Column: The importance of social distancing during COVID-19

If social distancing and home quarantine are practiced during the COVID-19 health crisis, the number of people needing critical care will decrease significantly. And there are ways for improving behavioral and mental health as we all cope.


This column is first in a series on the COVID-19 health crisis written by expert faculty and staff at UH Hilo.


Bryan Kim
Bryan Kim

By Bryan S. K. Kim, PhD
Professor of Psychology
University of Hawai‘i at Hilo

This is a time of high stress, anxiety, and helplessness. With the rapid spread of the novel coronavirus, the virus that causes COVID-19 illness, government leaders and health experts around the world are scrambling to contain the virus and keep people safe. In the United States, we also are in the midst of this scramble, as the number of positive tests has increased exponentially in some communities and the rate of deaths in these communities has rapidly climbed, particularly among people who are 70 years of age or older, have existing medical vulnerabilities, or both.

Several states, including California, New York, and Illinois, have instituted mandatory lockdowns, which means that residents are not allowed to leave their homes for any social-gathering reasons. In Hawai‘i, similar measures are being discussed by government leaders and health experts and recently mandated a 14-day quarantine for visitors and returning residents. Also, these leaders and experts have asked all of the residents to keep at least 6 feet away from each other (so called “social distancing”), and for people showing symptoms of respiratory illness, asked them to quarantine at home (of course, a person with symptoms should always consult with their medical professional first). Henceforth in this column, I will include the word “physical” to “social distancing” to emphasize that social (physical) distancing does not mean being socially distant but rather that it means being physically distant.

As these extraordinary measures are being taken, one cannot help but be stunned at the dramatic changes and what these changes mean for our near future and beyond. This sense of unknowing and fear can lead to a high level of anxiety and even panic, as we have witnessed with some people hoarding food and supplies in our stores. The anxiety also is fueled by a sense of helplessness of not knowing what to do.

In this article, my aim is to explain the scientific reasons for social (physical) distancing and home quarantine and offer recommendations of things you can do to cope and perhaps even thrive in this challenging time.

The importance of social distancing and home quarantine

First, let me explain the reasons for the recommendation for social (physical) distancing and home quarantine. When the coronavirus first emerged, health experts were stunned at how quickly it spread and began trying to understand the nature of the virus and the ways to slow down its spread. One team of researchers, the London’s Imperial College COVID-19 Response Team, issued a report on March 16, 2020, titled, “Impact of Non-pharmaceutical Interventions (NPIs) to Reduce COVID-19 Mortality and Healthcare Demand.” This report was authored by the team’s 31 scientists who used advanced statistical modeling and forecasting to examine the various outcomes of the disease’s spread when different behavioral interventions such as social (physical) distancing and home quarantine are implemented. It is important to note that currently there is no medical treatment for COVID-19 and only various behavioral practices have been observed to stop the spread of the virus.

In arriving at the results of this statistical simulation study, the team used several assumptions about the community. The closer a community is to these assumptions, more accurate the findings would be.

Here were the assumptions:

  1. Individuals reside in areas with greater population density.
  2. Transmission of the virus occurs in homes, work sites, schools, or community.
  3. People with symptoms are 50% more infectious than individuals without symptoms.
  4. People who recovered from COVID-19 are considered to be immune in the short-term and thus cannot infect others.

The researchers considered five behavioral interventions:

  1. Isolation of persons with symptoms at home (with 70% compliance rate).
  2. When a household member develops symptoms, all members of the home are quarantined at home for 14 days (with 50% compliance rate).
  3. Social (physical) distancing of people over 70-years-old (with 75% compliance rate).
  4. Social (physical) distancing by everyone (with 75% compliance by households).
  5. Closure of K-12 schools and universities (75% of universities comply).

The results are quite jarring. First of all, if none of the behavioral interventions are implemented, 81% of the population in the United States would be infected by the virus and there would be 2.2 million deaths in the country in the course of the epidemic. Also, at the disease’s peak, the need for critical care bed would be nearly 280 beds for every 100,000 people in the population; currently there are about 10 critical care beds for every 100,000 people in the population. Yes, these are very terrible numbers.

But there is hope.

Behavioral interventions

If the behavioral interventions are used, the results suggest that the number of people needing critical care will decrease significantly. For example, the number of critical care beds would go down from 280 beds to 90 beds per 100,000 people. Each of the behavioral interventions by itself has a positive effect but the best scenario seems to be the combination of using:

  1. General social (physical) distancing (particularly with those who are over 70-years-old).
  2. Isolation at home for the person with symptoms.
  3. Quarantining of the entire household when a household member has symptoms.
Chart showing success rates when behavioral interventions are done: Big difference between communities doing nothing, and communities practicing case isolation, household quarantine, closing schools and universities, and social distancing.
Mitigation strategy scenarios for GB showing critical care (ICU) bed requirements. The black line shows the unmitigated epidemic. The green line shows a mitigation strategy incorporating closure of schools and universities; orange line shows case isolation; yellow line shows case isolation and household quarantine; and the blue line shows case isolation, home quarantine and social distancing of those aged over 70. The blue shading shows the 3-month period in which these interventions are assumed to remain in place. Chart is from the Imperial College COVID-19 Response Team study cited above in this column.

Hence, the bottom line is that we need to use social (physical) distancing, people who have symptoms need to stay home, and all household members with a symptomatic member need to stay home, too. If you do not practice these behaviors, you may pass the virus onto others even without having symptoms. If those others are elderly, people with medical vulnerabilities, or both, that could kill them. We must do all we can to protect oneself and therefore protect others. In the study I described above, the researchers did not assume anywhere near a 100% compliance for each of the behavioral interventions thus projecting the continuation of the pandemic and continued death, although the peak effects would be lowered. This, however, suggests that if the percentage rates of compliance are increased by all of us, perhaps nearing 100%, we can really beat the virus and help to avoid terrible and tragic results.

I hope that what I have explained thus far shows the importance of keeping physically distant from each other, especially when we have symptoms of respiratory infection.

What follows are 10 suggestions for improving our behavioral and mental health as we all cope with the current situation. These action-oriented strategies also are intended to give you an increased sense of control that can be an effective antidote to anxiety and related emotional difficulties while keeping yourself and others safe during this time of crisis.

Top 10 To Do List

Here are 10 suggestions for improving behavioral and mental health as we all cope with the coronavirus crisis.

#1 Practice social (physical) distancing with aloha

  • In Hawai‘i, we are not accustomed to keeping away from people we know. When we see a familiar person in public, we typically give a hug and stay to chat for a while. Therefore, social (physical) distancing will not come naturally for us and may even be difficult for many of us. My suggestion to overcome this hurdle is to mention social (physical) distancing when you see a familiar person. For example, you can say something as simple as “Aloha Aunty! Sorry, I’m practicing social (physical) distancing. How are you doing?…” This will let the other person know that you care about their health.

#2 Wash your hands often and keep clean the often-touched surfaces

  • Health experts have repeatedly emphasized the importance of people washing their hands often and keeping clean the surfaces that are often touched (e.g., door handles, tables, chairs, smart phones, laptops) in order to keep the virus from being transferred to other people. Wash your hands with soap for at least 20 seconds and wipe surfaces often with appropriate cleaning tools.

#3 Social (physical) distancing does not mean emotional distancing

  • It is okay for one to be practicing social (physical) distancing but maintain emotional closeness in the public. Social (physical) distancing does not mean you cannot stay for a chat with a friend and relatives. Just keep 6 feet away from each other.

#4 Care for our kupuna

  • At this time of social (physical) distancing and quarantining, our kupuna are most vulnerable for experiencing a sense of isolation and loneliness. Reach out to them via a phone or perhaps even video-chat with them and see how they are doing and if they need anything.

#5 Care for our young ones

  • Children can see that our world has changed. It is important to explain to them honestly and in ways they understand the reasons for these changes and reassure them that we will be okay. At times of difficulty, children look to adults for a sense of protection and safety. We must provide this important psychological need to them. Talk to your young ones and assure them that we are doing things to help all of us and as long as we keep doing them, we will be okay.

#6 Reach out to others for support

  • In this time of turmoil and social (physical) distancing it’s easy for people to feel isolated. Reach out to others through the use of video-communication platforms such as Skype, Facetime, Google Meet, and Zoom. Perhaps even plan a social gathering among family and friends over videoconferencing. This is especially helpful if you need to express your thoughts and feelings about what is going on. Communicating to trusted others about what you are experiencing inside can be incredibly therapeutic.

#7 Obtain accurate information, limit the amount of stressful information, and stay away from the real fake news

  • In these rapidly changing times, we seek information to gain a better sense of control. However, some of the news you hear may be even more distressing, especially if they are not true. Even if the news is true, too much negative news will increase your anxiety. Identify news sources that you know are valid and credible and set a limit as to the amount of negative news you view, especially if the news sources are repeating the same information. Seeking out positive news, such as neighbors supporting neighbors, can be helpful.

#8 Exercise is therapeutic and physical care is important

  • It is not easy to stay home for a lengthy period of time. How about exercising at home or even walking around the block (while practicing social [physical] distancing)? You will feel less stressed and more relaxed. Related to exercising, take care of your physical health through good nutrition and sufficient amount of sleep.

#9 Laughter is healing

  • Find sources of laughter. Humor and laughter are therapeutic and will make you feel better.

#10 We are in this together!

  • Share the importance of social (physical) distancing and home quarantining to everyone around you. We need everyone to work together to fight this virus. Given Hawai‘i’s strong tradition of ‘ohana and sense of community, I know we can do this!

 

Bryan S. K. Kim is a professor of psychology and director of the Master of Arts in Counseling Psychology Program. His areas of expertise are multicultural psychotherapy process and outcome, measurement of culture-specific constructs, psychotherapist training, and immigrant experiences. His current research examines the effects of culture-specific interventions and client enculturation/acculturation (e.g., cultural values) on psychotherapy process and outcome. Kim’s interest in cross-cultural psychology largely stems from his experiences growing up in Hawai‘i as a 1.5-generation Asian American.

This post was updated on March 24 to add an example in the first paragraph of the section on behavioral interventions. 

Additional resources

World Health Organization Advice for the Public

Centers for Disease Control and Prevention

Hawai‘i Department of Health

UH System COVID-19 Information

UH Hilo COVID-19 Information