Boston became a ghost town this week following Governor Baker’s order to close schools, restaurants, bars and gatherings of 25 or more. Beloved local small businesses such as Brookline Booksmith closed proactively in order to halt the spread of COVID-19. Similar polices, based on the recommendations of infectious disease experts such as Marc Lipsitch and our other colleagues are being implemented across the country. We, as faculty at the Harvard T.H. Chan School of Public Health, support these policies. However, we are asking everyone to stop using the term “social distancing” and replace it with the more accurate “physical distancing.” To defeat COVID-19, we need physical distance and social solidarity. Social connection is critical to defeat COVID-19 and, as importantly, mitigate the downstream adverse consequences of infection control measures.
The concept of social distancing goes back to Biblical times, as a response to control the spread of leprosy: “All the days wherein the plague shall be in him he shall be defiled; he is unclean: he shall dwell alone; without the camp shall his habitation be.” (Leviticus 13:46, King James Version). The practice of minimizing individual and community interactions to decrease the spread of infectious diseases was notably exercised in the early 1900s to combat the 1918 Spanish flu pandemic. Over time, the term “social distancing” was coined as a reference to several non-pharmaceutical interventions such as cancellations of mass gatherings and school closures that are now recommended by public health agencies in the event of a pandemic.
Prior to the internet era, the mass adoption of smart phones, and social media, the term “social distancing” made sense. Social interaction was almost perfectly synonymous with physical interaction. Yes, we had the landline telephone, but our relationship-building was primarily achieved through face-to-face interactions with people.
The digital age has brought a lot of virtual opportunities to build and sustain social networks. Relationships are often created, reinforced, rekindled, and sometimes terminated on hand-held devices or from a computer screen. Conversations are held via SMS, WhatsApp, Facebook, or Twitter among friends all over the country and world. From this shift in ways of interacting, we have effectively dissociated the social versus physical space.
The use of “social distancing” as a way to create physical space is a mistake and needs revision. In the context of a pandemic, we need to strengthen social connection as we shrink our usual physical interactions through school, office, and store closures. We fear that this misnomer may cause dissonance or misunderstanding, making people feel compelled to be isolated, when in fact there are opportunities now more than ever to connect socially without being physical.
The negative health effects of social isolation, while not as immediate as those of viral infection, are great. Social connection is not a luxury, but a critical foundation of our well being. Evidence that affiliation is a basic human need has transformed medical practice in the last generation. The standard of care is for infants to receive skin-to-skin contact with the mother after birth rather than being whisked away to the newborn nursery. At older ages, loneliness increases risk of mortality. However, unlike COVID-19, which has differential effects by age, social isolation’s effects are pronounced over the entire life course. A longitudinal study of over 200 young adults in the U.K. found that “Lonelier young adults were more likely to experience mental health problems, to engage in physical health risk behaviours, and to use more negative strategies to cope with stress.” Ending loneliness has been declared a public health priority.
We all know we need to stay socially connected in this time of physical distancing. From using neighborhood email list serves to schedule virtual coffees, to pop-up live stream yoga classes, to everyone’s attempts to continue life as normal via Zoom, examples abound of members of our community striving to maintain relationships. However, without a broader recognition of the necessity of social connection we are at risk of increasing health disparities. 25% of Americans do not have home computers and 19% percent do not have smart phones.
The risk of increasing disparities due to differential access to technology has long been recognized. But COVID-19 has brought this into sharp focus. School closures and the move to online learning have motivated school boards to evaluate the needs for home computers in their districts, accelerating plans to distribute google chrome books to every child who does not have one at home. But much more is needed to insure that every American can satisfy their fundamental human need to connect.
As more area lawmakers call on Governor Baker to implement a shelter in place order, let this be our rallying cry: #Physical distance and #social solidarity! In every crisis there is opportunity. We will beat COVID-19. This global pandemic also offers us, as individuals and as a society, a chance to increase social connection and improve the public health for decades to come.