In public health, social distancing, also called physical distancing,
[ (NB. Regula Venske is president of the ]PEN Centre Germany
PEN Centre Germany is part of the worldwide association of writers founded in London in 1921, now known as PEN International. One of over 140 autonomous PEN centres around the world, PEN Centre Germany is based in Darmstadt, Hesse.
Work
PEN C ...
.) is a set of
non-pharmaceutical interventions or measures intended to
prevent the spread of a
contagious disease
A contagious disease is an infectious disease that is readily spread (that is, communicated) by transmission of a pathogen through contact (direct or indirect) with an infected person.
A disease is often known to be contagious before medical ...
by maintaining a physical distance between people and reducing the number of times people come into close contact with each other.
It usually involves keeping a certain distance from others (the distance specified differs from country to country and can change with time) and avoiding gathering together in large groups.
By minimising the probability that a given uninfected person will come into physical contact with an
infected person, the
disease transmission
In medicine, public health, and biology, transmission is the passing of a pathogen causing communicable disease from an infected host individual or group to a particular individual or group, regardless of whether the other individual was previo ...
can be suppressed, resulting in
fewer deaths.
The measures may be used in combination with others, such as good
respiratory hygiene, face masks and
hand washing
Hand washing (or handwashing), also known as hand hygiene, is the act of cleaning one's hands with soap or handwash and water to remove viruses/bacteria/microorganisms, dirt, grease, or other harmful and unwanted substances stuck to the hands ...
.
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
A quarantine is a restriction on the movement of people, animals and goods which is intended to prevent the spread of disease or pests. It is often used in connection to disease and illness, preventing the movement of those who may have been ...
,
restricting the movement of people and the cancellation of
mass gatherings.
[ (12 pages)] Drawbacks of social distancing can include
loneliness
Loneliness is an unpleasant emotional response to perceived isolation. Loneliness is also described as social paina psychological mechanism which motivates individuals to seek social connections. It is often associated with a perceived lack ...
, reduced
productivity
Productivity is the efficiency of production of goods or services expressed by some measure. Measurements of productivity are often expressed as a ratio of an aggregate output to a single input or an aggregate input used in a production proces ...
and the loss of other benefits associated with
human interaction
The concept of interpersonal relationship involves social associations, connections, or affiliations between two or more people. Interpersonal relationships vary in their degree of intimacy or self-disclosure, but also in their duration, in t ...
.
Social distancing measures are most effective when the infectious disease spreads via one or more of the following methods, droplet contact (coughing or sneezing), direct physical contact (including sexual contact), indirect physical contact (such as by touching a contaminated surface), and
airborne transmission
Airborne or aerosol transmission is transmission of an infectious disease through small particles suspended in the air. Infectious diseases capable of airborne transmission include many of considerable importance both in human and veterinary ...
(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
vector
Vector most often refers to:
*Euclidean vector, a quantity with a magnitude and a direction
*Vector (epidemiology), an agent that carries and transmits an infectious pathogen into another living organism
Vector may also refer to:
Mathematic ...
s such as mosquitoes or other insects.
Authorities have encouraged or mandated social distancing during the
COVID-19 pandemic
The COVID-19 pandemic, also known as the coronavirus pandemic, is an ongoing global pandemic of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The novel virus was first identi ...
as it is an important method of preventing
transmission of COVID-19
The transmission of COVID-19 is the passing of coronavirus disease 2019 from person to person. COVID-19 is mainly transmitted when people breathe in air contaminated by droplets/aerosols and small airborne particles containing the virus. Infec ...
. COVID-19 is much more likely to spread over short distances than long ones. However, it can spread over distances longer than 2 m (6 ft) in enclosed, poorly ventilated places and with prolonged exposure.
Although the term "social distancing" was not introduced until the 21st century, social-distancing measures date back to at least the 5th century BC. The
Bible
The Bible (from Koine Greek , , 'the books') is a collection of religious texts or scriptures that are held to be sacred in Christianity, Judaism, Samaritanism, and many other religions. The Bible is an anthologya compilation of texts ...
contains one of the earliest known references to the practice in the
Book of Leviticus
The book of Leviticus (, from grc, Λευιτικόν, ; he, וַיִּקְרָא, , "And He called") is the third book of the Torah (the Pentateuch) and of the Old Testament, also known as the Third Book of Moses. Scholars generally agree ...
13:46: "And the leper in whom the plague is... he shall dwell alone;
utsidethe camp shall his habitation be." During the
Plague of Justinian
The plague of Justinian or Justinianic plague (541–549 AD) was the first recorded major outbreak of the first plague pandemic, the first Old World pandemic of plague, the contagious disease caused by the bacterium ''Yersinia pestis''. The dis ...
of 541 to 542, Emperor
Justinian
Justinian I (; la, Iustinianus, ; grc-gre, Ἰουστινιανός ; 48214 November 565), also known as Justinian the Great, was the Byzantine emperor from 527 to 565.
His reign is marked by the ambitious but only partly realized ''renovat ...
enforced an ineffective quarantine on the
Byzantine Empire
The Byzantine Empire, also referred to as the Eastern Roman Empire or Byzantium, was the continuation of the Roman Empire primarily in its eastern provinces during Late Antiquity and the Middle Ages, when its capital city was Constantinopl ...
, including dumping bodies into the sea; he predominantly blamed the widespread outbreak on "
Jews
Jews ( he, יְהוּדִים, , ) or Jewish people are an ethnoreligious group and nation originating from the Israelites Israelite origins and kingdom: "The first act in the long drama of Jewish history is the age of the Israelites""The ...
,
Samaritans,
pagans,
heretics
Heresy is any belief or theory that is strongly at variance with established beliefs or customs, in particular the accepted beliefs of a church or religious organization. The term is usually used in reference to violations of important religi ...
,
Arians
Arianism ( grc-x-koine, Ἀρειανισμός, ) is a Christological doctrine first attributed to Arius (), a Christian presbyter from Alexandria, Egypt. Arian theology holds that Jesus Christ is the Son of God, who was begotten by God t ...
,
Montanists and
homosexuals
Homosexuality is romantic attraction, sexual attraction, or sexual behavior between members of the same sex or gender. As a sexual orientation, homosexuality is "an enduring pattern of emotional, romantic, and/or sexual attractions" to pe ...
".
In modern times, social distancing measures have been successfully implemented in several epidemics. In
St. Louis
St. Louis () is the second-largest city in Missouri, United States. It sits near the confluence of the Mississippi and the Missouri Rivers. In 2020, the city proper had a population of 301,578, while the bi-state metropolitan area, which e ...
, shortly after the first cases of
influenza were detected in the city during the
1918 flu pandemic
The 1918–1920 influenza pandemic, commonly known by the misnomer Spanish flu or as the Great Influenza epidemic, was an exceptionally deadly global influenza pandemic caused by the H1N1 influenza A virus. The earliest documented case was ...
, authorities implemented school closures, bans on public gatherings and other social-distancing interventions. The influenza fatality rates in St. Louis were much less than in
Philadelphia
Philadelphia, often called Philly, is the List of municipalities in Pennsylvania#Municipalities, largest city in the Commonwealth (U.S. state), Commonwealth of Pennsylvania, the List of United States cities by population, sixth-largest city i ...
, which had fewer cases of influenza but allowed a mass parade to continue and did not introduce social distancing until more than two weeks after its first cases.
The
World Health Organization
The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level of ...
(WHO) has suggested using the term "physical distancing" instead of "social distancing" because it is physical separation which prevents transmission; people can remain socially connected by meeting outdoors at a safe distance (when there is no
stay-at-home order
A stay-at-home order, safer-at-home order, movement control order (more common in Southeast Asia), or lockdown restrictions (in the United Kingdom) – also referred to by loose use of the terms (self-) quarantine, (self-) isolation, or lockdow ...
) and by meeting via technology.
/ref>
Definition
The American Centers for Disease Control and Prevention
The Centers for Disease Control and Prevention (CDC) is the national public health agency of the United States. It is a United States federal agency, under the Department of Health and Human Services, and is headquartered in Atlanta, Georgi ...
(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". During the 2009 swine flu pandemic
The 2009 swine flu pandemic, caused by the H1N1 influenza virus and declared by the World Health Organization (WHO) from June 2009 to August 2010, is the third recent flu pandemic involving the H1N1 virus (the first being the 1918–1920 Sp ...
the WHO described social distancing as "keeping at least an arm's length distance from others, ndminimizing gatherings". During the COVID-19 pandemic, the CDC defined social distancing as "remaining out of congregate settings, avoiding mass gatherings, and maintaining distance (approximately ) from others when possible".
Social distancing, combined with the use of face masks, good respiratory hygiene and hand washing
Hand washing (or handwashing), also known as hand hygiene, is the act of cleaning one's hands with soap or handwash and water to remove viruses/bacteria/microorganisms, dirt, grease, or other harmful and unwanted substances stuck to the hands ...
, is considered the most feasible way to reduce or delay a pandemic.
Measures
Several social distancing measures are used to control the spread of contagious illnesses. Research indicates that measures must be applied rigorously and immediately in order to be effective.
Avoiding physical contact
Keeping a set physical distance from each other and avoiding hugs and gestures that involve direct physical contact, reduce the risk of becoming infected during outbreaks of infectious respiratory diseases (for example, flu pandemic
An influenza pandemic is an epidemic of an influenza virus that spreads across a large region (either multiple continents or worldwide) and infects a large proportion of the population. There have been six major influenza epidemics in the las ...
s and the COVID-19 pandemic
The COVID-19 pandemic, also known as the coronavirus pandemic, is an ongoing global pandemic of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The novel virus was first identi ...
of 2020.)
/ref> These distances of separation, in addition to personal hygiene measures, are also recommended at places of work. Where possible, remote work may be encouraged.
The distance advised by authorities varies. During the COVID-19 pandemic, for example, the World Health Organization
The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level of ...
recommends that a distance of or more is safe. Subsequently, China, Denmark
)
, song = ( en, "King Christian stood by the lofty mast")
, song_type = National and royal anthem
, image_map = EU-Denmark.svg
, map_caption =
, subdivision_type = Sovereign state
, subdivision_name = Kingdom of Denmark
, establish ...
, France
France (), officially the French Republic ( ), is a country primarily located in Western Europe. It also comprises of overseas regions and territories in the Americas and the Atlantic, Pacific and Indian Oceans. Its metropolitan area ...
, Hong Kong
Hong Kong ( (US) or (UK); , ), officially the Hong Kong Special Administrative Region of the People's Republic of China (abbr. Hong Kong SAR or HKSAR), is a city and special administrative region of China on the eastern Pearl River Delta i ...
, Lithuania and Singapore
Singapore (), officially the Republic of Singapore, is a sovereign island country and city-state in maritime Southeast Asia. It lies about one degree of latitude () north of the equator, off the southern tip of the Malay Peninsula, bor ...
adopted a 1 m social distancing policy. South Korea
South Korea, officially the Republic of Korea (ROK), is a country in East Asia, constituting the southern part of the Korean Peninsula and sharing a land border with North Korea. Its western border is formed by the Yellow Sea, while its eas ...
adopted . Australia, Belgium
Belgium, ; french: Belgique ; german: Belgien officially the Kingdom of Belgium, is a country in Northwestern Europe. The country is bordered by the Netherlands to the north, Germany to the east, Luxembourg to the southeast, France to th ...
, Germany
Germany,, officially the Federal Republic of Germany, is a country in Central Europe. It is the second most populous country in Europe after Russia, and the most populous member state of the European Union. Germany is situated betwe ...
, Greece
Greece,, or , romanized: ', officially the Hellenic Republic, is a country in Southeast Europe. It is situated on the southern tip of the Balkans, and is located at the crossroads of Europe, Asia, and Africa. Greece shares land borders ...
, Italy
Italy ( it, Italia ), officially the Italian Republic, ) or the Republic of Italy, is a country in Southern Europe. It is located in the middle of the Mediterranean Sea, and its territory largely coincides with the homonymous geographical ...
, Netherlands
)
, anthem = ( en, "William of Nassau")
, image_map =
, map_caption =
, subdivision_type = Sovereign state
, subdivision_name = Kingdom of the Netherlands
, established_title = Before independence
, established_date = Spanish Netherl ...
, Portugal
Portugal, officially the Portuguese Republic ( pt, República Portuguesa, links=yes ), is a country whose mainland is located on the Iberian Peninsula of Southwestern Europe, and whose territory also includes the Atlantic archipelagos of ...
and Spain
, image_flag = Bandera de España.svg
, image_coat = Escudo de España (mazonado).svg
, national_motto = ''Plus ultra'' (Latin)(English: "Further Beyond")
, national_anthem = (English: "Royal March")
, i ...
adopted . The United States
The United States of America (U.S.A. or USA), commonly known as the United States (U.S. or US) or America, is a country primarily located in North America. It consists of 50 states, a federal district, five major unincorporated territori ...
adopted , and Canada
Canada is a country in North America. Its ten provinces and three territories extend from the Atlantic Ocean to the Pacific Ocean and northward into the Arctic Ocean, covering over , making it the world's second-largest country by tot ...
adopted . The United Kingdom
The United Kingdom of Great Britain and Northern Ireland, commonly known as the United Kingdom (UK) or Britain, is a country in Europe, off the north-western coast of the European mainland, continental mainland. It comprises England, Scotlan ...
first advised 2 m, then on July 4, 2020 reduced this to "one metre plus" where other methods of mitigation such as face masks were in use.
The WHO's one-metre recommendation stems from research into droplet-based transmission of tuberculosis
Tuberculosis (TB) is an infectious disease usually caused by '' Mycobacterium tuberculosis'' (MTB) bacteria. Tuberculosis generally affects the lungs, but it can also affect other parts of the body. Most infections show no symptoms, i ...
by William F. Wells, which had found that droplets produced by exhalation, coughs, or sneezes landed an average of from where they were expelled. ''Quartz
Quartz is a hard, crystalline mineral composed of silica ( silicon dioxide). The atoms are linked in a continuous framework of SiO4 silicon-oxygen tetrahedra, with each oxygen being shared between two tetrahedra, giving an overall chemical ...
'' speculated that the U.S. CDC's adoption of may have stemmed from a study of SARS transmission on an airplane, published in The New England Journal of Medicine
''The New England Journal of Medicine'' (''NEJM'') is a weekly medical journal published by the Massachusetts Medical Society. It is among the most prestigious peer-reviewed medical journals as well as the oldest continuously published one.
Hi ...
. When contacted, however, the CDC did not provide any specific information.
Some have suggested that distances greater than should be observed. One minute of loud speaking can produce oral droplets
A drop or droplet is a small column of liquid, bounded completely or almost completely by free surfaces. A drop may form when liquid accumulates at the lower end of a tube or other surface boundary, producing a hanging drop called a pendant d ...
with a load of 7 million SARS-CoV-2
Severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) is a strain of coronavirus that causes COVID-19 (coronavirus disease 2019), the respiratory illness responsible for the ongoing COVID-19 pandemic. The virus previously had a ...
virus per milliliter
The litre (international spelling) or liter (American English spelling) (SI symbols L and l, other symbol used: ℓ) is a metric unit of volume. It is equal to 1 cubic decimetre (dm3), 1000 cubic centimetres (cm3) or 0.001 cubic metre (m3). ...
that can remain for more than eight minutes, a time-period during which many people could enter or remain in the area. A sneeze can distribute such droplets as far as or . Social distancing is less effective than face masks at reducing the spread of COVID-19.
Various alternatives have been proposed for the tradition of handshaking
A handshake is a globally widespread, brief greeting or parting tradition in which two people grasp one of each other's like hands, in most cases accompanied by a brief up-and-down movement of the grasped hands. Customs surrounding handshakes a ...
. The gesture of namaste
''Namaste'' (, Devanagari: नमस्ते), sometimes called ''namaskar'' and ''namaskaram'', is a customary Hindu non-contact manner of respectfully greeting and honouring a person or group, used at any time of day. It is found on the In ...
, 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
Who or WHO may refer to:
* Who (pronoun), an interrogative or relative pronoun
* Who?, one of the Five Ws in journalism
* World Health Organization
Arts and entertainment Fictional characters
* Who, a creature in the Dr. Seuss book '' Horton He ...
, Dr. Tedros Adhanom Ghebreyesus, and Israeli Prime Minister Benjamin Netanyahu
Benjamin "Bibi" Netanyahu (; ; born 21 October 1949) is an Israeli politician who served as the ninth prime minister of Israel from 1996 to 1999 and again from 2009 to 2021. He is currently serving as Leader of the Opposition and Chairman of ...
. Other alternatives include the popular thumbs up gesture, the wave
In physics, mathematics, and related fields, a wave is a propagating dynamic disturbance (change from equilibrium) of one or more quantities. Waves can be periodic, in which case those quantities oscillate repeatedly about an equilibrium (re ...
, the shaka (or "hang loose") sign, and placing a palm on one's heart, as practiced in parts of Iran.
File:Social Distancing in a Computer Lab.jpg, In this computer lab, every other workstation has been closed off to increase the distance between people working, and screens between workstations are also in place.
File:Social Distancing Sign @ London Drugs (49684963711).jpg, alt=Floor markings for social distancing, Floor markings can help people maintain distance in public places, especially when queueing
Queue areas are places in which people queue (first-come, first-served) for goods or services. Such a group of people is known as a ''queue'' (British usage) or ''line'' ( American usage), and the people are said to be waiting or standing ''in ...
.
File:Pissoirs während der COVID-19-Pandemie.png, Urinal
A urinal (, ) is a sanitary plumbing fixture for urination only. Urinals are often provided in public toilets for male users in Western countries (less so in Muslim countries). They are usually used in a standing position. Urinals can be ...
s adjusted in a way close contacts are less likely
School closures
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.
Workplace closures
Modeling and simulation
Modeling and simulation (M&S) is the use of models (e.g., physical, mathematical, or logical representation of a system, entity, phenomenon, or process) as a basis for simulations to develop data utilized for managerial or technical decision makin ...
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. 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
Essential services may refer to a class of occupations that have been legislated by a government to have special restrictions in regard to labour actions such as not being allowed to strike.
The International Labour Office, a United Nations a ...
).[
]
Canceling mass gatherings
Cancellation of mass gatherings includes sports events, films or musical shows. Evidence suggesting that mass gatherings increase the potential for infectious disease transmission is inconclusive. 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 and Boston 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.[ A recent peer-reviewed study in the ''British Medical Journal'' (''The BMJ'') also suggested it as one of the key components of an effective strategy in reducing the burden of COVID-19.]
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. Airport screening was found to be ineffective in preventing viral transmission during the 2003 SARS outbreak in Canada and the U.S. Strict border controls between Austria
Austria, , bar, Östareich officially the Republic of Austria, is a country in the southern part of Central Europe, lying in the Eastern Alps. It is a federation of nine states, one of which is the capital, Vienna, the most populous ...
and the Ottoman Empire
The Ottoman Empire, * ; is an archaic version. The definite article forms and were synonymous * and el, Оθωμανική Αυτοκρατορία, Othōmanikē Avtokratoria, label=none * info page on book at Martin Luther University) ...
, 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.
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
Coronavirus disease 2019 (COVID-19) is a contagious disease caused by a virus, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The first known case was identified in Wuhan, China, in December 2019. The disease quickly ...
hen
Hen commonly refers to a female animal: a female chicken, other gallinaceous bird, any type of bird in general, or a lobster. It is also a slang term for a woman.
Hen or Hens may also refer to:
Places Norway
*Hen, Buskerud, a village in Ringer ...
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." The study found that the travel ban in Wuhan
Wuhan (, ; ; ) is the capital of Hubei Province in the People's Republic of China. It is the largest city in Hubei and the most populous city in Central China, with a population of over eleven million, the ninth-most populous Chinese city an ...
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.
Shielding
Shielding measures for individuals include limiting face-to-face contacts, conducting business by phone or online, avoiding public places and reducing unnecessary travel.
During the COVID-19 pandemic in the United Kingdom, shielding referred to special advisory measures put in place by the UK Government to protect those at the highest risk of serious illness from the disease. This included those with weakened immune systems (such as organ transplant recipients), as well as those with certain medical conditions such as cystic fibrosis or severe asthma. Until June 1, 2020, those shielding were strongly advised not to leave home for any reason at all, including essential travel, and to maintain a distance from anyone else in their household. Supermarkets quickly made priority grocery delivery slots available to those shielding, and the Government arranged for food boxes to be sent to those shielding who needed additional assistance, for example elderly people shielding on their own. This was gradually relaxed from June to allow shielders to spend more time outside, before being suspended indefinitely from August 1.
Quarantine
During the 2003 SARS
Severe acute respiratory syndrome (SARS) is a viral respiratory disease of zoonotic origin caused by the severe acute respiratory syndrome coronavirus (SARS-CoV or SARS-CoV-1), the first identified strain of the SARS coronavirus species, ''seve ...
outbreak in Singapore
Singapore (), officially the Republic of Singapore, is a sovereign island country and city-state in maritime Southeast Asia. It lies about one degree of latitude () north of the equator, off the southern tip of the Malay Peninsula, bor ...
, approximately people were subjected to mandatory home quarantine and an additional 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. Voluntary self-isolation may have helped reduce transmission of influenza in Texas in 2009. Short and long-term negative psychological effects have been reported.
Stay-at-home orders
The objective of stay-at-home orders is to reduce day-to-day contact between people and thereby reduce the spread of infection During the COVID-19 pandemic
The COVID-19 pandemic, also known as the coronavirus pandemic, is an ongoing global pandemic of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The novel virus was first identi ...
, early and aggressive implementation of stay-at-home orders was effective in "flattening the curve" and provided the much needed time for healthcare systems to increase their capacity while reducing the number of peak cases during the initial wave of illness.[ It is important for public health authorities to follow disease trends closely to re-implement appropriate social distancing policies, including stay-at-home orders, if secondary COVID-19 waves appear.][
]
''Cordon sanitaire''
In 1995, a ''cordon sanitaire'' was used to control an outbreak of Ebola virus disease in Kikwit
Kikwit is the largest city of Kwilu Province, lying on the Kwilu River in the southwestern part of the Democratic Republic of the Congo. Kikwit is also known in the region under the nickname "The Mother". The population is approximately 458,000 ( ...
, Zaire
Zaire (, ), officially the Republic of Zaire (french: République du Zaïre, link=no, ), was a Congolese state from 1971 to 1997 in Central Africa that was previously and is now again known as the Democratic Republic of the Congo. Zaire was, ...
. President Mobutu Sese Seko surrounded the town with troops and suspended all flights into the community. Inside Kikwit, the World Health Organization
The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level of ...
and Zaire's medical teams erected further ''cordons sanitaires'', isolating burial and treatment zones from the general population and successfully containing the infection.
Protective sequestration
During the 1918 influenza epidemic
The 1918–1920 influenza pandemic, commonly known by the misnomer Spanish flu or as the Great Influenza epidemic, was an exceptionally deadly global influenza pandemic caused by the H1N1 influenza A virus. The earliest documented case was ...
, 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. Several other communities adopted similar measures.
Other measures
Other measures include shutting down or limiting mass transit and closure of sport facilities (community swimming pools, youth clubs, gym
A gymnasium, also known as a gym, is an indoor location for athletics. The word is derived from the ancient Greek term " gymnasium". They are commonly found in athletic and fitness centres, and as activity and learning spaces in educational i ...
nasiums). Due to the highly interconnected nature of modern transportation hubs, a highly contagious illness can achieve rapid geographic spread if appropriate mitigation measures are not taken early.[ Consequently, highly coordinated efforts must be put into place early during an outbreak to proactively monitor, detect, and isolate any potentially infectious individuals.][ If community spread is present, more aggressive measures may be required, up to and including complete cessation of travel in/out of a specific geographic area.][
]
History
Leper colonies and lazaretto
A lazaretto or lazaret (from it, lazzaretto a diminutive form of the Italian word for beggar cf. lazzaro) is a quarantine station for maritime travellers. Lazarets can be ships permanently at anchor, isolated islands, or mainland buildings ...
s were established as a means of preventing the spread of leprosy
Leprosy, also known as Hansen's disease (HD), is a long-term infection by the bacteria ''Mycobacterium leprae'' or ''Mycobacterium lepromatosis''. Infection can lead to damage of the nerves, respiratory tract, skin, and eyes. This nerve damag ...
and other contagious diseases through social distancing, until transmission was understood and effective treatments invented.
File:Mole2.JPG, The Lazzaretto of Ancona
The Lazzaretto of Ancona, also called the Mole Vanvitelliana, is a pentagonal 18th-century building built on an artificial island as a quarantine station for the port town of Ancona, Italy.
The island is now connected to the mainland by three brid ...
was constructed in the 18th century on an artificial island to serve as a quarantine station
A quarantine is a restriction on the movement of people, animals and goods which is intended to prevent the spread of disease or pests. It is often used in connection to disease and illness, preventing the movement of those who may have been ...
and leprosarium
A leper colony, also known by many other names, is an isolated community for the quarantining and treatment of lepers, people suffering from leprosy. ''M. leprae'', the bacterium responsible for leprosy, is believed to have spread from East Afr ...
for the port town of Ancona
Ancona (, also , ) is a city and a seaport in the Marche region in central Italy, with a population of around 101,997 . Ancona is the capital of the province of Ancona and of the region. The city is located northeast of Rome, on the Adriatic ...
, Italy.
File:Leprosorium.jpg, Two lepers denied entrance to town. Woodcut by Vincent of Beauvais
Vincent of Beauvais ( la, Vincentius Bellovacensis or ''Vincentius Burgundus''; c. 1264) was a Dominican friar at the Cistercian monastery of Royaumont Abbey, France. He is known mostly for his ''Speculum Maius'' (''Great mirror''), a major work ...
, 14th century
File:Popular science monthly (1872) (14596283227).jpg, New York City parks and playgrounds were closed during a 1916 polio epidemic.
File:Tram operator refuses man without mask detail, from- 165-WW-269B-11-trolley-l (cropped).jpg , Passenger without mask being refused boarding of a streetcar amid 1918 flu pandemic
The 1918–1920 influenza pandemic, commonly known by the misnomer Spanish flu or as the Great Influenza epidemic, was an exceptionally deadly global influenza pandemic caused by the H1N1 influenza A virus. The earliest documented case was ...
. (Seattle, Washington, 1918)
1916 New York City polio epidemic
During the 1916 New York City polio epidemic, when there were more than 27,000 cases and more than 6,000 deaths due to polio in the United States, with more than 2,000 deaths in New York City alone, movie theaters were closed, meetings were cancelled, public gatherings were almost non-existent, and children were warned not to drink from water fountains, and told to avoid amusement parks, swimming pools and beaches.
Influenza, 1918 to present
During the influenza pandemic of 1918
The 1918–1920 influenza pandemic, commonly known by the misnomer Spanish flu or as the Great Influenza epidemic, was an exceptionally deadly global influenza pandemic caused by the H1N1 influenza A virus. The earliest documented case was ...
, Philadelphia saw its first cases of influenza on 17 September. The city continued with its planned parade and gathering of more than people on 28 September and over the subsequent three days, the city's 31 hospitals became fully occupied. During the week ending 16 October, over people died. Social distancing measures were introduced on 3October, on the orders of St. Louis
St. Louis () is the second-largest city in Missouri, United States. It sits near the confluence of the Mississippi and the Missouri Rivers. In 2020, the city proper had a population of 301,578, while the bi-state metropolitan area, which e ...
physician Max C. Starkloff, more than two weeks after the first case. Unlike Philadelphia, St. Louis experienced its first cases of influenza on 5October and the city took two days to implement several social distancing measures, including closing schools, theatres, and other places where people get together. It banned public gatherings, including funerals. The actions slowed the spread of influenza in St. Louis and a spike in cases and deaths, as had happened in Philadelphia, did not occur. The final death rate in St. Louis increased following a second wave of cases, but remained overall less than in other cities. Bootsma and Ferguson analyzed social distancing interventions in sixteen U.S. cities during the 1918 epidemic and found that time-limited interventions reduced total mortality only moderately (perhaps 10–30%), and that the impact was often very limited because the interventions were introduced too late and lifted too early. It was observed that several cities experienced a second epidemic peak after social distancing controls were lifted, because susceptible individuals who had been protected were now exposed.
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School closures were shown to reduce morbidity
A disease is a particular abnormal condition that negatively affects the structure or function of all or part of an organism, and that is not immediately due to any external injury. Diseases are often known to be medical conditions that a ...
from the Asian flu
Asian may refer to:
* Items from or related to the continent of Asia:
** Asian people, people in or descending from Asia
** Asian culture, the culture of the people from Asia
** Asian cuisine, food based on the style of food of the people from Asi ...
by 90% during the 1957–1958 pandemic, and up to 50% in controlling influenza in the U.S., 2004–2008. Similarly, mandatory school closures and other social distancing measures were associated with a 29% to 37% reduction in influenza transmission rates during the 2009 flu epidemic in Mexico.
The 2009 swine flu pandemic
The 2009 swine flu pandemic, caused by the H1N1 influenza virus and declared by the World Health Organization (WHO) from June 2009 to August 2010, is the third recent flu pandemic involving the H1N1 virus (the first being the 1918–1920 Sp ...
caused social distancing to rise in popularity, most notably in Mexico, with the country's Ministry of Health advising people to avoid handshakes and kissing as ways of greeting people. A mandatory nationwide school closure enacted in Mexico, which lasted for 18 days from late April 2009 to early May 2009, was a form of social distancing aimed at reducing the transmission of Swine flu
Swine influenza is an infection caused by any of several types of swine influenza viruses. Swine influenza virus (SIV) or swine-origin influenza virus (S-OIV) refers to any strain of the influenza family of viruses that is endemic in pigs. As ...
. A study from 2011 found the mandatory nationwide school closure and other forms of social distancing in Mexico were effective at reducing influenza transmission rates.
During the swine flu outbreak in 2009 in the UK, in an article titled "Closure of schools during an influenza pandemic" published in ''The Lancet Infectious Diseases
''The Lancet'' is a weekly peer-reviewed general medical journal and one of the oldest of its kind. It is also the world's highest-impact academic journal. It was founded in England in 1823.
The journal publishes original research articles ...
'', a group of epidemiologists endorsed the closure of schools to interrupt the course of the infection, slow the further spread and buy time to research and produce a vaccine. Having studied previous influenza pandemics including the 1918 flu pandemic
The 1918–1920 influenza pandemic, commonly known by the misnomer Spanish flu or as the Great Influenza epidemic, was an exceptionally deadly global influenza pandemic caused by the H1N1 influenza A virus. The earliest documented case was ...
, the influenza pandemic of 1957 and the 1968 flu pandemic, they reported on the economic and workforce effect school closure would have, particularly with a large percentage of doctors and nurses being women, of whom half had children under the age of 16. They also looked at the dynamics of the spread of influenza in France during French school holidays and noted that cases of flu dropped when schools closed and re-emerged when they re-opened. They noted that when teachers in Israel went on strike during the flu season of 1999–2000, visits to doctors and the number of respiratory infections dropped by more than a fifth and more than two fifths respectively.
SARS 2003
During the SARS outbreak of 2003, social distancing measures were implemented, such as banning large gatherings, closing schools and theaters, and other public places, supplemented public health measures such as finding and isolating affected people, quarantining their close contacts, and infection control procedures. This was combined with the wearing of masks for certain people. During this time in Canada, "community quarantine" was used to reduce transmission of the disease with moderate success.
COVID-19 pandemic
During the COVID-19 pandemic
The COVID-19 pandemic, also known as the coronavirus pandemic, is an ongoing global pandemic of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The novel virus was first identi ...
, social distancing and related measures are emphasized by several governments as alternatives to an enforced quarantine of heavily affected areas.[ According to ]UNESCO
The United Nations Educational, Scientific and Cultural Organization is a specialized agency of the United Nations (UN) aimed at promoting world peace and security through international cooperation in education, arts, sciences and culture. It ...
monitoring, more than a hundred countries have implemented nationwide school closures in response to COVID-19, impacting over half the world's student population. In the United Kingdom, the government advised the public to avoid public spaces, and cinemas and theaters voluntarily closed to encourage the government's message.
With many people disbelieving that COVID-19 is any worse than the seasonal flu
Flu season is an annually recurring time period characterized by the prevalence of an outbreak of influenza (flu). The season occurs during the cold half of the year in each hemisphere. It takes approximately two days to show symptoms. Influen ...
,['We're going to have more deaths': Influenza kills more people than the coronavirus so everyone is overreacting, right? Wrong—and here's why](_blank)
, ''MarketWatch'', Quentin Fottrell, 9 March 2020 it has been difficult to convince the public—particularly youth, and the anti vaxx community to voluntarily adopt social distancing practices. In Belgium
Belgium, ; french: Belgique ; german: Belgien officially the Kingdom of Belgium, is a country in Northwestern Europe. The country is bordered by the Netherlands to the north, Germany to the east, Luxembourg to the southeast, France to th ...
, media reported a rave was attended by at least before it was broken up by local authorities. In France
France (), officially the French Republic ( ), is a country primarily located in Western Europe. It also comprises of overseas regions and territories in the Americas and the Atlantic, Pacific and Indian Oceans. Its metropolitan area ...
, teens making nonessential trips are fined up to . Beaches were closed in Florida
Florida is a state located in the Southeastern region of the United States. Florida is bordered to the west by the Gulf of Mexico, to the northwest by Alabama, to the north by Georgia, to the east by the Bahamas and Atlantic Ocean, and to ...
and Alabama
(We dare defend our rights)
, anthem = "Alabama"
, image_map = Alabama in United States.svg
, seat = Montgomery
, LargestCity = Huntsville
, LargestCounty = Baldwin County
, LargestMetro = Greater Birmingham
, area_total_km2 = 135,765 ...
to disperse partygoers during spring break. Weddings were broken up in New Jersey and an 8p.m. curfew
A curfew is a government order specifying a time during which certain regulations apply. Typically, curfews order all people affected by them to ''not'' be in public places or on roads within a certain time frame, typically in the evening and ...
was imposed in Newark
Newark most commonly refers to:
* Newark, New Jersey, city in the United States
* Newark Liberty International Airport, New Jersey; a major air hub in the New York metropolitan area
Newark may also refer to:
Places Canada
* Niagara-on-the ...
. New York, New Jersey, Connecticut and Pennsylvania were the first states to adopt coordinated social distancing policies which closed down non-essential businesses and restricted large gatherings. Shelter in place orders in California
California is a state in the Western United States, located along the Pacific Coast. With nearly 39.2million residents across a total area of approximately , it is the most populous U.S. state and the 3rd largest by area. It is also the m ...
were extended to the entire state on 19 March. On the same day Texas
Texas (, ; Spanish: ''Texas'', ''Tejas'') is a state in the South Central region of the United States. At 268,596 square miles (695,662 km2), and with more than 29.1 million residents in 2020, it is the second-largest U.S. state by ...
declared a public disaster and imposed statewide restrictions.
These preventive measures such as social-distancing and self-isolation
In health care facilities, isolation represents one of several measures that can be taken to implement in infection control: the prevention of communicable diseases from being transmitted from a patient to other patients, health care workers ...
prompted the widespread closure of primary, secondary, and post-secondary schools in more than 120 countries. As of 23 March 2020, more than 1.2 billion learners were out of school due to school closures in response to COVID-19. Given low rates of COVID-19 symptoms among children, the effectiveness of school closures has been called into question. Even when school closures are temporary, it carries high social and economic costs. However, the significance of children in spreading COVID-19 is unclear. While the full impact of school closures during the coronavirus pandemic are not yet known, UNESCO advises that school closures have negative impacts on local economies and on learning outcomes for students.
In early March 2020, the sentiment "Stay Home" was coined by Florian Reifschneider, a German engineer and was quickly echoed by notable celebrities such as Taylor Swift
Taylor Alison Swift (born December 13, 1989) is an American singer-songwriter. Her discography spans multiple genres, and her vivid songwriting—often inspired by her personal life—has received critical praise and wide media coverage. Bor ...
, Ariana Grande and Busy Philipps
Elizabeth Jean "Busy" Philipps (born June 25, 1979) is an American actress. She is best known for her roles on the television series '' Freaks and Geeks'' (1999–2000), ''Dawson's Creek'' (2001–2003), ''Love, Inc.'' (2005–2006) and '' ER' ...
in hopes of reducing and delaying the peak of the outbreak. Facebook
Facebook is an online social media and social networking service owned by American company Meta Platforms. Founded in 2004 by Mark Zuckerberg with fellow Harvard College students and roommates Eduardo Saverin, Andrew McCollum, Dustin Mosk ...
, Twitter
Twitter is an online social media and social networking service owned and operated by American company Twitter, Inc., on which users post and interact with 280-character-long messages known as "tweets". Registered users can post, like, and ...
and Instagram also joined the campaign with similar hashtags, stickers and filters under #staythefhome, #stayhome, #staythefuckhome and began trending across social media. The website claims to have reached about two million people online and says the text has been translated into 17 languages.
Impact on mental health
There are concerns that social distancing can have adverse affects on participants' mental health.[ It may lead to ]stress
Stress may refer to:
Science and medicine
* Stress (biology), an organism's response to a stressor such as an environmental condition
* Stress (linguistics), relative emphasis or prominence given to a syllable in a word, or to a word in a phrase ...
, anxiety
Anxiety is an emotion which is characterized by an unpleasant state of inner turmoil and includes feelings of dread over anticipated events. Anxiety is different than fear in that the former is defined as the anticipation of a future threat wh ...
, depression or panic
Panic is a sudden sensation of fear, which is so strong as to dominate or prevent reason and logical thinking, replacing it with overwhelming feelings of anxiety and frantic agitation consistent with an animalistic fight-or-flight reactio ...
, especially for individuals with preexisting conditions such as anxiety disorders, obsessive compulsive disorders
Obsession may refer to:
Psychology
* Celebrity worship syndrome, obsessive addictive disorder to a celebrity's personal and professional life
* Fixation (psychology), a persistent attachment to an object or idea
* Idée fixe (psychology), a preo ...
, and paranoia
Paranoia is an instinct or thought process that is believed to be heavily influenced by anxiety or fear, often to the point of delusion and irrationality. Paranoid thinking typically includes persecutory beliefs, or beliefs of conspiracy co ...
.[ Widespread media coverage about a pandemic, its impact on economy, and resulting hardships may create anxiety. Change in daily circumstances and uncertainty about the future may add onto the mental stress of being away from other people.][
People with autism also suffer impact from social distancing. Adjusting to a new routine can be stressful for everyone within the spectrum but especially for children who have trouble with change.] Children with autism may not know what is going on or might not be able to express their fears and frustrations. They also may need extra support to understand what's expected of them in some situations. The adjustment to a new situation can lead to challenging behavior uncharacteristic of the autistic individual's true character. In some countries and demographics, teenagers and young adults within the autistic spectrum disorder
The autism spectrum, often referred to as just autism or in the context of a professional diagnosis autism spectrum disorder (ASD) or autism spectrum condition (ASC), is a neurodevelopmental condition (or conditions) characterized by difficulti ...
(ASD) receive support services including special education, behavioral therapy
Behaviour therapy or behavioural psychotherapy is a broad term referring to clinical psychotherapy that uses techniques derived from behaviourism and/or cognitive psychology. It looks at specific, learned behaviours and how the environment, or o ...
, occupational therapy, speech services, and individual aides through school, but this can be a major challenge, particularly since many teenagers with ASD already have social and communication difficulties. Aggressive and self-injurious behaviors may increase during this time of fear and uncertainty.
Portrayal in literature
In his 1957 science fiction
Science fiction (sometimes shortened to Sci-Fi or SF) is a genre of speculative fiction which typically deals with imaginative and futuristic concepts such as advanced science and technology, space exploration, time travel, parallel uni ...
novel ''The Naked Sun
''The Naked Sun'' is a science fiction novel by American writer Isaac Asimov, the second in his ''Robot'' series. Like its predecessor, '' The Caves of Steel'', this is a whodunit story. It was first published in book form in 1957 after being ...
'', Isaac Asimov portrays a planet where people live with social distancing. They are spread out, miles from each other, across a sparsely-populated world. Communication is primarily through technology. A male and a female still need to engage in sex to make a baby, but it is seen as a dangerous, nasty chore. In contrast, when communication is through technology the situation is the reverse: there is no modesty, and casual nudity is frequent. The novel's point of departure is a murder: this seemingly idyllic world, in fact, has serious social problems.
Theoretical basis
From the perspective of epidemiology, the basic goal behind social distancing is to decrease the effective reproduction number
In epidemiology, the basic reproduction number, or basic reproductive number (sometimes called basic reproduction ratio or basic reproductive rate), denoted R_0 (pronounced ''R nought'' or ''R zero''), of an infection is the expected number of ...
, or , which in the absence of social distancing would equate to the basic reproduction number
In epidemiology, the basic reproduction number, or basic reproductive number (sometimes called basic reproduction ratio or basic reproductive rate), denoted R_0 (pronounced ''R nought'' or ''R zero''), of an infection is the expected number of ...
, i.e. the average number of secondary infected individuals generated from one primary infected individual in a population where all individuals are equally susceptible to a disease. In a basic model of social distancing, where a proportion of the population engages in social distancing to decrease their interpersonal contacts to a fraction of their normal contacts, the new effective reproduction number is given by:
Where the value of can be brought below1 for sufficiently long, containment is achieved, and the number infected should decrease.
For any given period of time, the growth in the number of infections can be modeled as:
where:
* is the number of infected individuals after incubation periods (5 days, in the case of COVID-19)
Using COVID-19 as an example, the following table shows the infection spread given:
* A: No social distance mitigation
* B: 50% reduction in social interaction
* C: 75% reduction in social interaction
Effectiveness
An empirical study published in July 2020 in ''The BMJ'' (''British Medical Journal'') analyzed data from 149 countries, and reported an average of 13% reduction in COVID-19 incidence after the implementation of social distancing policies. Another study found that four social distancing interventions combined resulted in a reduction of the infection rate from 66% to less than 1%.
Animals also practice social distancing to avoid disease.
See also
* COVID-19 party
* Civil inattention Civil inattention is the process whereby strangers who are in close proximity demonstrate that they are aware of one another, without imposing on each other – a recognition of the claims of others to a public space, and of their own personal bound ...
* Herd immunity
Herd immunity (also called herd effect, community immunity, population immunity, or mass immunity) is a form of indirect protection that applies only to contagious diseases. It occurs when a sufficient percentage of a population has become im ...
* Lockdown
A lockdown is a restriction policy for people, community or a country to stay where they are, usually due to specific risks (such as COVID-19) that could possibly harm the people if they move and interact freely.
The term is used for a prison ...
* Normalization of deviance
Normalization of deviance is a term used by the American sociologist Diane Vaughan to describe the process in which deviance from correct or proper behavior or rule becomes normalized in a government or corporate culture.
Vaughan defines this as ...
– one reason people stop using effective prevention measures
* Pest house
A pest house, plague house, pesthouse or fever shed was a type of building used for persons afflicted with communicable diseases such as tuberculosis, cholera, smallpox or typhus. Often used for forcible quarantine, many towns and cities had one ...
* Stay-at-home order
A stay-at-home order, safer-at-home order, movement control order (more common in Southeast Asia), or lockdown restrictions (in the United Kingdom) – also referred to by loose use of the terms (self-) quarantine, (self-) isolation, or lockdow ...
References
External links
CDC Social Distancing
Johns Hopkins: Social and Physical Distancing
{{COVID-19 pandemic
Infectious diseases
Quarantine
Epidemics
Epidemiology
Medical hygiene