Social distancing for covid-19: is 2 metres far enough?
BMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m2010 (Published 21 May 2020) Cite this as: BMJ 2020;369:m2010
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There is much we continue to learn about SARS-CoV-2 and policies and guidelines around personal protective equipment (PPE) for COVID-19 continue to be rewritten with new information. Endless amounts of data continue to be generated on the infectivity, incubation period and virulence of the virus but the variability of its clinical impact across varying demographics and global communities confirms that there is much we still don’t know.
Scientific analysis on the distance that respirable particles can travel and duration of viral viability on inert surfaces offers insights into the potential for SARS-CoV-2 to infect others. In real life, however, infection and case fatality rates are dependent on multiple other variables including community prevalence and transmission, individual susceptibility, lifestyle and cultural factors and duration of exposure (1).
Social distancing measures have been exceptionally effective in flattening the curve and controlling the spread of COVID-19 infection in many countries (2). These measures have been adopted not in isolation but rather as part of wider community based practices including restricted movement, respiratory etiquette, hand hygiene and contact tracing. Other positive effects of these measures that have already benefitted populations from a public health perspective have included reported reductions in respiratory infective diseases such as influenza and bronchiolitis in children. Social distancing does however carry potential risks for worsening loneliness and mental health issues and widening the gulf of socioeconomic disparities (2).
Within our healthcare organisation a conscious and whole of organisation approach to social isolation was readily adopted and resulted in a positive sense of wellbeing in staff. The expanded utilisation of technological aids and enhancements to flexible work arrangements have assisted many workplaces, including ours to have greater agility in exercising and promoting social distancing measures.
A practical and pragmatic approach to changing public behaviour with regard to social distancing is what the world needs- now and into the future. It is no longer a question whether another pandemic will happen but rather when - and with embedded social distancing principles, we shall be better prepared.
References:
1.Stein RA. COVID-19 and rationally layered social distancing [published online ahead of print, 2020 Mar 14]. Int J Clin Pract. 2020;e13501. doi:10.1111/ijcp.13501
2.Lewnard JA, Lo NC. Scientific and ethical basis for social-distancing interventions against COVID-19 [published online ahead of print, 2020 Mar 23]. Lancet Infect Dis. 2020;S1473-3099(20)30190-0. doi:10.1016/S1473-3099(20)30190-0
Competing interests: No competing interests
Dear Editor
I understand the research on distance travelled by particles when breathing or smoking. There is though another important factor, that is of infectious dose. There is no evidence that the Sars-Cov-2 virus is at a high enough dose to be considered infective at that distance or further. Even if particles are found further, in what quantity, density are they travelling?
Regards
Kavita Kothari MPH
Competing interests: No competing interests
COVID-19 Pandemic and social distancing: more work in the works to be there
The ‘COVID-19 Pandemic’ increasingly poses a ‘Difficult Nut to Crack’ with the ‘Rapidly Transmuting Specifics and Programmatic Challenges’ by the day. We seem to be enmeshed and working in a ‘Cul-de-Sac’ in the ‘Global Fight’ against the ‘Unprecedented Unbelievably Impossible 21st Century Scourge’! A Failure to ‘Weather the Storm’ [1] is not an option and, therefore, the ‘Global Fight’ MUST continue even as a ‘Difficult Work in Progress’! Previous ‘Communications’ have exposed the ‘Interventional Inequity’, intertwined with the amplification of the ‘Inverse Equity Hypothesis’ inherent in the ‘Global Fight’ against the ‘COVID-19 Pandemic’, which increasingly portends that, ‘Victory if actually Feasible’, is increasingly ‘Further down the Road’ [2,3]!! The ‘COVID-19 Pandemic Interventions’ that are proven to be effective are the ‘Non-Pharmaceutical Interventions (NPIs)’: Social Distancing, Social Solidarity, Self-Isolation, Mass Gatherings Restrictions, Schools Shutdown, Public Worship Prohibition, Economic Shutdown, Travel Lockdown, Country Shutdown etc. Others are the Global Universal and Specific Precautionary Measures which include, among others: Appropriate Hand-washing Techniques/ Hand Hygiene/ Proper Hand Sanitizer Use, Avoiding and Frequently Cleaning Surfaces that are Frequently Touched, Avoiding Touching Eyes, Nose and Mouth and Good Respiratory Hygiene! The ‘Programmatic Difficulty’ in the ‘Global Fight’ against the ‘Pandemic’ is the fact that the NPIs are very ‘Poorly Researched’ to shore up ‘Evidence-based Data’ to drive their implementation with convincing disposition, confidence, Populace Compliance and the desired success [3-5]! Worse still, there is unacceptable programmatically comparatively unproductive ‘Disproportionate Research Funding’ of the ‘COVID-19 Pandemic Interventions’ with ‘Questionable Effect’: Anti-COVID-19 Drugs (Hydroxychloroquine, Azithromicin, Zinc, Selenium, Vitamin D etc), Antibodies Formulations and Clinical Trials, Immunomodulators in Clinical Trials, Candidate Vaccines/ Vaccines in Clinical Trials, Emergency Critical Care Facilities etc! Still further worsening the ‘Difficult Programmatic Picture’ is the ‘Waste in COVID-19 Research’ [3-5]!!
For ‘Programmatic Operational Expedience’ and ‘COVID-19 Pandemic Interventions Conversation’, we could conjecture ‘Implementation Dyadic Intertwining’ between ‘Face Masks Use’ and ‘Social Distancing’. There are ‘Communications’ distilling and dissecting the ‘Contextual Conversational Issues’ with ‘Face Masks Use’ in the ‘Global Fight’ against ‘COVID-19 Pandemic’ [6-11]! It is feared that ‘Face Masks Use’ gives a ‘Programmatically Dangerous False Security’ in the protection against ‘Transmitting’ or ‘Contracting’ the ‘Coronavirus (SARS-CoV-2)’ and the ‘Coronavirus Disease (COVID-19)’ [12]!! While there is the worrisome lack of a bountiful harvest of ‘Evidence-based Research Data’ on ‘Face Masks Use’, ‘Rational Programmatic Recommendations’ have been proffered for ‘Practicality Expedience’ [8,13]!! With the ‘Inappropriate Population Masks Use-induced Security’, the compliance with ‘Prescribed Social Distancing’ is irresponsibly and arrogantly vacated!!! The ‘Programmatic Dyadic Intertwining’ of ‘Face Masks Use’ and ‘Social Distancing’ assures a reasonable protection against ‘Contracting’ and ‘Transmitting’ the ‘COVID-19 Pandemic’. With ‘Lockdown-Shutdown’/ ‘Shelter-in-Place’, the ‘Dyadic Twinning’ of ‘Face Masks Use’ and ‘Social Distancing’ is a ‘Sine Qua Non’ for anyone stepping out and away from their homes!! It is irrational to rely on ONLY one of the ‘Twin Interventions’!! There are worrisome unsettled and rattling ‘Issues’ with ‘Social Distancing’!!!
The ‘Optimal Distance’ for ‘Programmatically Effective Social Distancing’ in the ‘Global Fight’ against ‘COVID-19 Pandemic’ remains ‘Information in a Flux’! The distance travelled by ‘Droplets (Large and Small)’ from ‘Human Exhalation’ in ‘Quiet and Forceful Circumstances’ have been investigated and reported [14,15]! It is reported the ‘Small and Large Droplets’ from ‘Quiet Exhalation’/ ‘Short Small Breaths’ travel much more than 1 meter while, with ‘Forceful Exhalation’/ ‘More Energetic Breaths’, the ‘Larger Volumes with More Droplet Loads/ Burden’ travel much more than 2 meters [14]!! Clearly, the prescribed ‘1 meter Separation’ is ineffective in preventing ‘Transmitting’ or ‘Contracting’ the ‘COVID-19’ and the ‘2 meters Rule’ is also definitely not appropriate for protecting against ‘Transmitting’ or ‘Contracting’ the disease. Recall that ‘Aerosolization/ Aerosols’ and ‘Airborne Transmission’ has been a ‘Controversial Conversation’ in the ‘COVID-19 Pandemic’ and remains an ‘Unresolved Issue’ [6]! In spite of this, ‘Airborne Outdoor Tobacco Smoke’ has been rigorously investigated ‘Standing Proxy’ for ‘Small Droplets (Possible Aerosols) Transmission’ [16,17]! The ‘Exhaled Outdoor Tobacco Smoke’ has been detected as far away as 9 meters from the ‘Smoke Source’ and several Countries now have ‘Legislations against Tobacco Smoking in Public’ prescribing and enforcing mandatory ‘2 to 10 meters Social Distancing’! It is increasingly becoming incontrovertible that the ‘Prescribed 2 meters Social Distancing’ is ‘Programmatically Operationally Ineffective’ and coupled with the ‘False Face Masks Use-induced Security’ courts undesired and undeserved avoidable cataclysm!! This is even more so with Countries ‘Reopening their Economies and ALL Human Enterprises from Complete Lockdowns’. Worse still are those Countries ‘Reopening from Lockdowns’ while still on the ‘Ascending Limb’ of their ‘COVID-19 Epidemic Curves’!! We MUST avoid the ‘Politics’ of the ‘COVID-19 Pandemic’ and kowtow to the Science, Facts and Best Available Research Evidence undergirding the ‘Totality of the Pandemic’ [18]!! The delicate ‘Optimal Balance’ MUST be achieved at ALL times between ‘Livelihood and Life’ and ‘Making a Living and Living’ in the ‘Socio-Political Rush and Enormous Pressure’ to ‘Reopen the Economy”!!! We MUST stoutly AVOID ‘COVID-19 Infodemic’ concerning ‘Social Distancing’ to assure ‘SURGES’ and ‘RESURGENCES’ are not allowed to sprout as ‘Unfettered Realities’ during the ‘Reopening of Economies’ from ‘Complete Country Lockdowns’!!!
This ‘Communication’ is an ‘Add On’ to the ‘Raging Conversation’ on ‘Face Masks Use’ and ‘Social Distancing’! In the ‘Global Fight’ against the ‘COVID-19 Pandemic’, neither ‘Non-Pharmaceutical Intervention (NPI)’singly is ADEQUATE as a SOLITARY Intervention as neither also has ‘Proven Effectiveness’ beyond all reasonable ‘Scientific Doubt’!! Ipso facto, the ‘Dyadic Programmatic Operational Intertwining’ of ‘Face Masks Use’ and ‘Appropriate Social Distancing’ is a ‘Sine Qua Non’ for Success against the ‘COVID-19 Pandemic’ and Victory for ‘Our Common Humanity’!!! The current ‘Prescribed 2 meters Social Distancing’ is ‘Programmatically Inappropriate’ and, therefore, remains ‘Work in Progress’ with certainly significantly ‘More Work in the Works’ to be at the ‘Globally desired Terminus’ for the ‘COVID-19 Pandemic’!!!
REFERENCES
1. Godlee F. COVID-19: Weathering the storm. BMJ 2020; 368:m1199 of 26th March 202
2. Eregie C.O. Obesity as a Public Health Emergency: A look at the ‘Pre-FOAD Hypothesis’ as a Panacea for the ‘Interventional Inequity. https://www.bmj.com/content/366/bmj.l5463/rr-0 of 4th October 2019
3. Eregie CO. COVID-19 Pandemic: The multifaceted picture of compromised COVID-19 research and the COVID Phenomenon’. https://www.bmj.com/content/369/bmj.m1847/rr-12 of 10th June 2020
4. Trials Clinical Trials.gov. History of changes for study. NCT04280705, 1 May 2020. https://clinicaltrials.gov/ct2/history/NCT04280705?A=10&B=15&C=Side-by-S....
5. Glasziou PP, Sanders S, Hoffmann T. Waste in covid-19 research. BMJ 2020; 369:m1847
6. Wetsman N. CDC recommends people wear cloth masks to block the spread of COVID-19. The Verge of 3rd April 2020
7. Krstic Z. Coronavirus and Face Masks: Everything You Need to Know This Summer. https://www.goodhousekeeping.com/health/a32703820/coronavirus-face-mask-... of 10th June 2020
8. Association of Schools of Public Health in the European Region. Strategic use of masks as an element of non-pharmaceutical measures set for a pandemic. 24 Apr 2020. https://www.aspher.org/download/412/strategic_use_of_masks_as_an_element...
9. Centers for Disease Control and Prevention. Use of cloth face coverings to help slow the spread of covid-19. https://cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/diy-cloth-fac...
10. Nuki P. Face masks: have we been asking the wrong questions all along? Daily Telegraph 2020 Apr 16. https://www.telegraph.co.uk/global-health/science-and-disease/face-masks...
11. Eregie C.O. COVID-19 Pandemic and face mask use: Limitless matters for extant conversation. https://www.bmj.com/content/369/bmj.m2030/rr-0 of 11th June 2020
12. Javid B, Weeks MP, Matheson NJ. Covid-19: should the public wear face masks? BMJ 2020; 369:m1442
13. Greenhalgh T, Schmidt MB, Czypionka T, Bassler D,Gruer L. Face masks for the public during the covid-19 crisis. BMJ 2020; 369:m1435
14. Denison D, Porter A, Mills M, Schroter RC. Forensic implications of respiratory derived blood spatter distributions. Forensic Sci Int 2011; 204:144-55
15. Schroter RC. Social distancing for covid-19: is 2 meters far enough? BMJ 2020; 369:m2010
16. Kaufman P, Griffin K, Cohen J, Perkins N, Ferrence R. Smoking in urban outdoor public places: behavior, experiences and implications for public health. Health Place 2010; 16:961-8
17. Hwang J, Lee K. Determination of outdoor tobacco smoke exposure by distance from a smoking source. Nicotine Tob Res 2014; 16:478-84
18. Eregie C.O. COVID-19 Pandemic, ‘COVID Phenomenon’ and the politics of the science, facts, research evidence and ‘evidence-based medicine (EBM): the imperative for rekindling the ‘multiparameter-based medicine (MBM) in the 21st Century. https://www.bmj.com/content/369/bmj.m1336/rr-20 of 17th April 2020
Professor Charles Osayande Eregie,
MBBS, FWACP, FMCPaed, FRCPCH (UK), Cert. ORT (Oxford), MSc (Religious Education),
Professor of Child Health and Neonatology, University of Benin, Benin City, Nigeria.
Consultant Paediatrician and Neonatologist, University of Benin Teaching Hospital, Benin City, Nigeria.
UNICEF-Trained BFHI Master Trainer,
ICDC-Trained in Code Implementation,
*Technical Expert/ Consultant on the FMOH-UNICEF-NAFDAC Code Implementation Project in Nigeria.
*No Competing Interests.
Competing interests: No competing interests