We Live in Each Other’s Shadow: Social Distancing is Our Social Responsibility
As always, I want to preface this with saying that:
I am speaking as an individual and not as a representative of my employer.
This post is a supplementary collation of the excellent resources on social distancing that public health agencies are producing, not a replacement for them
You may also be interested in my previous post Preparing not Panicking: Finding Good Information in a (Potential) Pandemic.
Ar scáth a chéile a mhaireann na daoine — we live in each other’s shadow, from @clodafoto
As you may know, a new coronavirus called SARS-CoV-2 has been spreading, causing a disease that epidemiologists have named COVID-19. The disease is new (so the majority of people aren’t immune), spreads easily from person-to-person, and can cause severe illness in the elderly and medically fragile. The spread of the disease to so many people in so many places has led the World Health Organisation to declare the spread COVID-19 a pandemic.
The situation is very, very serious, but there are lots of steps you can be taking to keep yourself healthy. At this stage, Public Health is also needing us to keep our communities healthy through actions we call “social distancing.”
Defining social distancing
Social distancing applies to a variety of actions we take to reduce (mitigate) the spread of a disease in a community. As the spread of a disease outpaces the ability of Public Health to control it, they move from into what’s called the “containment phase” into the “mitigation phase” and implement social distancing practices, including:
Working from home when we’re able, which can reduce the likelihood of transmission on transport and in our workplaces (tips below to help make this work!)
Staying at least 6 feet away from people in public to reduce the chances that they could spread COVID-19 to us (or that we could spread to them!)
Staying home as much as we’re able, which means not travelling and not unnecessarily gathering in groups of 10 or more
Cancelling gatherings of 250 or more people because adequate social distancing precautions can’t reliably be undertaken in groups that large
Cancelling gatherings of fewer than 250 people if social distancing won’t be possible to protect staff, volunteers, and attendees, meaning that organisers must:
Meet recommendations for social distancing and limitations on close contact
Screen the employees or volunteers at the event daily for symptoms (fever, cough, shortness of breath, difficulty breathing)
Ensure that proper hand washing, cleaning, and sanitation is “readily available”
Ensure that cleaning facilities are available and will be used appropriately to sanitise high-touch surfaces like counters and doorknobs
Discourage elders and others especially vulnerable to severe infection to not attend
Closing schools when there has been a confirmed case or the school doesn’t feel that they can adequately meet their educational mission due to poor attendance among students or staff
Some health districts are not recommending the closure of childcare settings, however, because the risk of transmission is lower when there are smaller groups of children and parents of young children may need to work
Keep children from people especially vulnerable to severe infection, including their grandparents
There have been false reports that children can’t contract COVID-19, but the reality is that it seems they are more likely to have mild illness which may not be recognised as COVID—making them more likely to spread it to others undetected
Keeping the emergency room for emergencies and managing mild illness at home as much as possible to help keep our healthcare system able to respond to severe cases of COVID
Calling ahead before going to the doctor’s office if you suspect you may have COVID to make sure they are prepared to isolate you from other patients
Understanding the need for social distancing
Social distancing serves two primary purposes:
Protecting those among us who are most vulnerable to severe infection, even if we may ourselves have only a mild illness
Giving our healthcare system time to respond to the (potentially very large numbers of) people who will need medical attention
Social distancing may be inconvenient and can be a hardship for people. It’s hard to keep a toddler home for weeks with a cough until it subsides. It can be hard to work from home. It can be really, really hard to keep your life moving and work when schools close for at least 6 weeks. This has been a struggle for our family since I’m working at least 10-12 hours every day on COVID response. This level of response is necessary to save lives, though.
Protecting the vulnerable
There are people in our community, some of whom we know and love (or maybe just like), who are especially vulnerable to severe COVID-19 infections. While the majority of people who get sick (80%) will have mild illness and may not even know it’s not a regular cold, that means 20% could still have severe illness and need medical attention. Epidemiologists are reasonably confident that people can spread COVID even when they don’t have symptoms and may feel well. This means that, even if you are staying home when you feel sick, you could still spread the virus in public spaces and make people ill who could become very, very sick or even die.
While there’s certainly variance across age groups for the risk of an individual dying from COVID, the Case-Fatality Rate (CFR—the number of people who have the disease divided by the number of people who die from the disease), is 3.4% overall. That number is even higher for those who are older or have an underlying medical condition like diabetes, heart disease, or pregnancy.
Case-Fatality Rate by age group
Case-Fatality Rate by existing medical condition
In the graphs above, we can see the the CFR increases sharply with an individual’s age and with the existence of underlying medical conditions, making the need to protect these people through social distancing our social responsibility. We would want our own grandmother or immunocompromised child to be protected and we need to do the same for others. Public Health scientists understand that these measures are a big challenge for people, so at the bottom of this post I have some suggestions for ways to ease the disruption of social distancing.
Supporting our healthcare system
There has been a lot of talk about a graphic initially produced by Professor Carl Bergstrom at the University of Washington to illustrate two possible scenarios in a pandemic like we’re seeing with COVID-19:
We very quickly see a high number of cases and our healthcare system’s capacity is far exceeded, resulting in many people unable to get the care they need and dying
The same number of people get sick, but they become sick much more slowly, allowing the healthcare system to deliver medical care for those with severe illness, thereby reducing the number of deaths (mortality).
These situations are both scary. The reality is that the global healthcare system is experiencing a shortage of personal protective equipment (PPE)—gowns, gloves, masks, and other devices intended to keep people delivering healthcare safe. I’ve seen reports of masks and gloves being stolen from hospitals, in blatant disregard of the people who need them the most. It is absolutely essential that masks in particular be kept for the people who need them: people who are sick with COVID and healthcare workers. The WHO and CDC continue to remind people that masks keep germs in not out and should not be used by healthy people except in some very limited circumstances.
In the United States, some of the people most likely to need healthcare—people living in poverty, people who aren’t stably housed—are some of the least able to access the care they may need if they become ill with COVID. I’m a professional epidemiologist working on COVID response and I’m very worried. I’m also very hopeful, though, that Public Health Agencies are taking action quickly to limit the spread in our communities. In order to “flatten the curve” so we see the fewest number of severe illness (and deaths) possible, we need to make sure that we’re all adhering to public health guidance.
I know this is challenging, but keeping the number of sick people below our healthcare system’s threshold of being able to care for them will save many, many, many lives and that is always worth the effort.
Making social distancing possible
As many people transition to working from home and having their children home, the restrictions on movement may be increasingly difficult to manage. Public Health emphasises that the goal of social distancing is not social isolation. But, when schools are closed and grandparents can’t babysit because they’re high risk for severe illness what do we do? How do we fill the days for the next several months until the risk of infection is low enough that we can resume our normal lives? How do we work when small humans are also needing our attention?
For families with young children
Try to build a routine — Give children a sense of normality; include them in the process to give them a sense of control
Establish a few hours everyday for School Time and work through lessons together
It’s okay to get creative about how to deliver content—baking is great for fractions!
It’s really hard to do this when things are so fluid, but doing subjects in a similar order to the way they’re done in “regular school” may help your children adapt
Video chat the people we can’t visit — Stay in touch with them and stay safe at the same time
Walk in the park or take a hike — Explore outside or just get some Vitamin D if you are symptom free (staying 6ft away from others as much as possible)
I’ve found Rónán is much keener to go on a hike if there’s something exciting at the end of it (waterfalls always do it for him)
Your local trail association should have a list of kid-friendly hikes in your area
Watch live feeds from zoos, aquariums, and museums — Lots of fantastic places are have been posting some seriously wonderful content (for free!)
Making childcare work — If you do share childcare, try to limit it to fewer than 10 children and take everyone’s temperature at the beginning of the day
Learn a new subject together by renting e-books from your local library — Alternatively, you could research on the internet as a family
I bought lots of graph paper and have Rónán making me graphs of cases and fatalities—learning how to calculate the positive predictive value of Mama’s data queries is up next
Make a stop motion video with toys — Practice storytelling and writing skills with the bonus of a fun thing to share with friends at the end of the project
Talk about what’s happening — Relieve some of your children’s fears—this time is scary for them too
I really love this comic specifically for children to help them understand what COVID is and why it’s going to be okay, even though this is a worrying time
For teleworking
I’ve been completely home-based in my regular job for almost 4 years now and have established some practices which are helpful for me to keep a good rhythm of productivity:
Get dressed — Putting on clothes can help signal to your brain and body that working time has arrived and sleeping time has ended
Don’t work in bed — I made this mistake my first year of teleworking because I’d done it in grad school and it killed my back
Eat breakfast — The breakfast part is actually less important, but the part where you tell your body to get moving is and having tea and toast is how I do that
Work on a flat surface — The sofa is really comfortable (like your bed), but you’re going to kill your back (I promise. I’ve done it.)
Move around your house — I don’t use a desk often and instead work on a variety of flat surfaces including the kitchen counter (standing desk!) and the kitchen table (convenient bird watching!)
This part gets you moving (important!) and reduces the stress on any given body part (like your back!)
Take your breaks — It’s really, really easy to forget to take breaks when you’re in the zone because you’re comfortable at home
It’s okay to do chores too — I do some of my best cooking and laundry folding (muted!) on conference webinars for which I’m just a listener
Close your computer at the end of the day — I spent most of the last 4 years really struggling to master this one and it’s still a growth edge for me, but it’s not healthy to always be on and working from home can easily transition to always being at work if we don’t watch our habits
Drink lots of water — It’s super easy, at least for me, to mistake thirst for hunger and eat goldfish crackers all day
Stagger your workday if multiple people are working from home — Times are desperate right now and everyone being home at one and trying to work is a lot to manage
Talk to your employer about shifting some of your hours so that parents can switch off childcare and working duties
A lot of places are still learning how to negotiate telework and so providing feedback about how to make it workable (and staying flexible with your coworker’s situations!) can go a long way
Find something nice to listen to while you work — I like to have a single stream of audio playing in the background while I work to help prevent being overstimulated
Podcasts (Motherfoclóir and The Read) and instrumental scores (Jurassic Park, ballets) are staples for me
Acknowledge that this isn’t fun — Sometimes just letting myself say “this is really unpleasant and I’m not having a good time” when I’m in an undesirable working environment or situation helps me process those feelings and push through
Scientific Briefing — xkcd