Don’t Stand So Close to Me

March 19, 2020|11:00 a.m.| Marcus Plescia MD, MPH | ASTHO Chief Medical Officer

Marcus PlesciaThe refrain from the popular Police song “Don’t Stand So Close to Me” takes on new meaning in the current era of COVID-19 infection and control. We also know there are three actions we can all take to control the spread of the virus and reduce the risk of infection nationwide:

  • Isolate: Ask individuals who are ill to stay home.
  • Quarantine: Protect those who are most likely to experience severe illness from infection by asking them to reduce their exposure by staying indoors altogether.
  • Social distance: Slow the spread of infection (coughing, sneezing, touching) in the general population by limiting our physical contact with others.

Staying Home When Sick or Having Been in Contact with COVID-19 Positive Individuals
We should all stay home when sick. That’s important for our own health and recovery but also important to the health of others who may be at risk of infection when in contact with sick people. Ideally an accurate, widely available diagnostic test would be used by public health professionals to identify individuals infected with coronavirus and recommend that they stay home to avoid transmitting the virus to others.

When testing is not widely available, however, people who are sick should stay home until they can be tested. That is what we need to focus on now. Individuals who are sick should stay at home until they recover, or test negative for COVID-19. This also goes for individuals in close contact with COVID-19 positive people. Staying at home can and should be a public expectation or social norm. Employers can support this behavior by providing compensation for people when they stay home when sick (paid sick leave) and we can all support this behavior by reminding colleagues to stay at home if they are not feeling well.

Protect Those Who Are Most At Risk
Viral infections are most rapidly contained when there is a vaccine or treatment. Without either, the disease continues to spread until the most people have been infected and build a natural immunity. While it spreads, some populations will become severely ill and need medical care, and some will die from the infection or its complications. Early research in China shows that most people infected with COVID-19 will experience a mild illness, but about 15 to 20 percent will develop more severe symptoms and require medical care—and some will need intensive care for breathing support. People 60 years or older and/or those with underlying medical conditions or other chronic diseases are most likely to become severely ill from COVID-19. That is why we need to do everything we can to keep older people from becoming infected. Older Americans should stay at home and practice other social distancing techniques to reduce potential exposure. Nursing homes and assisted living settings can restrict visitors so residents are less likely to encounter the virus, a practice becoming more common nationwide in response to COVID-19.

Slowing the Spread of the Virus
The United States has one of the most advanced and sophisticated systems in the world to care for people who are severely ill. However, our health care system will not be able keep up if a large number of severe cases occur rapidly. The best way to handle this is to slow the rate of infection down. To do this, folks should stay at least six feet away from each other. When we stay at least six feet away from each other, people are less likely to get infected since the virus is passed from a cough, sneeze, or touching an infected surface. While we can’t completely isolate ourselves from each other—we all need basic supplies like food, to take care of each other, and to maintain law and order—but we can limit our contact with others and use protective behaviors when we have to be together. Studies have shown that keeping a distance of at least six feet from other people in social situations prevents the spread of respiratory germs.

Prohibitions on Mass Gatherings
To maintain the six feet rule, officials are now taking action to limit large groups. These approaches include encouraging or mandating teleworking, limiting social gatherings and events—movies, concerts, restaurants, and bars—avoiding the use of mass transit, and closing schools. These interventions are very disruptive to our daily lives and the economy, but they do work. We have used them in prior infectious disease outbreaks, and we are seeing them implemented around the world now for COVID-19. By limiting our interactions with each other, we slow down the spread of infection so that health care and other vital functions of our society do not get overwhelmed.

It is not easy, but we will get through the COVID outbreak if everybody does their part to prevent infections. We do not all have to be couch potatoes or stay inside on a beautiful spring day. We can exercise outside and perform necessary tasks—like grocery shopping—if you keep a healthy distance from other people. You also do not have to be alone—you can keep in touch with other people through telephone, social media, or even talking from a distance. Videos of people in China and Italy singing to each other across empty streets may be some of the most lasting images of this pandemic when it ends.

Remember:

  • Stay home if you are sick, regardless of your illness, unless you need medical care
  • Stay home if you are at risk of severe COVID-19 illness (if you are over 60 and/or have a medical condition that would be made worse by COVID infection)
  • Stay at least six feet away from other people (a healthy distance)
  • Stay informed on what local, state, and federal health officials recommend for you and your family to help prevent illness and promote health.