significantly limiting your contact with other people and avoiding public spaces will leave many South Africans feeling helpless, restless and even angry. However, if we decide to ignore the calls of government for isolation, social distancing and quarantine, we will see the spread of the virus and the full devastation it wreaks in our country.

WikiPedia

Social distancing, also called physical distancing,[1][2][3] is a set of non-pharmaceutical interventions or measures taken to prevent the spread of a contagious disease by maintaining a physical distance between people and reducing the number of times people come into close contact with each other.[1][4] It typically involves keeping a certain distance from others (the distance specified may differ from time to time and country to country) and avoiding gathering together in large groups.[5][6]

By reducing the probability that a given uninfected person will come into physical contact with an infected person, the disease transmission can be suppressed, resulting in fewer deaths.[1] The measures are combined[by whom?] with good respiratory hygiene and hand washing.[7][8] During the COVID-19 pandemic, the World Health Organization (WHO) suggested favoring the term “physical distancing” as opposed to “social distancing”, in keeping with the fact that it is a physical distance which prevents transmission; people can remain socially connected via technology.[1][2][9][10] To slow down the spread of infectious diseases and avoid overburdening healthcare systems, particularly during a pandemic, several social-distancing measures are used, including the closing of schools and workplaces, isolation, quarantine, restricting the movement of people and the cancellation of mass gatherings.[4][11]

Although the term was only introduced in the twenty-first century,[12] social-distancing measures date back to at least the fifth century BC. The Bible contains one of the earliest known references to the practice in the Book of Leviticus 13:46: “And the leper in whom the plague is … he shall dwell alone; [outside] the camp shall his habitation be.”[13] During the Plague of Justinian of 541 to 542, emperor Justinian enforced an ineffective quarantine on the Byzantine Empire, including dumping bodies into the sea; he predominantly blamed the widespread outbreak on “Jews, Samaritans, pagans, heretics, Arians, Montanists, and homosexuals“.[14] In modern times, social distancing measures have been successfully implemented in several epidemics. In St. Louis, shortly after the first cases of influenza were detected in the city during the 1918 flu pandemic, authorities implemented school closures, bans on public gatherings and other social-distancing interventions. The case fatality rates in St. Louis were much less than in Philadelphia, which despite having cases of influenza, allowed a mass parade to continue and did not introduce social distancing until more than two weeks after its first cases.[15] Authorities have encouraged or mandated social distancing during the COVID-19 pandemic.

Social distancing measures are more effective when the infectious disease spreads via one or more of the following methods:[16]

  • droplet contact (coughing or sneezing)
  • direct physical contact (including sexual contact)
  • indirect physical contact (e.g., by touching a contaminated surface)
  • airborne transmission (if the microorganism can survive in the air for long periods)

The measures are less effective when an infection is transmitted primarily via contaminated water or food or by vectors such as mosquitoes or other insects.[17]

Drawbacks of social distancing can include loneliness, reduced productivity and the loss of other benefits associated with human interaction.[18]

Definition

Social Distancing

A poster (in Arabic, English and Urdu) encouraging social distancing during the COVID-19 pandemic

The Centers for Disease Control and Prevention (CDC) have described social distancing as a set of “methods for reducing frequency and closeness of contact between people in order to decrease the risk of transmission of disease”.[11] During the 2009 flu pandemic the WHO described social distancing as “keeping at least an arm’s length distance from others, [and] minimizing gatherings”.[7] It is combined with good respiratory hygiene and hand washing, and is considered the most feasible way to reduce or delay a pandemic.[7]

During the COVID-19 pandemic, the CDC revised the definition of social distancing as “remaining out of congregrate settings, avoiding mass gatherings, and maintaining distance (approximately six feet or two meters) from others when possible”.[5][6] It is not clear why six feet was chosen. Recent studies have suggested that droplets from a sneeze or forceful breathing during exercise can travel over six meters.[19][20][21] Some have suggested the required distance is based on debunked research from the 1930s and 1940s[22] or confusion regarding units of measurement. Researchers and science writers have recommended that larger social distances[20][23][24] and/or both mask wearing and social distancing be required.[20][25]

Measures

See also: Flatten the curve

Social Distancing

Social distancing helps prevent a sharp peak of infections (“flattens the epidemic curve“) to help healthcare services deal with demand, and extends time for healthcare services to be increased and improved.[26][27][28]

Knowing that a disease is circulating may trigger a change in behavior by people choosing to stay away from public places and other people. When implemented to control epidemics, such social distancing can result in benefits but with an economic cost. Research indicates that measures must be applied rigorously and immediately in order to be effective.[29] Several social distancing measures are used to control the spread of contagious illnesses.[11][16][5]

Avoiding physical contact

Social distancing includes eliminating the physical contact that occurs with the typical handshake, hug, or hongi; this New Zealand illustration offers eight alternatives.

Keeping at least two-metre (six-foot) distance (in the US or UK) or 1.5 metres distance (in Australia) or 1 metre distance (in France or Italy) from each other and avoiding hugs and gestures that involve direct physical contact, reduce the risk of becoming infected during flu pandemics and the coronavirus pandemic of 2020.[5][30] These distances of separation, in addition to personal hygiene measures, are also recommended at places of work.[31] Where possible it may be recommended to work from home.[8]

Various alternatives have been proposed for the tradition of handshaking. The gesture of namaste, placing one’s palms together, fingers pointing upwards, drawing the hands to the heart, is one non-touch alternative. During the COVID-19 pandemic in the United Kingdom, this gesture was used by Prince Charles upon greeting reception guests, and has been recommended by the Director-General of the WHO, Tedros Adhanom Ghebreyesus, and Israeli Prime Minister Benjamin Netanyahu.[32] Other alternatives include the wave, the shaka (or “hang loose”) sign, and placing a palm on your heart, as practiced in parts of Iran.[32]

  • In this computer lab, every other workstation has been closed off to increase the distance between people working.
  • Floor markings can help people maintain distance in public places.

School closures

Swine flu cases per week in the United Kingdom in 2009; schools typically close for summer in mid-July and re-open in early September.[33]

Mathematical modeling has shown that transmission of an outbreak may be delayed by closing schools. However, effectiveness depends on the contacts children maintain outside of school. Often, one parent has to take time off work, and prolonged closures may be required. These factors could result in social and economic disruption.[34][35]

Workplace closures

Modeling and simulation studies based on U.S. data suggest that if 10% of affected workplaces are closed, the overall infection transmission rate is around 11.9% and the epidemic peak time is slightly delayed. In contrast, if 33% of affected workplaces are closed, the attack rate decreases to 4.9%, and the peak time is delayed by one week.[36][37] Workplace closures include closure of “non-essential” businesses and social services (“non-essential” means those facilities that do not maintain primary functions in the community, as opposed to essential services).[38]

Canceling mass gatherings

Cancellation of mass gatherings includes sports events, films or musical shows.[39] Evidence suggesting that mass gatherings increase the potential for infectious disease transmission is inconclusive.[40] Anecdotal evidence suggests certain types of mass gatherings may be associated with increased risk of influenza transmission, and may also “seed” new strains into an area, instigating community transmission in a pandemic. During the 1918 influenza pandemic, military parades in Philadelphia[41] and Boston[42] may have been responsible for spreading the disease by mixing infected sailors with crowds of civilians. Restricting mass gatherings, in combination with other social distancing interventions, may help reduce transmission.[43]

Travel restrictions

Border restrictions or internal travel restrictions are unlikely to delay an epidemic by more than two to three weeks unless implemented with over 99% coverage.[44] Airport screening was found to be ineffective in preventing viral transmission during the 2003 SARS outbreak in Canada[45] and the U.S.[46] Strict border controls between Austria and the Ottoman Empire, imposed from 1770 until 1871 to prevent persons infected with the bubonic plague from entering Austria, were reportedly effective, as there were no major outbreaks of plague in Austrian territory after they were established, whereas the Ottoman Empire continued to suffer frequent epidemics of plague until the mid-nineteenth century.[47][48]

A Northeastern University study published in March 2020 found that “travel restrictions to and from China only slow down the international spread of COVID-19 [when] combined with efforts to reduce transmission on a community and an individual level. […] Travel restrictions aren’t enough unless we couple it with social distancing.”[49] The study found that the travel ban in Wuhan delayed the spread of the disease to other parts of mainland China only by three to five days, although it did reduce the spread of international cases by as much as 80 percent. A primary reason travel restrictions were less effective is that many people with COVID-19 do not show symptoms during the early stages of infection.[50]

Shielding

Social distancing markers and plexiglass shield at Whole Foods Market checkout in Toronto to reduce physical contact.

Shielding measures for individuals include limiting face-to-face contacts, conducting business by phone or online, avoiding public places and reducing unnecessary travel.[51][52][53]

Quarantine

Main article: Quarantine

During the 2003 SARS outbreak in Singapore, approximately 8000 people were subjected to mandatory home quarantine and an additional 4300 were required to self-monitor for symptoms and make daily telephone contact with health authorities as a means of controlling the epidemic. Although only 58 of these individuals were eventually diagnosed with SARS, public health officials were satisfied that this measure assisted in preventing further spread of the infection.[54] Voluntary self-isolation may have helped reduce transmission of influenza in Texas in 2009.[55] Short and longterm negative psychological effects have been reported.[18]

Stay-at-home orders

Main article: Stay-at-home orders

The objective of stay-at-home orders is to reduce day-to-day contact with between people and thereby reduce spread of infection[56]

Cordon sanitaire

Main article: Cordon sanitaire

In 1995, a cordon sanitaire was used to control an outbreak of Ebola virus disease in Kikwit, Zaire.[57][58][59] President Mobutu Sese Seko surrounded the town with troops and suspended all flights into the community. Inside Kikwit, the World Health Organization and Zaire’s medical teams erected further cordons sanitaires, isolating burial and treatment zones from the general population and successfully containing the infection.[60]

Protective sequestration

Main article: Protective sequestration

During the 1918 influenza epidemic, the town of Gunnison, Colorado, isolated itself for two months to prevent an introduction of the infection. Highways were barricaded and arriving train passengers were quarantined for five days. As a result of the isolation, no one died of influenza in Gunnison during the epidemic.[61] Several other communities adopted similar measures.[62]


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