Isolating sick persons to avoid infecting the rest of the population isn’t new. In fact, it’s in the Bible.
The Book of Leviticus decrees for a leper: “All the days wherein the plague shall be in him he shall be defiled; he is unclean: he shall dwell alone; without the camp shall his habitation be.”
But the concept of total “social distancing,” in which people stay home or re-route themselves in grocery aisles and on sidewalks to remain 6 feet from others, is rather novel.
Merriam-Webster describes it as a 21st-century phenomenon. Its first known use of the term was in 2003, after the SARS outbreak in East Asia.
The idea took hold in the U.S. bureaucracy a few years later, as the post-9/11 environment and emerging threats led President George W. Bush to fear a pandemic without a vaccine.
At the time, the idea of widespread shutdowns was seen as too drastic — some officials said vaccine or bust — but the Centers for Disease Control and Prevention developed the policy. The Obama administration accepted the guidelines, which were revised in the first year of the Trump administration.
“There has never been a social distancing strategy this big in world history — that’s been pretty well established,” said Howard Markel, a University of Michigan professor who worked on the science behind the 2007 guidelines. “Before COVID, the largest use of these measures was during the 1918-19 flu pandemic, but that’s all they had available to them.”
What is social distancing?
The concept of social distancing — some prefer “physical distancing” — means keeping space between yourself and people outside your home, according to the CDC. It also entails closing offices and schools and ordering many people to work and learn from home.
It is considered a non-pharmaceutical way to prevent a healthy person from coming in contact with an infected person, slow the transmission of disease and maintain hospital capacity.
After all, the new coronavirus mainly spreads person to person, according to the CDC, which just announced it no longer believes it spreads easily on surfaces.
“COVID-19 is a new disease and we are still learning about how it spreads. It may be possible for COVID-19 to spread in other ways, but these are not thought to be the main ways the virus spreads,” the agency’s website reads in a list that includes surfaces.
Social distancing as we know it today involves staying about two arms’ length, from others, refusing to gather in groups and staying out of crowded spaces.
Part of the justification for these measures is that people may spread pathogens before they realize they are sick, get tested and isolate themselves.
The Merriam-Webster dictionary says it found the first known use of the term in an Associated Press International story about the SARS outbreak nearly two decades ago.
“There is this heightened social distancing and it has affected me a lot,” said Dr. Lim Ing Haan, 31-year-old cardiologist who recovered from the disease, said in the article. “After I was discharged, for a long period of time, I refused to go out and do the usual things like the gym and the pool.”
Many people hadn’t heard of it until this year, as European hotspots went into lockdown and many U.S. states issued stay-at-home orders to slow the spread of the coronavirus discovered in Wuhan, China, in December.
As the virus crept across the world in February, the White House told reporters to add “social distancing” to their lexicon, saying there were mitigation steps, including school closures, that could be taken if the outbreak reached the pandemic stage (which it did).
“We call these different forms of social distancing, OK?” Health Secretary Alex Azar said at a Feb. 28 briefing. “It can be indicated under certain circumstances that it might make sense to close a school or schools, or take other measures like that.”
Have these techniques been used before?
Some of them, yes. Indeed, quarantining the sick and sealing off neighborhoods during outbreaks has been a feature of urban life at least since Leviticus.
During the famous 1918 influenza pandemic, when quarantines were locally driven, the city of St. Louis closed schools, courthouses and other public locations within days of cases arriving. It also limited capacity on streetcars, while staggering work shifts.
Other cities, notably Philadelphia, adopted similar measures much later and held a large parade despite the outbreak.
Researchers say the disparity was clear, with Philadelphia seeing a much higher death rate.
Those findings played a role in the development of Bush-era guidelines that are often attributed to two federal government doctors, Richard Hatchett and Carter Mecher.
A recent New York Times article on their story said they based their research in part on input from Robert J. Glass, a scientist in New Mexico who was struck by his 14-year-old daughter’s science project on school groups, and “how they were a near-perfect vehicle for a contagious disease to spread.”
Mr. Markel, on whose research the CDC relied in drafting its 2007 strategy, said the arguments for social distancing ran into opposition at the time from experts who said it would be too disruptive.
Mr. Markel said the “loudest opponent” was a former professor of his at Johns Hopkins University, D.A. Henderson, who is known for efforts to eradicate smallpox. He thought social distancing guidelines were unworkable and wanted to direct work to vaccines.
“The 2007 guidelines came out of the George W. Bush administration. They were accepted by the Obama administration and were set to be implemented during the 2009 H1N1 flu pandemic but that was not lethal enough to warrant such disruptive measures,” said Dr. Markel. “The guidelines were recently re-examined and revised and improved by CDC in 2017.”
Finally implemented in earnest, the impact has been keenly felt across the nation.
The 6-foot-rule was derived from the physics of how the new coronavirus spreads. Coughing, sneezing and talking can emit virus-laden droplets into the air, especially in colder, drier weather. There are concerns that droplets can remain in the air for longer than realized, so the concept may be revisited at some point.
Howard Koh, a professor at the Harvard T.H. Chan School of Public Health, said people are told every flu season to cover coughs, wash their hands and stay a way from someone who is clearly coughing.
“To my knowledge, this is the first time it’s been so explicit as a 6-foot rule,” Dr. Koh said.
Has social distancing been effective in slowing COVID-19?
It appears so.
After widespread fears that hospitals would be overrun, places across the U.S. have managed to “flatten the curve” of transmission, though it’s a long slog down the other side, as the country still reports over 20,000 cases per day.
A study published in Health Affairs suggests up to 35 million more Americans would have been infected if four big restrictions hadn’t been put in place: large event bans; school closures; shuttering entertainment venues, gyms, bars, and restaurant dining areas; and shelter-in-place orders (SIPOs).
“Adoption of government-imposed social distancing measures reduced the daily growth rate by 5.4 percentage points after 1–5 days, 6.8 after 6–10 days, 8.2 after 11–15 days, and 9.1 after 16–20 days,” wrote the researchers, who looked at the period between March 1 and April 27. “Holding the amount of voluntary social distancing constant, these results imply 10 times greater spread by April 27 without SIPOs (10 million cases) and more than 35 times greater spread without any of the four measures (35 million).”
Disease modelers from Columbia University argue roughly 36,000 lives could have been saved as of May 3 — 29,410 compared to 65,307 — if the nation had locked down one week earlier in March.
Are there drawbacks?
Certainly.
Economies across the world are in disarray from the freeze in commerce. The retail and restaurant industries were hit particularly hard, and a large number of these businesses may never reopen.
Companies are furloughing and laying off workers en masse, with 38.6 million American workers having filed unemployment claims since the crisis began in March.
Congress has scrambled to extend loans to businesses and cash payments to everyday Americans.
Mr. Trump, in his push to get the economy revving, has said the cure can’t be worse than the disease, pointing to fears that economic woes and emotional distress will lead to a spike in addiction or suicide.
Mr. Trump had one of the administration’s experts from the Health and Human Services Department deliver a lengthy statement on the effects during a Cabinet meeting at the White House.
“The research literature is clear on the effects of quarantine and stay-at-home practices on mental health,” said Elinore McCance-Katz, the assistant HHS secretary for mental health and substance use. “We know that the longer the duration of these orders, the greater the intensity of the mental health problems experienced.”
