Why Social Distancing Doesn’t Seem to be Working

Short answer: it is.

On Monday, March 23, 2020, President Trump tweeted:

The tweet appeared to indicate impatience with the effectiveness of social distancing. The President elaborated in his press conference that he was eager to see Americans get back to work, and was looking into ways to make that happen immediately after the 15 days of social distancing. His message contradicted nearly every medical expert in the country, many of whom believe that we may need to continue this for 8 weeks or even longer.

Because hundreds of thousands of people apparently agreed with the President’s tweet, it seems important to explain why our “new normal” of self-isolation is unlikely to show any noticeable effect during the rest of March, and why, as we watch the numbers go up dramatically and hear more and more tragic stories of hospital workers pushed beyond their limits, social distancing is nonetheless working and essential.

To understand this, we need to understand how this virus works. The current medical thinking is that coronavirus is spread by touching infected surfaces and then touching the mouth, eyes or nose. However, it is also spread by breathing exhaled microdroplets from an infected person. That is why it is so important to keep a distance of 6′ from others and assume that anyone could be infected.

Coronavirus has a median incubation period (you’ve caught it, show no symptoms, and are contagious) of 5.1 days. Some cases have a longer incubation period – up to 15.6 days. During that time, it is estimated that an infected person will spread the virus to 2-3 people. During their incubation periods, those people will also spread the virus to 2-3 people, and so on. Once each person begins to show symptoms, they will not immediately be added to the government statistics of “confirmed cases.” Most will wait for several days trying to decide if it is worth getting tested, especially given the limited number of tests that we have available in the United States. Those who get tested will likely have a 2-3 day wait before their test results come in, at which point, they will be added to the government statistics if they are infected.

This delay in data is why the President’s main adviser on this pandemic, Dr. Fauci, says that “if you think you’re in line with the outbreak, you’re already 3 weeks behind.” The effects of our lax attitude toward the virus will still be with us in 2-3 weeks, and similarly the effects of our actions to contain the virus will only begin to show up in 2 weeks at the earliest.

On March 16, the President released his plan for “15 Days to Slow the Spread.” While the plan is far less strict than it needs to be, it is America’s first real effort to contain the spread of the virus. Its effects will likely not become visible until April. In the meantime, the graph below shows what the rest of March is likely to look like in America, based on a spread rate of 32% per day, 20% of cases requiring hospitalization, a 35% increase in deaths per day, and 45,000 ventilators nationwide.

This is possibly the worst situation for America to have an impulsive President whose life experience has been guided by easy solutions and instant gratification, and whose closest aides charitably describe his personality as “childlike.” The consequences of ending social distancing early would be severe and crippling for our country. Hopefully our governors will have more sense than the President and will increase, rather than decrease, measures to contain the spread.

There is good news and bad news for April if social distancing remains in effect. The good news is that the rate of spread will likely begin to slow in early April. Italy has finally had its first day of single-digit increases in the number of people needing hospitalization.

The bad news is that America’s hospital system will have already become overwhelmed by then. Particularly critical in this dynamic is the shortage of N95 masks that our hospital workers have experienced thus far. Nurses have been told to reuse masks, create their own masks, use bandanas, etc. As a result, they have been inadequately protected from the virus, and while masks finally seem to have begun to be made available, it may be too late for some of our nurses. This means that not only is their own health now at risk, but also that these nurses will be unable to continue working as they recover or need treatment themselves – all at a time when our hospitals are being pushed beyond their capacity.

The best thing that Americans can do to limit the spread of this virus and eventually get it under control is to continue social distancing measures and ideally to take precautions that are one or two steps more extreme than we think are reasonable at the moment.

We should also note that as China began practicing social distancing, they saw the virus begin to take hold in family clusters. If one person in the family had become infected before their confinement or while out getting supplies, they would spread the virus to other family members. If someone in the home shows symptoms (fever, dry cough), they need to be isolated in a room away from other family members, one family member needs to be assigned to care for them, and that caregiver needs to have limited exposure, wear whatever protective gear that they can when providing care, and take measures to sanitize themselves and exposed objects immediately after each incident of providing care.

China’s eventual solution involved many extreme steps, including taking people’s temperature at the entrances to public places like grocery stores, isolating the infected in stadiums and sectioned-off hospital wings until they recovered or died, and other steps that were even more severe. For our President to look at that and think that America’s trajectory will magically be different from China or Italy if we end social distancing after 15 days and “get back to work” is folly. If the projection above is accurate, by March 26, America will have far surpassed the total number of cases that China has had during the entire outbreak.

– rob rünt