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What are the rules of social distancing?


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What are the rules of social distancing?

Staying home will stem the coronavirus outbreak, but what if you’re healthy — and bored? Is it ethical to go to the gym, get your hair done, or order delivery?

Many Americans in recent days have received emails directing them to start working remotely, or announcing that schools would be canceled for weeks in light of the coronavirus pandemic. Major events are also being called off with a domino-like effect, including Coachella and South by Southwest, March Madness and virtually all sports events, business conferences, even religious services across the country.


In many cases, the action is prophylactic — no one at work or school may be sick yet — though with each passing day, more of these decisions are being made in response to a community member testing positive for Covid-19, or the risk that contact with large groups of people could exacerbate transmission of the virus.


The closures are a way to enforce social distancing, a crucially important public health intervention that can help stop coronavirus transmission by avoiding crowds and large gatherings such as weddings, concerts, conferences, sporting events, and mass transit. Best practice requires maintaining at least a six-foot distance between yourself and others.


You may have already come into contact with an infected person — the woman who rode the bike before you at SoulCycle, the kindly fellow who coughed while standing next to you in line at Costco, or someone who touched your mail as it made its way to your mailbox. (At least one study estimates that about 25 percent of transmissions of coronavirus may have occurred in pre-symptomatic stages — meaning it may be spread by people who don’t yet know they have the virus.)


With Covid-19, “many people in the US will at some point, either this year or next, get exposed to this virus,” the Centers for Disease Control and Prevention’s immunization czar announced this month. Social distancing, health authorities argue, can dramatically slow the rate at which the infection is spreading, easing the burden on the health care system.


To that end, the CDC is now urging all gatherings of more than 50 people to stop for the next eight weeks. But how should social distancing affect your visits to the gym? Your weekly manicure? Play dates for your kids? Your weekend reservation at the buzzy Michelin-starred omakase spot you’ve been dying to try? Are those risky for an ostensibly healthy person like yourself?


What do you, as a responsible, socially conscious human being, owe to your fellow men and women — particularly those who are sick, immunocompromised, and older? Are you breaking the social contract by going to hot yoga?


Or, by not going, are you overreacting and hurting the economy?


Vox spoke with six experts in public health, medicine, psychology, and bioethics for answers. (Please remember that as the Covid-19 landscape transforms week by week, so, too, will the advice.)

I feel healthy. Why shouldn’t I get out a little bit to make this time pass easier?

Vox’s Kelsey Piper makes a strong argument for choosing to stay home as much as possible, inconvenient as it may seem, to help your fellow human. “If you are young and healthy, you ought to take precautions because doing so can end up saving someone’s life,” she writes.


Leah Lagos, a New York City-based psychologist and author of Heart, Breath, Mind, agrees. “Now is the time to do something for your fellow community members,” she says. Staying home as much as possible, even if you believe you aren’t infected, is the type of altruistic decision that, when performed en masse, has the potential to slow the infection rate, Lagos says.

An infographic that shows the goals of mitigation during an outbreak with two curves. The X-axis represents the number of daily cases and they Y-axis represents the amount of time since the first case. The first curve represents the number of cases when no protective measures during an outbreak are implemented and displays a large peak. The second curve is much lower, representing a much smaller rise in the number of cases if protective measures are implemented.

Christina Animashaun/Vox

Considering — and prioritizing — the welfare of strangers is difficult, she acknowledges, but it helps to think of them instead as someone else’s parent, grandparent, or child. “It can be an interesting experiment in compassion for people we don’t know.”


“A lot of us might be relatively healthy and think we might be able to withstand the rigors of an infection,” adds Jonathan Kimmelman, director of the Biomedical Ethics Unit at McGill University in Montreal, “but there’s the concern about spreading it to vulnerable individuals, as well as the pressure this outbreak will place on our health care system.”


Kimmelman invokes the idea of “social solidarity,” saying “we have an ethical obligation to curtail activities, practice social distancing, and substitute activities with safer alternatives,” like teleconferencing instead of in-person work meetings, or changing a first date from a wine bar to a walk outside.


But should you even be going on dates, period?


If the messages are confusing, understand that “there are different levels of social distancing” in effect around the world, and that local health departments’ recommendations vary currently depending on known cases, says Syra Madad, an NYC-based special pathogens specialist who was featured in Netflix’s docuseries Pandemic: How to Prevent an Outbreak. In Washington state’s King County, for example, the current recommendation is that “social interaction is still vitally important to the mental health of young people, and it is still possible for families to have safe gatherings among children and parents.” The county recommends, however, limiting indoor groups to 10 or fewer children and outdoor groups to 50 or fewer, and for residents to avoid parties, retail spaces, and movie theaters.


Still, Madad notes, “It is better to operate under the pretense that there is transmission in your community already. There’s going to be disruption to daily life, but we want people to feel empowered by this. The decisions you make will ultimately affect the trajectory of this outbreak.”

An empty restaurant in New York City on March 13, 2020.
Jeenah Moon/Getty Images

If I have to go out, how can I do it in the safest way possible — to protect myself as well as others?

Kate Vergara, a public health and infectious disease specialist based in Chicago and New York City, has spent time fighting polio in Ethiopia and helping Ebola survivors in Sierra Leone (without contracting either disease). In order to even begin to approach the ethics of social distancing, she says, we must have a firm grip on how the virus is spreading.


“Covid-19 is not airborne,” she says. “It is transmitted through droplets — being coughed on, or touching something that someone coughed on, for example, and then touching your face and allowing that pathogen to get into your system through your eyes, nose, or mouth.”


It’s important to practice good hygiene, like hand-washing — which protects not only you but others as well. When considering the ethics of spending time out and about, Vergara suggests reframing your view of hand-washing in the following way: “Wash your hands before you go out to protect others, and wash them again after the activity to protect yourself.” If you’re low-risk and itching to hit the gym, wash your hands first so you’re touching machines and weights with pristine hands; that protects others. Then, after your workout, wash them again to scrub off anything you may have picked up. And wipe down your exercise equipment, or anything else you might have touched. The same goes for getting a haircut, visiting the ATM, and the like.

Should I feel guilty for wanting to go to the gym, or on a date?

Between the relentless news alerts, social media memes, and gossipy texts, it’s easy to feel overwhelmed, anxious, and scared. We need self-care more than ever, says LaMar Hasbrouck, a public health physician and past medical epidemiologist with the CDC. “It’s important during these times to hold fast to any sense of normalcy that you can.”


But try to find prudent ways to do so. Hasbrouck now picks off-peak hours to exercise to minimize contact with others; other options include walking, jogging, or biking outdoors. The more ventilated an area, the lower the risk of transmission, plus “if you cough, nobody is around and the droplets just fall and hit the ground,” he says. Better yet: breaking a sweat at home with help from an app or online video.


Grocery shopping will need to happen, but instead of going at noon on a Saturday when the place is sure to be packed, try going really early on a weekday morning. If it’s still possible, order online. And wipe down any deliveries, just to be safe.

Should I keep using grocery delivery services ... and ride-hailing companies … and restaurants?

Hasbrouck encourages those who have access to services such as Postmates, Grubhub, Lyft, and Instacart to use them. “It’s a good way to social distance,” he says, noting that two main factors when it comes to Covid-19 transmission are closeness of contact and duration. “The handoff is five seconds, you go inside and wash your hands. Or just have them leave it at your doorstep.” (Last week, Instacart introduced a “Leave at My Door Delivery” option.)


This poses some ethical questions, however: Having milk and bread delivered is convenient for you, minimizing your exposure to the virus. But what about the person doing your grocery shopping or picking up your Thai food? Or the Uber driver ferrying you to your significant other’s apartment? Is it right to ask them to assume the risk of being out and about?


Yes, say both Hasbrouck and Vergara. However, contaminated hands pose a risk to drivers and riders, so be ultra-diligent about hand hygiene, washing or sanitizing hands before getting in the car and not touching your face at all. Cracking a window is a smart move for both you and the driver, as it promotes airflow.


As for restaurants, honor upcoming reservations or attend gatherings as necessary. Unlike norovirus or hepatitis A, “food isn’t known to be a way of transmitting this or other respiratory viruses,” says Benjamin Chapman, a professor and food safety extension specialist at North Carolina State University. “You mainly need to be mindful about the surfaces you touch: menus, the table, condiments, things that other patrons might have used.” But the choice to dine out may soon be very limited for many Americans: Governors of several states, including Illinois and Washington, this week ordered all restaurants and bars closed; major cities such as New York and Los Angeles are following suit.


Chapman, who continues to dine out, says that while he might not know who touched that soy sauce bottle or pepper shaker before him, “I do know I can break the pathway of transmission by using hand sanitizer or washing my hands.” With social distancing in mind, opt for establishments where it’s easy to keep six to eight feet between yourself and other diners (maybe save sitting at the packed bar for after the pandemic ends) and feel free to be “a public health nerd” like Chapman and ask if they’re using Environmental Protection Agency-approved sanitizing products, which they should be.


Chapman notes that he lives in North Carolina, which is not currently a Covid-19 hot spot. “I’d have a different response if I was in New Rochelle, New York, or Seattle,” he says, two cities where the risk of transmission is greater due to higher numbers of community-acquired infections. In cities such as those, he would advocate taking advantage of the “great infrastructure we have set up for home delivery of food.”

Should I cancel play dates? What are the rules for my kids?

In Ireland, public health officials are encouraging a “no parties, no playdates, no playground” policy, per the Irish Times. Muireann Ní Chrónín, a consultant respiratory pediatrician at Cork University Hospital, told the paper: “Children will get through this no problem. [But] remember with corona, children are vectors, not victims. In most epidemics, young children are the transmitters.”


Here in the US, school closures are smart, Vergara says. “It’s a responsible practice for schools to shut down. That’s several hundred kids interacting in close quarters, and kids aren’t known for washing their hands very well.” But that leaves millions of working parents frantic about career responsibilities, and unsure of whether it’s appropriate to schedule play dates or try to split child care duties with friends.


The experts interviewed for this story had differing opinions about whether play dates should continue in a pandemic. Vergara says that, if following healthy practices, small play dates are feasible, but before the kids come over, use disinfecting wipes to clean high-touch items like doorknobs, remote controls, and the table where they’ll be playing. Replace the hand towel in the bathroom with a fresh one, and when the visiting kiddos show up, everyone — your children included — should wash their hands thoroughly.


Lagos worries that play dates during school closures are essentially “quasi-quarantines, defeating the purpose of social distancing.” Kimmelman concurs, and though he says no one knows the exact right answer, “we don’t know how things are going to unfold, and from my standpoint, the risks of underreaction are so much more catastrophic than the risks of overreaction.”


Alyssa F. Westring and Stewart D. Friedman, co-authors of Parents Who Lead, writing in the Harvard Business Review, recommended finding inventive ways for children to play together virtually. “While it may not be feasible to trade-off childcare responsibilities (depending on quarantine restrictions),” they wrote, “consider other ways in which you can make things easier for one another — whether it’s sharing creative activities to keep the kids entertained or taking turns grocery shopping. … Be open to new ways of doing things.”

When should I completely self-quarantine?

The CDC has issued recommendations for travelers arriving from dozens of countries with widespread cases to stay home for 14 days. If someone at your work or school was definitely exposed, it’s also time to assess your own risk of exposure, and of spreading the coronavirus. “If you say, ‘Well, I know I’ve been mostly in my office, avoiding meetings and conference rooms, and I’ve been washing hands a lot,’ you could probably go about your daily routine with some social distancing to protect yourself, not so much to avoid infecting others,” Hasbrouck says.


But if you have a fever or receive new information — that it was John, in the cubicle next to you, who was exposed — “you’re going to want to radically change your assessment.” That likely means self-quarantining, because that’s “the ethical decision and you don’t want to expose others. It’s a constant risk assessment, and it’s more of an art than a science. It’s about protecting yourself but also being socially responsible.”

How far should we take social distancing advice?

“Look at the trajectory of what’s happening in Italy. We’re 11 days behind Italy,” where a national lockdown that began March 10 has curtailed all travel and shuttered nearly all shops, schools, museums, movie theaters, and bars, says Madad. “Measures like travel bans and quarantining entire localities — you may not see that here,” she says. But we can undertake distancing measures ourselves. “One of the things we’ve learned from the H1N1 pandemic is that if you educate people, they will listen. You have to give them the facts, and speak with one voice.”


The Vox guide to Covid-19 coronavirus


Source: What are the rules of social distancing? (Vox)

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