DOES SOCIAL DISTANCING ACTUALLY WORK AGAINST COVID-19?
AN EXPERIENCED HEALTH PROFESSIONAL SPEAKS OUT.
We are living in a time of unprecedented violation of the civil liberties that are central to democracy, as governments around the world issue edicts that prescribe who is allowed to attend work or operate their business, where we are allowed to go, how many people we may have in our homes or go outside with, how many times per day we may leave our homes and for what purposes, how far from our homes we are permitted to drive in our own cars, and what we are allowed to do while in public and even private places.
The absurd and egregious abuses of these edicts are too numerous to mention; check the COVID Policing in Australia website if you feel in need of a blood pressure spike.
It amazes me that, as James Corbett points out in his video “How to Practice Proper Social Distancing” (see below), the vast majority of people have incorporated the term “social distancing” and the mantra “flatten the curve” into their everyday lexicon in a matter of a few short weeks.
It’s even more disturbing to me that the public, the media, politicians, public health bureaucrats and medical personnel alike have, almost en masse, accepted the notion that every measure grouped under the rubric ‘social distancing’ is A Good Thing That Everyone Should Be Doing.
But the evidence for most social or physical distancing measures is exceedingly thin, and in some cases, entirely non-existent. Let’s look at each of these measures in turn.
Mass gatherings
Mass gatherings, including music festivals, trade and agricultural fairs, and religious, cultural and sporting events, were some of the earliest casualties of the response to COVID-19.
At this early point, there is insufficient evidence in relation to how mass gatherings impact on COVID-19 infection rates, leaving researchers to extrapolate from studies of other acute respiratory tract infections.
These studies show that:
- Infectious diseases are the most common health threat reported in religious mass gatherings such as the Hajj.
- Infectious disease outbreaks are relatively uncommon during art and music festivals, with only 2 out of 11 studies of such festivals reporting acute infectious illness, one in the Solomon Islands(influenza-likee illness and diarrhoea; no complications or deaths) and one in Serbia (influenza; no complications or deaths).
- Over a 10 year period from 2005-2014, only 72 outbreaks of infectious disease occurred in mass gatherings in the United States; of these, 56% were associated with agriculture fairs in which influenza A H3N2v transmission probably occurred due to exposure to pigs, and 35% were associated with youth summer camps in which people live communally for a week or more at a time.
- There is only a marginal increase in infectious diseases associated with major sporting events such as the Olympics and the soccer World Cup, and most of these infections occur between competitors and staff rather than crowds attending or the wider community.
- Evidence suggests that event duration, crowdedness and venue (outdoor vs indoor) may be the key factors that determine the risk of transmission of influenza and related acute respiratory tract infections; single-day, outdoor events that are not overcrowded are low risk.
In summary,
“The effect of restricting and cancelling mass gatherings and sporting events on respiratory disease rates during pandemics in general is poorly established and requires further assessment. Although limited; the best-available evidence appear to suggest multiple-day events with crowded communal accommodations are most associated with increased risk of transmission of respiratory infections.”
School closures
A systematic review published in Lancet reported that 107 countries had implemented national school closures by March 18, 2020. However, the authors found limited benefits of school closures on slowing the spread of the SARS-CoV-2 virus, largely because in contrast to influenza outbreaks in which children drive transmission of the infection, children do not appear to be a significant vector for spreading the novel coronavirus that causes COVID-19.
In a previous coronavirus pandemic, the SARS outbreak of 2003, data from mainland China, Hong Kong, and Singapore suggest that school transmission played no substantial role in the outbreak, and school closures did not contribute to the control of the epidemic.
At best, school closures might be expected to prevent only 2-4% of deaths from COVID-19 infection.
In summary,
“Currently, the evidence to support national closure of schools to combat COVID-19 is very weak and data from influenza outbreaks suggest that school closures could have relatively small effects on a virus with COVID-19’s high transmissibility and apparent low clinical effect on school children. At the same time, these data also show that school closures can have profound economic and social consequences.”
Workplace/business closures
There is no evidence supporting a beneficial effect of workplace or business closures on infection rates or mortality from COVID-19.
Hendrik Streeck, professor for virology and the director of the Institute of virology and HIV Research at the University Bonn, conducted a forensic examination of SARS-CoV-2 infections in the small German village of Heinsberg, which included taking air samples, smears from doorknobs, cell phones and remote controls, pet fur samples and even toilet water samples from infected homes). Streeck’s team did not find “any live virus on any surface”, leading him to conclude that
“There is no significant risk of catching the disease when you go shopping.”
A review of studies of social distancing measures found weak evidence that workplace changes such as remote working, staggered shifts, and extended holidays, could slow down transmission and delay the epidemic peak of pandemic influenza by a mere 5-8 days.
Simulation studies “predicted that workplace closures would be able to reduce [influenza] transmission somewhat in the community, but probably would have a smaller effect on transmission than school closures.”
In summary,
“We found limited evidence that workplace measures and closures would be effective in reducing influenza transmission… However, workplace measures and closures could have considerable economic consequences, and inclusion in pandemic plans would need careful deliberations over which workplaces might be suitable for application of interventions, whether to compensate employees or companies for any loss in income or productivity, and how to avoid social inequities in lower income workers, including persons working on an ad hoc basis.”
Quarantine
Quarantine refers to restrictions on the movement of people who may have been exposed to a communicable disease, but do not have a confirmed medical diagnosis.
As yet, there is insufficient evidence for the effect on quarantining on the spread of SARS-CoV-2. Sweden, which did not implement quarantine measures, is nonetheless experiencing a rapid decline in new infections, while Italy’s infection rate continued to climb more than a month after it implemented nationwide confinement.
Given that up to four fifths of infected people have no symptoms, identifying the contacts of infected people is an impossibility.
There is weak evidence that home quarantining contacts of people with influenza slows down transmission of the influenza virus, but there is an increased risk of quarantined people becoming ill if they are confined with another person who is already displaying signs of infection.
Perhaps the best case scenario comes from a modelling study applied to Mongolia, in which quarantining 50% of all case contacts of an influenza-infected person for 4 weeks prior to the epidemic peak, reduced the peak case-load by 25% and the attack rate (the number of people who become infected by the virus) by a paltry 1.5%, and delayed the peak of infection by only around 1 week.
Since Australia is well within its capacity for healthcare demand and at least 3 weeks past the peak of infection, quarantining of contacts is unlikely to offer any benefit at this stage.
Case isolation
Case isolation refers to restricting the movement of people who are already ill, preferably at home in the case of mild to moderate illness in order to minimise spread of infection in healthcare settings.
There is significant evidence that case isolation reduces the attack rate of influenza, and some evidence that it delays the peak of the epidemic. However, as with SARS-CoV-2, there is a potentially high proportion of influenza transmission that occurs from mild or asymptomatic infections, which may limit the impact of isolation.
Maintaining a specified distance from other people
There is simply no evidence whatsoever that maintaining a 1.5 metre, 6 feet or any other specified distance between oneself and other people offers any benefit in reducing the transmission of SARS-CoV-2 or preventing illness, because it has never been tested in a real-life setting.
Henrick Streeck has pointed out that the virus is highly unlikely to be transmitted through brief, casual contact: there have been “No proven infections while shopping or at the hairdressers”, and
“Severe outbreaks of the infection were always a result of people being closer together over a longer period of time, for example the après- ski parties in Ischgl, Austria.”
In summary, the evidence base for the social distancing measures that most egregiously infringe civil liberties is either thin or entirely lacking. Case isolation – staying home and minimising contact with others in your household – shows the most benefit, and is simply a common-sense measure that should be employed whenever one is ill with an infectious disease.
Epidemiologist and biostatistician, Knut Wittkowski, has graphed the incidence of SARS-CoV-2 infections country by country, and convincingly demonstrated that extreme social distancing measures, including ‘lockdowns’ (a term drawn, revealingly, from the parlance of prison management), have either had no effect on the spread of SARS-CoV-2 or has had counterproductive effects.
There is no medical justification for the majority of the suite of social distancing measures that have been imposed on people throughout the world, and it’s time for health professionals to point out the lack of evidence for these measures and the tremendous harm that they are inflicting on the health and well-being of billions of people throughout the world, including (but not limited to):
“physical inactivity, weight gain, behavioral addiction disorders, insufficient sunlight exposure and social isolation.”
Important caveat: Elderly and frail people, and those with illnesses that increase the risk of serious complications of COVID-19, including cardiovascular disease, diabetes, high blood pressure, chronic respiratory disease and cancer, should take all possible steps to minimise their exposure to SARS-CoV-2.
Remember, taking good care of your health is even more important than usual due to the high levels of stress generated by the world’s response to COVID-19, and the fact that people with pre-existing chronic disease are at higher risk of serious complications of infection.