We can’t live in isolation forever. But we can learn better habits to protect us from disease.
“Social distancing” is a term new to our vocabulary to define the necessary etiquette of public interaction in the days of COVID-19. Crowds of 50, then 10, and, in the case of Germany, more than 2 people in close proximity of one another are discouraged or prohibited to curb the spread of the virus.
As seasonal viral infections go, COVID-19 poses unique challenges. It is more contagious than influenza, has a death rate of more than 10 times that of influenza, and it has the potential to cause adult respiratory distress syndrome (ARDS) which often requires 2-3 weeks of ventilator support for those critically ill with it. Our current attempts to eliminate spread of the virus by encouraging social distancing were never made in the hopes of forcing the disease to die out but, rather, to “flatten the curve”-- that is, to slow the rate of spread so that the number of those becoming ill enough to require intensive care and ventilator support would not suddenly increase to the point of overwhelming our national healthcare infrastructure.
The question is often asked, “When will things return to normal?” Is it normal to return to a point of disregard of possibly contracting a viral illness from someone else with “normal” social interaction? As a practicing internist for more than 30 years, I and most of my colleagues know that the way to keep from catching a virus is to avoid the cough or sneeze of a sick person and, which is more important, cultivate the habit of not touching one’s face (especially the nose) with unwashed hands. My last cold was contracted at a county fair, touching hard surfaces on carnival rides and brushing my nose.
The most common cause of infectious death worldwide is influenza. The Center for Disease Control estimates that between 24,000 and 62,000 Americans have died of influenza this flu season. Eighty percent of those who die from flu failed to receive a flu vaccine which is universally available but received by only 45% of the American public. As of this writing, 2,484 Americans have died of COVID-19. The same principles of preventing the spread of COVID-19 apply to colds and influenza, and that is what concerns me. Are we to defend the “new normal” as an ongoing strategy in recognition of innumerable other contagious viral illnesses to which we are and always will be exposed?
As a physician, I welcome increased public awareness of how viral diseases are spread. Lessons of handwashing and hygiene begin in elementary school. It would behoove anyone to adopt the habits that have protected me quite well over decades of interacting with ill patients. However, being with others will always increase the risk of contracting contagious illnesses. That risk will be greatly reduced by the common hygiene habits that have become the topic of public discourse in recent weeks. Despite those precautions, being in close physical proximity with others will always pose more infectious disease risk than one experiences being alone.
It is not emotionally healthy to be alone for long periods of time. This temporary halt on social interaction is logical and necessary, but it will be just as necessary for mental and, indeed, our physical health to return to encouraging togetherness when the current crisis subsides. An alarming trend toward social distancing has been underway as noted by traditional parents watching their children’s prolific use of texting and internet to communicate with others. Tech savvy young people take fewer opportunities to learn the subtleties of body language and facial expression so essential for fully effective communication and to build healthy relationships.
It is no surprise that humans carry diseases that can be spread to others by careless or, simply, normal social interaction. Customs of handshaking, hugging, and even kissing as a form of greeting are deeply ingrained in the world’s cultures. Religious congregations are essential to the world’s faith traditions. The Bible admonishes Christians “not to neglect meeting together”, and Islam encourages followers to “gather together to read the Quran”.
While the medical establishment hopes that lessons have been learned about how to greatly reduce one’s risk of acquiring a viral infection, the current extremes which we are forced to implement should not become the norm after COVID-19. Life, as with love, is messy and involves risk. We need each other and, without others, it is not worth living.
James L. Borders, M.D., F.A.C.P. is the Vice President and Chief Medical Officer of Baptist Health Lexington.