On Monday, prime minister Boris Johnson laid out the most far-reaching Covid-19 advice in the UK yet. People with symptoms were to self-isolate for seven days, while households in which one person was showing symptoms were to quarantine themselves for 14 days. Everyone else, he said, was to avoid unnecessary social contact and shun pubs, restaurants and theatres.
But there’s a lot of confusion as to what this actually means, especially with other countries acting differently. Social distancing doesn’t mean you have to lock yourself away completely, and it certainly isn’t the same as quarantine. Neither is it a government-enforced lockdown. The idea is to reduce the amount of contact each person has with others. If an infected person goes to the theatre, they could potentially spread it to many other people in the room. Whereas if the whole country stayed at home then the virus would have less chance to move across the population. Social distancing won’t stop Covid-19 completely, but will mean that not everyone catches it at once.
Reducing the number of people you see every day will reduce the number of people you could potentially spread the virus to. According to research from the World Health Organisation each person with coronavirus will go on to infect between two and two-and-a-half other people on average. Over several generations of infection, that can quickly spill into hundreds and then thousands of cases – as we’ve seen in places like Italy and Iran where the virus has spread at an alarming rate.
The biggest problem is that with such a high infection rate (a person with seasonal flu, for example, tends to infect 1.3 other people) medical facilities won’t be able to cope with the added pressure. Already hospitals have had to cancel non-emergency surgeries to increase capacity to care for Covid-19 patients. If you were to plot the number of new cases every day on a graph, until now the rate has been increasing on a steep exponential curve, with a very high number of people getting sick over a very short period of time. But the government is trying to flatten that curve, with fewer people sick at once and a slower spread. Social distancing in theory should help to do this.
“It’s possible that social distancing and flattening the curve will also reduce the number of people that will become infected,” says David McCoy, professor of global public health at Queen Mary University of London. The theory is that with fewer people infected at one time, it’s less likely that an individual will come into contact with coronavirus.
In order to suppress the growth of the virus, the entire population will need to employ distancing tactics according to research from Imperial College London. However there is a difference between the levels of distancing. Social distancing is the lightest form of isolation – it is simply cutting down on the number of people you see, and avoiding all ‘non-essential’ contact as Johnson has suggested.
Self-isolation is more strict. The government has advised that if you have symptoms of the virus, for example a fever or persistent cough, you should self isolate for seven days, not leaving the house and avoiding all human contact. If a family member or housemate shows symptoms, everyone in the household should self isolate for 14 days. Self-isolation in this way is like quarantine, where you are kept separate from society until it is certain you don’t have the virus.
For more vulnerable people, such as those over 70-years-old or with underlying health conditions, the government has advised more stringent social distancing measures. This isn’t called self-isolating as it is for an indefinite period of time, though they have been advised to avoid all face-to-face contact. This is because older people infected with Covid-19 tend to become more severely ill. In one Chinese study, 14.8 per cent of people over 80 infected with the virus died as a result of it, although this does not take into account those infected with the virus who were not tested for it.
A lockdown, as France and Italy have decided to implement, is a measure beyond simply advising people not to leave the house. The government shuts down travel and stops people from setting foot outside their houses without an essential reason. In Italy for example, residents are expected to carry a form justifying their reason for travel with those in violation facing a €206 (£179) fine or even three months in prison.
However this has its limitations, as shutting yourself away can lead to feelings of isolation and loneliness says Hynek Pikhart, professor of epidemiology at University College London. He notes that if the government recommends more extreme measures of social isolation for longer periods of time, other issues such as cognitive and physical decline or even malnutrition may become problems. Employing a softer strategy where people are encouraged not to gather in large groups, but not forced to be alone will reduce the number of people who are infected while avoiding some of the negative consequences of isolation.
Self isolation is only recommended for people who have shown symptoms and their households. The worry is that if people are advised to cut themselves off from the world too severely, it may reduce cases of Covid-19 in the short term but they will soon tire of it, leading to another boom with more people getting sick.
A report published last month in the scientific journal The Lancet warned about taking away people’s liberty for the wider social good, as the psychological impact of quarantine can be substantial and long-lasting. “The people who make policy in this area live in big houses with gardens,” says Robert Dingwall, a professor at Nottingham Trent University. “It's not like being a single parent in a homeless family accommodation where you're sharing a room with three kids.”
Coronavirus is spread through close contact of up to six feet, through droplets in the air from someone breathing, coughing or sneezing according to the Centres for Disease Control and Prevention. If people are able to work from home, this could also reduce the risk of spread as it takes out contact with not only colleagues but people on public transport. Likewise going to the pub or theatre, where people are stuck in an enclosed space for an extended period of time surrounded by others is probably not a good idea.
Maria Mellor is a writer for WIRED. She tweets from @Maria_mellor
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This article was originally published by WIRED UK
