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Medical School Hot Topic: Social Distancing
Social distancing, a word previously unknown to the general population, became a buzzword in 2020 as COVID-19 spread across the planet. However, it is of interest to examine exactly what social distancing is, the benefits it bestows, and how far one might actually find benefit in distancing. We might also examine the role of physical distancing - that is, how far away from one another to stand in order to reduce the risk of infection.
What is Social Distancing?
Social distancing is a public health measure that aims to prevent the sick from coming into close contact with the well. It will include individual measures and decisions as well as large-scale measures. The goal of social distancing is principally to slow an outbreak in order to reduce infection in high risk populations, and to reduce the burden on healthcare systems and workers. It is unlikely to eliminate a disease, and is instead part of an overall plan that should include effective therapy, testing and vaccination.
Social distancing is defined by the CDC as ’remaining out of congregate settings, avoiding mass gatherings, and maintaining distance (approximately 6 feet or 2 meters) from others when possible.’ If we look at large scale methods of social distancing, we must consider the closure of organisations like schools, colleges and universities - and the closure of workplaces in which working from home is possible. Events like sports, music concerts, cinema-going and festivals will all be cancelled, and conferences and large gatherings like weddings may also be halted. Houses of worship may have to suspend their services. Individuals must consider their own actions too in the context of social distancing - not seeing their friends, not socialising in large groups, not making unnecessary trips into public, and of course avoiding any contact with others if they feel ill.
Social distancing should be remembered as one part of our collective and individual response to a pandemic - we should be careful also to wash our hands, avoid touching our faces, wear masks, ensure appropriate cleaning of public and private spaces, and both produce and follow clear public health messaging.
Physical Distancing
Physical distancing is the simplest part of social distancing - maintaining a physical space between you and others. In general, the rules are that one must stay either 1m, 1.5m or 2m away from other people around them. The 2m rule, which is perhaps the norm, originated in the 19th century, with research done by Flugge in 1897 proposing a 1-2m distance as safe based on how far a visible droplet travelled with pathogens in. A 1948 study would find that the majority of large droplets produced by a coughing or sneezing patient would travel less than six feet. This led to an entrenchment in the scientific community of the concept of a 2m physical distancing as appropriate, with the idea of two droplet sizes - large and small - being part of this.
However, we should look to divide respiratory droplets into a whole spectrum of sizes rather than the two above. In reality they exist on a scale, and various factors like the ambient airflow, windows being open, the heat of the air, and the force of exhalation can have a huge effect. Smaller droplets, invisible to the naked eye and called aerosols can readily travel beyond 2m in exhaled air, and large droplets have the same ability given the right conditions.
We should therefore perhaps look to develop a graded system of safe physical spacing, depending on factors like occupancy of a building, how well it is ventilated, whether one is inside or outside, whether one is wearing a face mask, and whether one is silent, talking or shouting. This could allow different places to allow different levels of physical distancing - a shop having a smaller distance than a concert for example. This would mean much greater freedom for most people in the lower risk areas, leading hopefully to normal life being resumed more quickly for many.
Example Questions
- What is social distancing?
- How does a country deal with a pandemic?
- What is physical distancing?
- How does a virus travel in air?
- How far do viruses travel in air?
- What measures should an individual take to protect their health and the health of others in a pandemic?
Interview Questions & Example Answers
What is social distancing?
Social distancing is the name given to a public health measure aiming to prevent those that are sick from an infectious disease from coming into close contact with the well, where they might transfer the disease. The measure is designed to slow an outbreak, reduce the risk of infection in highest risk populations, provide time for a healthcare service to act, and reduce the burden on a nation and its healthcare system.
The CDC defines social distancing as ‘remaining out of congregate settings, avoiding mass gatherings, and maintaining distance (2m) from others when possible.’ Methods of social distancing might include closing schools, events, and sports, and working from home where possible.
How does a country deal with a pandemic?
A country should have a basic level of preparedness for an outbreak that will entail the stockpiling of PPE and reagents for testing, as well as training of necessary personnel. It should act quickly with a contact tracing process that allows for the tracking of any infected people at the outset of a pandemic. Social distancing measures should be imposed quickly and should include personal measures such as hand hygiene and physical distancing, physical distancing in public spaces, movement measures to prevent spread of the virus, and special protection measures for the most clinically vulnerable. There should be cooperation between the country and others to share results and data, and work to develop a vaccine should begin as fast as possible, be well-funded, and rely too on international cooperation.
Public health messaging should be clear in order to keep the population onside during a difficult time, and certainly through more stringent measures that may have to be imposed like national lockdowns.
What is physical distancing?
Physical distancing is a term that is now used largely in place of social distancing, due to the number of studies confirming the negative impact that social distancing has on mental health, notably if it results in social isolation. Physical distancing is defined by the physical aspect of a 2m gap between people, and in order to maintain a focus on this, whilst moving away from people feeling that they must be socially isolated, there has been a shift away from the term social distancing.
Some publications will still use the term physical distancing to mean the core part of a social distancing effort - i.e. remaining 2m away from each other, whilst they will use social distancing to encompass the whole process.
How does a virus travel in air?
In general, a respiratory virus might be transmitted in one of three ways. The first is contact transmission - where someone has come into direct contact with someone who has been infected or touches a surface that they have contaminated. The second is droplet transmission of respiratory droplets, which contain the virus, occurring near someone who has been infected. The third is airborne transmission - smaller droplets and particles that are able to ‘float’ longer distances in the air, for a longer period of time.
Initially it was thought that COVID-19 was not transmitted via airborne transmission, but as of the 5th of October 2020 the CDC updated their webpage to state that ‘there is growing evidence that COVID-19 infection can occur from airborne exposure to the virus under certain circumstances.’
How far do viruses travel in air?
This is a source of some debate. The 2m figure has been used for a century or so, but increasingly there appears to be evidence that a more refined method of understanding the distance viruses travel is needed, as it is dependent on various factors - the activity being performed (e.g. singing), airflow in the space, whether one is inside or outside, etc. As it stands the WHO suggests that 1m is a safe distance, whilst the CDC and NHS both state 2m as being safe.
Most particles that fall to the ground within 2m are likely to be in the size range of 60-100μm - but many pathogens are found in small aerosol particles that are less than 5 μm and breathable.
What measures should an individual take to protect their health and the health of others in a pandemic?
There are various measures that all people should take to protect themselves and others. Firstly, you should wear a mask in public, and stay 6 feet - 2m - away from anyone else outside your home, or anyone that may be sick in your home. You should do your utmost to avoid crowds, be that in a restaurant, bar, sporting event or even on the street.
You should avoid poorly ventilated spaces and try to bring fresh outdoor air into any indoor space where possible. You should wash your hands often, using soap and water, especially if you have just been in a public space, coughed, sneezed or blown your nose.
You should cover any coughs or sneezes with the inside of your elbow or a tissue. Clean and disinfect any frequently touched surfaces.
Monitor your health daily, be aware of the symptoms and new guidance. Follow local guidelines if you develop symptoms. Get vaccinated as soon as it is your turn. .
Social distancing is the name given to a public health measure aiming to prevent those that are sick from an infectious disease from coming into close contact with the well, where they might transfer the disease. The measure is designed to slow an outbreak, reduce the risk of infection in highest risk populations, provide time for a healthcare service to act, and reduce the burden on a nation and its healthcare system.
The CDC defines social distancing as ‘remaining out of congregate settings, avoiding mass gatherings, and maintaining distance (2m) from others when possible.’ Methods of social distancing might include closing schools, events, and sports, and working from home where possible.
How does a country deal with a pandemic?
A country should have a basic level of preparedness for an outbreak that will entail the stockpiling of PPE and reagents for testing, as well as training of necessary personnel. It should act quickly with a contact tracing process that allows for the tracking of any infected people at the outset of a pandemic. Social distancing measures should be imposed quickly and should include personal measures such as hand hygiene and physical distancing, physical distancing in public spaces, movement measures to prevent spread of the virus, and special protection measures for the most clinically vulnerable. There should be cooperation between the country and others to share results and data, and work to develop a vaccine should begin as fast as possible, be well-funded, and rely too on international cooperation.
Public health messaging should be clear in order to keep the population onside during a difficult time, and certainly through more stringent measures that may have to be imposed like national lockdowns.
What is physical distancing?
Physical distancing is a term that is now used largely in place of social distancing, due to the number of studies confirming the negative impact that social distancing has on mental health, notably if it results in social isolation. Physical distancing is defined by the physical aspect of a 2m gap between people, and in order to maintain a focus on this, whilst moving away from people feeling that they must be socially isolated, there has been a shift away from the term social distancing.
Some publications will still use the term physical distancing to mean the core part of a social distancing effort - i.e. remaining 2m away from each other, whilst they will use social distancing to encompass the whole process.
How does a virus travel in air?
In general, a respiratory virus might be transmitted in one of three ways. The first is contact transmission - where someone has come into direct contact with someone who has been infected or touches a surface that they have contaminated. The second is droplet transmission of respiratory droplets, which contain the virus, occurring near someone who has been infected. The third is airborne transmission - smaller droplets and particles that are able to ‘float’ longer distances in the air, for a longer period of time.
Initially it was thought that COVID-19 was not transmitted via airborne transmission, but as of the 5th of October 2020 the CDC updated their webpage to state that ‘there is growing evidence that COVID-19 infection can occur from airborne exposure to the virus under certain circumstances.’
How far do viruses travel in air?
This is a source of some debate. The 2m figure has been used for a century or so, but increasingly there appears to be evidence that a more refined method of understanding the distance viruses travel is needed, as it is dependent on various factors - the activity being performed (e.g. singing), airflow in the space, whether one is inside or outside, etc. As it stands the WHO suggests that 1m is a safe distance, whilst the CDC and NHS both state 2m as being safe.
Most particles that fall to the ground within 2m are likely to be in the size range of 60-100μm - but many pathogens are found in small aerosol particles that are less than 5 μm and breathable.
What measures should an individual take to protect their health and the health of others in a pandemic?
There are various measures that all people should take to protect themselves and others. Firstly, you should wear a mask in public, and stay 6 feet - 2m - away from anyone else outside your home, or anyone that may be sick in your home. You should do your utmost to avoid crowds, be that in a restaurant, bar, sporting event or even on the street.
You should avoid poorly ventilated spaces and try to bring fresh outdoor air into any indoor space where possible. You should wash your hands often, using soap and water, especially if you have just been in a public space, coughed, sneezed or blown your nose.
You should cover any coughs or sneezes with the inside of your elbow or a tissue. Clean and disinfect any frequently touched surfaces.
Monitor your health daily, be aware of the symptoms and new guidance. Follow local guidelines if you develop symptoms. Get vaccinated as soon as it is your turn. .