Social Distancing: A medical prescription

Countrywide social distancing by observing one-day “Janata Curfew” on Sunday last was indeed a success in terms of people’s support and participation. It was a prelude to unavoidable and more rigorous steps so as to prevent rapid escalation of Covid-19 that many countries are witnessing.

People’s curfew is not just a symbolic gesture or a one-day event. It was immediately    followed by lockdown issued by the government in 80 districts across 17 States and 5 Union Territories affected by the pandemic. By 24 March, 30 States and UTs declared a complete lock down mode with punitive action for violations.

As Covid-19 is going strong and no effective vaccine is in sight, the world is depending on measures to control its spread by means of non-clinical approach. Epidemics and pandemics have to be fought both by medical remedies and non-medical treatment, for protecting the unaffected is as important as curing the affected. Infectious and contagious diseases have a strong social side and hence need social distancing as a medical prescription.

Social distance is a sociological concept and in medical sociology, it is used to denote an action labeled as social distancing. Merriam Webster’s Dictionary defines “social distance” as “the degree of acceptance or reflection of social interaction between individuals and especially those belonging to different social groups such as those based on race, ethnicity, clan, or gender”. It has four different dimensions – pertaining to sympathy between groups, norms to determine “insider” and “outsider”, frequency of interaction between groups, and habitual and cultural distance. Modern societies, democratic ideals and concept of human rights endeavour to reduce social distance.

“Social distancing” is a set of non-pharmaceutical infection control intended to stop or slow down the spread of a contagious disease. The object is to lessen and minimise contact between the person carrying and also suspected to be carrying the infection and others so as to prevent transmission of the disease to some extent. Social distancing is advocated and actively promoted and even strictly enforced in fighting contagious diseases.

It is one of the most effective methods of containing diseases particularly when an infection spreads through droplet contact occurring in coughing and sneezing, direct physical touch with the affected or touching any surface contaminated with the virus. Though the idea of separating the affected from others is known all along and practised everywhere, it has now become a common practice in view of the global spread of Covid-19.

In epidemiology, social distancing is meant to decrease the basic reproduction number of the disease, which shows roughly how many people an infected individual will go on to infect.  Currently, estimates of the reproductive number of the new coronavirus ranges from 1.4 to 6.5 with an average of 3.3. Increase in this number denotes faster spread of the disease.

A calculation by a scholar says that 25% of the population reducing their social contacts by 50% of their normal can effectively reduce their basic reproduction number to about 81%.  The number looks small and even insignificant considering the efforts required to achieve this, but in epidemiology, where exponential growth and spread are the chief villains, even small reduction can substantially reduce and delay the spread of the disease.

Factors that determine reproduction number include both the character of the disease and the reaction of the people. Highly contagious diseases and people susceptible to infections make for high reproduction number. Number, frequency and duration of contacts being the main determinant of the contagion, social distancing becomes important. Epidemiologists are of the opinion that since we cannot control the biological behaviour of the virus, we should control the human behaviour and contact.

Arresting the rate of spread of the epidemic is the primary concern of all in which non-medical people’s role is called for. Several measures are undertaken to promote social distancing. Educational institutions and workplaces are closed; the affected are isolated and kept in quarantines; mass gatherings are prohibited; places of worship and festivals are shut; public transport facilities are curtailed or stopped; and recreational events, theatres and clubs are closed. Depending on the degree of risk, restrictions are imposed on shops – big malls, retail shops, small trade, and roadside vendors, etc.

“Cordon sanitaire”, another method of social distancing, is restriction of movement of people into or out of a defined geographic area such as a community, region, or country. The term used metaphorically to refer to attempts to prevent spread of ideologies was first applied in medical field to insulate French troops from Yellow Fever in 1821. Originally, it was adopted as a barrier against the spread of an infectious disease. In the present century also, it was used to distance the less affected and the unaffected from affected places and people in containing SARS outbreak in 2003 in China and Canada, and Ebola in West Africa. Border sealing between countries, between States in a country, and between areas and localities within a States have been adopted in fighting coronavirus.

“Protective sequestration” denotes measures taken to protect a small and healthy population from an epidemic before it reaches their doorsteps. It is also called “reverse cordon sanitaire”.  It is difficult to implement as people are reluctant to undergo restrictions before they become inevitable. But, presently, because of massive information about the spread of coronavirus, unaffected areas and people are generally willing to accept any inconvenience and adopt voluntary restrictions. During Spanish Flu in 1917, several communities in the US adopted this method which is also a type of social distancing.

The outbreak of COVID-19 has forced many companies and other institutions to take to work from home as the rule and attendance in workplace an exception even before lockdown announced by the government. However, not all types of work can be done from home.   Those that need field work, presence of the worker at the site or in a work-place will definitely suffer.

Cancellation of air and rail traffic, closing of inter-State and inter-district travel – all for imposing social distancing — will disrupt normal life and affect many commercial activities, but have to be borne silently. The present arrangements may adversely impact output on short and long-term which is to be assessed, but presently unavoidable whatever the impact. The nation has to pay a heavy price to conquer the disease.

Social distancing requires complete public support. Until the call for “Janata Curfew” by the Prime Minister, anti-CAA and anti-NPR protests were going on in Delhi and Chennai with no reason and with no concern for public health. When organising leaders show no sign of understanding the imminent danger of the spread of the disease and the urgency of disbanding all kinds of mass gatherings, strong and strict action is necessary to disperse crowds.

In times of epidemics, government has to take firm action and democratic rights and individual liberty will have to be subordinated to the needs of public health and welfare.  When people are getting ready to face tremendous personal and national economic loss in fighting the disease, a temporary curtailment of individual liberty for broader community benefit is not a big price.



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