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Self-Distancing Vital Tactic in Coronavirus Fight

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March 16, 2020 -- Whenever people gather, there are opportunities to spread germs.

From one recent corporate conference in Boston, where 175 people gathered, for instance, the new coronavirus spread to more than 100 people.

Although not every gathering will be so contagious, it’s impossible to know ahead of time who is going to be coughing or sneezing, and remember: You don’t have to have symptoms to be infected and contagious.

That’s why the Trump administration on March 16 asked everyone to avoid gatherings of 10 or more for the next 15 days, including restaurants and bars and food courts, along with discretionary travel. It's why more states are taking the extra step to close restaurants and bars. It’s why schools and universities are closing and why people are working from home. They want us to stay apart -- “self-distancing” in their lingo. If we don’t get within 6 feet of another person, or at least lessen the number of people we let into this 6-foot zone, we will cut our chances of getting sick, says Jeanne Marrazzo, MD, a professor of medicine and director of the Division of Infectious Diseases at the University of Alabama at Birmingham.

“At this point, we’ve got nothing else, which is why people are willing to jump on board,” she says.

It’s hard to make life-altering decisions based on what may seem like a theoretical threat to those who apparently aren’t infected.

“I and many other Italians just didn’t see the need to change our routines for a threat we could not see,” Italian journalist Mattia Ferraresi wrote in a Boston Globe op-ed published over the weekend, headlined: “A coronavirus cautionary tale from Italy: Don’t do what we did.” Now, the entire nation is on lockdown. “In the end,” Ferraresi wrote, “each of us is giving up our individual freedom in order to protect everybody, especially the sick and the elderly.”

That’s the best approach right now, echoes Michael Mina, an assistant professor of epidemiology at Harvard T. H. Chan School of Public Health.

“It seems like in the U.S., people are really starting to take this seriously and we are starting to see cities empty out,” he says. “I can only hope that this is going to be beneficial to reduce the peak of the curve of this epidemic and slow it down.”

Unfortunately, there is no specific treatment for COVID-19, the disease caused by the new coronavirus, and no vaccine to protect against it, though researchers all over the world are rushing to develop both. Treatments are likely to come first, with one already being tested; vaccines could take several years to be approved and then made on a large enough scale to make a difference.

For people who think “I’m going to get it anyway, so why bother” -- yes, it’s possible that 40%-70% of the public may ultimately get COVID-19, says Seth Berkley, CEO of Gavi, the Vaccine Alliance, a nonprofit that supports the use of new and underused vaccines for low-income countries and outbreaks.

But if it’s unrestrained in the community, “then, it’s a numbers game,” he says. Several Chinese doctors died, despite being in their late 20s and early 30s. “If enough [young] people get it, there will certainly be deaths” among them, he says.

Tips and tricks aplenty

So, what does it mean to socially distance yourself? Here are some guidelines from Marrazzo, Mina, and the CDC:

  • Stay at least 6 feet away from other people, if possible.
  • Avoid sports arenas, theaters, museums, and other places where you are likely to come into contact with large numbers of people. The Trump administration on March 16 asked all Americans to avoid gatherings of more than 10 people for the next 15 days. 
  • Avoid restaurants or bars. Mina, who ordered takeout over the weekend, says that’s a better way to go. Many states are already ordering bars and restaurants to close, except for takeout and delivery.
  • It may also be a good idea to stay away from hairdressers, barbers, and nail salons, for instance, because these folks have to get closer than 6 feet. Massages may be great for easing stress, but you might consider finding another path right now.
  • Skip playdates, parties, sleepovers, or families visiting each other's houses.
  • Do not visit nursing homes, rehab centers, or assisted living facilities, as older people are at highest risk for complications and death from coronavirus. Find virtual ways, such as FaceTime or Skype video visits, to lessen the social isolation of people in these kinds of facilities.
  • Riding mass transit is a major challenge because it’s hard to stay 6 feet from other straphangers. Having fewer people go to work will help cut the risk for those who don’t have an alternative.
  • Wash your hands frequently and longer than you usually do. The recommended length of time for handwashing is 20 seconds, or about as long as it takes to sing “Happy Birthday to You” through twice. Soap and water is just as good if not better than hand sanitizers. But hand sanitizers are OK to use if you can’t get to soap and running water.
  • The virus can remain alive for up to 3 days on hard surfaces, meaning if you touch a metal doorknob that someone with the virus has recently touched, you could pick up the virus. (But the CDC does not consider this to be a major way the virus spreads.)
  • Touch your face less, especially your eyes and mouth.
  • Don’t wear a mask unless you are sick yourself. Every available mask may soon be needed by health care workers, and masks haven’t been shown to prevent healthy people in the general public from falling ill.
  • It’s important to stay healthy, so don’t forget to get enough sleep, and ease stress by exercising, talking with friends and family, and practicing your hobbies, if possible.
  • Walks outside and hikes can be a good way to get exercise without coming into close contact with others.
  • If you must go to the gym, wipe down equipment before and after use, but Mina thinks exercising outdoors is a much better idea, as people might emit more virus particles when they are breathing heavily.
  • Keep going to the grocery store and drugstore as needed, but postpone other nonessential shopping trips.
  • Purchase a 1- to 3-month supply of prescription medications, if possible.
  • Monitor information about COVID-19 in your community.
  • Know the signs and symptoms of COVID-19, such as fever, coughing, and body aches. (It’s spring allergy season in some parts of the country, with trees budding, so stuffy noses may be allergies.)
  • If you think you may have COVID-19, call ahead before going to your doctor’s office or an emergency room to avoid spreading germs to others.

Be ready to hunker down a while

If you are sick or have likely been exposed to the virus, you should take even more extreme measures, staying at home and sending others to the store and on other crucial errands on your behalf. If you live with others, you should try to isolate yourself as much as you can, staying alone in a bedroom and using a dedicated bathroom, if possible. Obviously, frequent hand-washing becomes even more important for everyone in this situation.

People over 65, those with reduced immunity -- because of cancer treatment, other medications, or medical conditions that weaken the immune system -- and people in contact with either of these groups need to be particularly careful.

“I realize that not everyone can do everything,” Asaf Bitton, MD, an assistant professor of medicine at Harvard Medical School, wrote on Medium. “But we have to try our absolute best as a community, starting today. It is a public health imperative. If we don't do this now voluntarily, it will become necessary later involuntarily, when the potential benefits will be much less than doing so right now.”

How long will we need to keep this up? Projections suggest that the U.S. is less than 2 weeks behind Italy in terms of the growth of our COVID-19 caseload.

No one can predict how quickly the danger will pass. In China, at the epicenter of the outbreak, where the virus raged out of control for weeks, the government shut down all public life and enforced quarantines beginning almost 2 months ago, and they haven’t let everyone out yet.

President Donald Trump said at a White House news conference that experts have told him the outbreak could last until July or August. That doesn't necessarily mean we'll be in self-quarantine for that long. Trump said they will evaluate whether the social distancing measures need to be extended beyond 15 days at that time.

WebMD Health News Reviewed by Brunilda Nazario, MD on March 16, 2020

Sources

The Journal of the American Medical Association: “Critical Care Utilization for the COVID-19 Outbreak in Lombardy, Italy: Early Experience and Forecast During an Emergency Response.”

World Health Organization: “Situation Report -- 54,” March 14, 2020.

Jeanne Marrazzo, MD, professor of medicine and director, Division of Infectious Diseases, University of Alabama at Birmingham.

NBCBoston.com: “Number of Coronavirus Cases Rises to 138 in Massachusetts.”

The Boston Globe: “A coronavirus cautionary tale from Italy: Don’t do what we did.”

Michael Mina, MD, PhD, assistant professor of epidemiology, Harvard T. H. Chan School of Public Health; core member, Center for Communicable Disease Dynamics. 

Seth Berkley, MD, medical epidemiologist and CEO of Gavi, the Vaccine Alliance.

CDC: “How to prepare,” “How it spreads.”

The Washington Post: “Coronavirus can stay infectious for days on surfaces. But it’s still okay to check your mail.”

The New York Times: “Surgeon General Urges the Public to Stop Buying Face Masks.”

Medium: “Social Distancing: This is Not a Snow Day.”

White House press briefing, March 16, 2020. 

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