Published on Apr 07, 2020

  • Published on Apr 7, 2020
  • Experts are swapping the phrase social distancing for physical distancing, saying it's important to stay socially connected.
  • Research based on the 1918 flu pandemic showed that cities that followed distancing guidelines and closed gathering places had fewer cases of the illness and flattened the curve.
  • The U.S. Federal Government isn't in charge of setting or enforcing distancing guidelines, but the public health authority in every jurisdiction can quarantine anyone, yet it's rarely done.
  • It's difficult to predict if current distancing measures will lead to a significant decrease in COVID-19 cases come summer 2020.
  • The reason for distancing and flattening the curve is to delay the number of cases until a vaccine is available.

Video Transcript

JOHN WHYTE: Hello, I'm Dr. John Whyte, chief medical officer at WebMD. And welcome to Coronavirus in Context. Today, we're going to talk about social distancing. What exactly is it? How long do we need to do it? And is it really a benefit?

And my guest is Dr. Catherine Troisi. She is an Associate Professor at the University of Texas Health Science Center at Houston School of Public Health. Dr. Troisi, thanks for joining us.

CATHERINE TROISI: Thank you for having me.

JOHN WHYTE: You know, is social distancing the right word? We've been hearing a lot about that maybe it should be physical distancing.


JOHN WHYTE: [INAUDIBLE] exactly what it is.

CATHERINE TROISI: I've been trying to use the word physical distancing. Um, we don't want to socially disconnect from people. And instead, we're talking about maintaining that physical distance of six feet or so to stop spread of the virus.

JOHN WHYTE: Is it more important than hand washing? Are they same? Or is that not even the right question?

CATHERINE TROISI: Yeah, it's probably not the right question, that both are important. But we do think that most of the transmission occurs through the air. So if you had to rank them, I would say social distancing was more important. But still, wash your hands.

JOHN WHYTE: And then why do we hear some guidelines are 10 people, other are 25 people, others are don't go with any people unless you don't need to. What's the right number?

CATHERINE TROISI: Well, it's all a probability thing, isn't it. You could be in a crowd of 100 people that you're very close to. And if no one has the virus, you're not going to get it. You could be with one other person. And if they are infected, then you might get infected yourself. So it's really a probability thing.

Um, what we're saying now is the safest thing is to just -- you know, the members of your household you pretty much have to interact with. Although if someone's sick, you might want to physically distance them anyways. But other than people in your household, you're better off just not interacting with anybody else.

JOHN WHYTE: Because if we don't practice social distancing, remind us what happens.


CATHERINE TROISI: Yeah, we base this on experience during our last big pandemic, the 1918 flu. And, um, there are studies showing that cities that instituted social distancing guidelines, as well as community mitigation -- that is, closing the schools, houses of worship, movie theaters, places like that -- um, experienced fewer cases of influenza and flattened the curve, as we're talking about. So they spread the number of cases out over time, which we're very concerned about here because of a lack of medical equipment, or a shortage of medical equipment.

JOHN WHYTE: Well, what about for those persons who say there's not a lot of COVID-19 in their area. Or that's their belief. Um, so they don't need to be as vigilant about it as, say, if you were in New York City. What do you say to those persons?

CATHERINE TROISI: Uh, we are finding out more and more information about when people can spread the virus. And there's a study out of China showing that 86% -- more than -- almost 9 out of 10 cases of infection came from somebody who was showing either no symptoms or minimal symptoms that they didn't think was, um, a coronavirus symptom.

JOHN WHYTE: 80%? Wow.

CATHERINE TROISI: 86%, yeah. And so we're finding that people can transmit the virus either before they have symptoms -- we're not quite sure how long before they have symptoms. And that a certain percentage of people -- and again, it varies. I've seen as low as 1%. I've seen as high as 25% of people who are infected may never have symptoms. And so, um, everybody needs to act as if they themselves are infected and you are protecting other people.

JOHN WHYTE: And you talked about flattening that curve. And everyone's talking about flattening the curve. Although I heard in Canada they're calling plank the curve. So --



JOHN WHYTE: -- everyone comes up with something new. And I guess the idea is that if you prevent people from interacting with others, you're going to prevent the spread. Is that basically what we're talking --


JOHN WHYTE: -- about?

CATHERINE TROISI: That is basically, um, why we're doing it. But the other reason we're doing it is, even if people get infected, um, there is concern we won't have enough ICU beds, enough ventilators. So if we can, um, stop that curve from being so tall, that is, a lot of people infected at once, then we can spread out the number of beds, et cetera. Um, so that's a second reason why we're doing it.

JOHN WHYTE: How do you know if it's working?

CATHERINE TROISI: [LAUGHS] You don't really -- well, we think that it is. We have seen in Italy, for example, the number of cases is coming down. Um, you don't really know until you're on the other side of that curve, though, that roller coaster side where it's going down. Uh, so, um, you know, we're not going to know right away.

But again, we know from previous pandemics that, um, social distance -- physical distancing works. And, it just makes sense. If you're not in contact with someone, you're not going to spread the virus.

JOHN WHYTE: Yeah. Do you think Americans are going to be able to stay in their homes for at least another 30 days?

CATHERINE TROISI: Um, there was a report out today from Kaiser Health News showing, uh, a poll showing that a majority of people are doing it. Now, that's right now. We're in -- what -- it depends on where you live how long you are into it. I think we're -- we're in week two in Houston.

Um, and it does get hard. It's hard depending on the work that you do where you may not be able to stay home. Uh, but, again, this poll showed that most people, the vast majority, agreed that it was important just to do this physical distancing. So my answer is, I hope so.

JOHN WHYTE: It doesn't work if everyone's not doing it. Isn't that part of the problem that we might see? That, you know, some folks are doing it very rigorously. Yet, we still see people having crowds.

CATHERINE TROISI: Yeah. And that is a problem. And it's also a, um, unique problem here in the United States where it's not the federal government that's in charge of this. It's the states. And so different states have different guidelines. And in some states -- um, Texas would be an example -- it's even county by county.

And so you're absolutely right. If people -- you know, I could stay inside my house for six weeks and not get exposed. But as soon as I come out, if someone else is infected, then I might get infected.

JOHN WHYTE: And some folks have these neighborhood apps. There's different ones that exist. Um, what do you say to those folks who say, we should be calling the police on our neighbors who are having more than 10 cars in their driveways or those, you know, younger adults who are playing a basketball game or soccer? Is there a role for that? Or is that going overboard in terms of social distancing?

CATHERINE TROISI: Um, I can't speak for every place in the country. But at least here in Texas, it is not against the law. So I'm not sure what the police -- [LAUGHS] you know, it --


CATHERINE TROISI: I mean, the public health --

JOHN WHYTE: Or you could call your neighbors and shame them. Should we --

CATHERINE TROISI: Right, right. I mean, the public health authority in every jurisdiction can quarantine people. We do that with people who have TB. But it's a rarely used -- you know, this -- um, what was acceptable in China is just not going to be acceptable here.

And you can think about it as a triangle where there's three parts. Um, you know, keeping people safe, um, keeping, um, our civil liberties -- and then the economy. And all three of these are, um --


CATHERINE TROISI: -- uh, you know, at odds with each other. And where you draw those boundaries really depends on the culture of your-- of your country and its government.

JOHN WHYTE: And keeping people safe isn't just ourselves and our family members --


JOHN WHYTE: -- but our community. And that's what we're trying to get people to recognize. Now, uh, put on your, uh -- or take out your crystal ball.



JOHN WHYTE: OK, you have it? And tell us what you see three months from now. So you know, we're in midsummer.

CATHERINE TROISI: Yeah, [LAUGHS] well, first of all, my crystal ball is not working so well today.


But, um, you know, the big question is, are we going to see a decrease in cases in the summer? It's really hard to say. Um, we do with some other respiratory viruses. We don't with others. Some viruses, mumps, for example, we see an increase in the spring.

We are seeing an increase in cases in Australia, which is just coming out of their summer. Um, and -- so, um, it's -- the four coronaviruses that cause the mild colds that have been around for a while, two of those we do see wane in the summer. Two of them we don't. So it's just really, really hard to say.

I will say that even if it does go away in the summer or the number of cases decreases significantly, um, my, um, not functioning so well crystal ball is telling me we will see an upsurge in the fall again. And particularly when we stop the physical distancing, and kids go back to school, and we go back to working in groups again.

JOHN WHYTE: Do you expect us to see music concerts this year or sporting events?

CATHERINE TROISI: Yeah, I don't know. It's -- you know, it's -- um --

JOHN WHYTE: We ask tough questions.

CATHERINE TROISI: It's really one day at a time, isn't it? You know, um, it's -- life as we know it has changed right now. And it's hard to see what it's going to be like on the other side.

Um, the other reason for flattening the curve is to delay enough cases till we do have a vaccine, which is going to be at least 12 to 18 months, maybe even longer. And, um -- or -- we have antivirals to treat those severe cases.

JOHN WHYTE: What are you hopeful about?

CATHERINE TROISI: I am hopeful about how people seem to be, um, really coming together on this. I got a note on my front door last weekend from my neighbors, some kids -- it wasn't signed -- on my street, saying, dear, neighbor. We hope you're doing well, you know. And, you just see all the time about people really going out of their way to help other people.

And again, I hope on the other side of this, we have that sense of community again that we have lost in recent years.

JOHN WHYTE: Well, that's a good note to end on. And I want to thank you, Dr. Troisi, for taking the time.


JOHN WHYTE: And I want to thank our viewers for watching Coronavirus in Context. I'm Dr. John Whyte.