Conundrums of Enforcing Social Distancing
Social or physical distancing has become a catch-all phrase for a wide range of measures undertaken across the world to slow the spread of the COVID infection. Best way to understand social distancing is as a non-pharmaceutical prevention method to reduce the droplet transmission of the virus. COVID-19 spreads mainly among people who are in close contact (within about 6 feet) for a prolonged period. Spread happens when an infected person coughs, sneezes, or talks, and droplets from their mouth or nose are launched into the air and land in the mouths or noses of people nearby. The droplets can also be inhaled into the lungs. Recent studies indicate that people who are infected but do not have symptoms likely also play a role in the spread of COVID-19. Maintaining a 6 ft distance between ourselves and other individuals in public settings can dramatically reduce the spread of virus.
There are a number of ways social distancing measures have been implemented, listed below in order of increasing aggressiveness –
a) public advisory – communication about risk and mitigation measures (distancing); compliance is voluntary
b) restrictions on gatherings in public and private spaces – large gatherings and movement in high risk areas is monitored and dissuaded
c) shelter-in-place guidelines – movement outside private spaces is strongly dissuaded; suspension of non-essential services and economic activities is advised
d) lock downs – shelter-in-place measures and suspension of non-essential services are enforced through fines and punishments
These measures slow down the spread of the virus or ‘flatten the curve’, thereby reducing the abrupt load on the health infrastructure to test and treat infected persons, so that the impact of the epidemic on health infrastructure is soft and can be slowly absorbed without overloading and overwhelming the system.
What is likely to work
Evidence suggests aggressive social distancing intervention in early stages of the epidemic has the maximum impact on slowing the spread of the virus and minimizing the load on health infrastructure. For example, Complexity Science Hub in Vienna is clustering countries by how early in their epidemics they began interventions and escalation of aggressiveness of interventions. In Europe, Germany, Austria and Czech Republic adopted early and aggressive control strategies. These countries have been able to control the spread of the virus and minimize the fatalities among infected person far better than countries like Italy, Spain and France which implemented similar measures, but later in their epidemics. By far, United Kingdom and Netherlands have delayed aggressive measures the most, and Sweden is yet to adopt such measures. The epidemic situation in these countries is rapidly worsening.
What could be improved
Aggressive social distancing interventions, although most efficacious in slowing the spread of the virus, have severe social and economic costs, which may often outweigh the benefits of such measures, especially in case of prolonged lockdowns.
a) Aggressive lockdowns have resulted in massive job loss and income loss worldwide. While governments have rolled out financial aid to support households impacted by the immediate economic fallout of the lockdowns, a large chunk of adversely impacted population, often the most vulnerable, are still out of this protective net. This is especially the case in developing countries with a large informal economy like India, where hundreds of deaths have been caused by the lockdown, including people who died of starvation and migrants fleeing the cities for rural areas who collapsed of exhaustion or were run over on the roads.
b) Lockdowns also lead to negative externalities and second order impacts such as mental health crisis due to social isolation and uncertain future, and threat to civil liberties due to government overreach and breach of individual privacy norms in enforcing such aggressive measures.
c) Prolonged shock to economic activity can lead to irreversible damage which may take years to repair and recover.
Therefore, while early aggressive measures may be necessary, prolonged lockdowns can do significant harm, unlike other control measures such as hygiene and mask usage. Governments, sooner than later, will need to experiment with and move towards more targeted lockdowns with higher restrictions on hotspot areas, and focus on aggressive testing and contact-tracing to identify, isolate and treat infected individuals, while allowing reasonable freedom of movement and assembly to non-infected individuals.