Events & Issues
New Delhi, 26 March 2020
Social Distancing
A MEDICAL PRESCRIPTION
By Dr S. Saraswathi
(Former Director, ICSSR, New Delhi)
Countrywide social
distancing by observing one-day “Janata Curfew” on Sunday last was indeed a
success in terms of people’s support and participation. It was a prelude to
unavoidable and more rigorous steps so as to prevent rapid escalation of
Covid-19 that many countries are witnessing.
People’s curfew is not
just a symbolic gesture or a one-day event. It was immediately followed by lockdown issued by the
government in 80 districts across 17 States and 5 Union Territories affected by
the pandemic. By 24 March, 30 States and UTs declared a complete lock down mode
with punitive action for violations.
As Covid-19 is going
strong and no effective vaccine is in sight, the world is depending on measures
to control its spread by means of non-clinical approach. Epidemics and
pandemics have to be fought both by medical remedies and non-medical treatment,
for protecting the unaffected is as important as curing the affected.
Infectious and contagious diseases have a strong social side and hence need
social distancing as a medical prescription.
Social distance is a
sociological concept and in medical sociology, it is used to denote an action
labeled as social distancing. Merriam Webster’s Dictionary defines “social
distance” as “the degree of acceptance or reflection of social interaction
between individuals and especially those belonging to different social groups
such as those based on race, ethnicity, clan, or gender”. It has four different
dimensions – pertaining to sympathy between groups, norms to determine
“insider” and “outsider”, frequency of interaction between groups, and habitual
and cultural distance. Modern societies, democratic ideals and concept of human
rights endeavour to reduce social distance.
“Social distancing” is a
set of non-pharmaceutical infection control intended to stop or slow down the
spread of a contagious disease. The object is to lessen and minimise contact
between the person carrying and also suspected to be carrying the infection and
others so as to prevent transmission of the disease to some extent. Social
distancing is advocated and actively promoted and even strictly enforced in
fighting contagious diseases.
It is one of the most
effective methods of containing diseases particularly when an infection spreads
through droplet contact occurring in coughing and sneezing, direct physical
touch with the affected or touching any surface contaminated with the virus.
Though the idea of separating the affected from others is known all along and
practised everywhere, it has now become a common practice in view of the global
spread of Covid-19.
In epidemiology, social
distancing is meant to decrease the basic reproduction number of the disease,
which shows roughly how many people an infected individual will go on to
infect. Currently, estimates of the
reproductive number of the new coronavirus ranges from 1.4 to 6.5 with an
average of 3.3. Increase in this number denotes faster spread of the disease.
A calculation by a scholar
says that 25% of the population reducing their social contacts by 50% of their
normal can effectively reduce their basic reproduction number to about
81%. The number looks small and even
insignificant considering the efforts required to achieve this, but in
epidemiology, where exponential growth and spread are the chief villains, even
small reduction can substantially reduce and delay the spread of the disease.
Factors that determine
reproduction number include both the character of the disease and the reaction
of the people. Highly contagious diseases and people susceptible to infections
make for high reproduction number. Number, frequency and duration of contacts
being the main determinant of the contagion, social distancing becomes
important. Epidemiologists are of the opinion that since we cannot control the
biological behaviour of the virus, we should control the human behaviour and
contact.
Arresting the rate of spread
of the epidemic is the primary concern of all in which non-medical people’s
role is called for. Several measures are undertaken to promote social
distancing. Educational institutions and workplaces are closed; the affected
are isolated and kept in quarantines; mass gatherings are prohibited; places of
worship and festivals are shut; public transport facilities are curtailed or
stopped; and recreational events, theatres and clubs are closed. Depending on
the degree of risk, restrictions are imposed on shops – big malls, retail
shops, small trade, and roadside vendors, etc.
“Cordon sanitaire”,
another method of social distancing, is restriction of movement of people into
or out of a defined geographic area such as a community, region, or country.
The term used metaphorically to refer to attempts to prevent spread of
ideologies was first applied in medical field to insulate French troops from
Yellow Fever in 1821. Originally, it was adopted as a barrier against the
spread of an infectious disease. In the present century also, it was used to
distance the less affected and the unaffected from affected places and people
in containing SARS outbreak in 2003 in China and Canada, and Ebola in West Africa.
Border sealing between countries, between States in a country, and between
areas and localities within a States have been adopted in fighting coronavirus.
“Protective sequestration”
denotes measures taken to protect a small and healthy population from an
epidemic before it reaches their doorsteps. It is also called “reverse cordon
sanitaire”. It is difficult to implement
as people are reluctant to undergo restrictions before they become inevitable.
But, presently, because of massive information about the spread of coronavirus,
unaffected areas and people are generally willing to accept any inconvenience
and adopt voluntary restrictions. During Spanish Flu in 1917, several
communities in the US adopted this method which is also a type of social
distancing.
The outbreak of COVID-19
has forced many companies and other institutions to take to work from home as
the rule and attendance in workplace an exception even before lockdown
announced by the government. However, not all types of work can be done from
home. Those that need field work,
presence of the worker at the site or in a work-place will definitely suffer.
Cancellation of air and
rail traffic, closing of inter-State and inter-district travel – all for
imposing social distancing -- will disrupt normal life and affect many
commercial activities, but have to be borne silently. The present arrangements
may adversely impact output on short and long-term which is to be assessed, but
presently unavoidable whatever the impact. The nation has to pay a heavy price
to conquer the disease.
Social distancing requires
complete public support. Until the call for “Janata Curfew” by the Prime
Minister, anti-CAA and anti-NPR protests were going on in Delhi and Chennai
with no reason and with no concern for public health. When organising leaders
show no sign of understanding the imminent danger of the spread of the disease
and the urgency of disbanding all kinds of mass gatherings, strong and strict
action is necessary to disperse crowds.
In times of epidemics,
government has to take firm action and democratic rights and individual liberty
will have to be subordinated to the needs of public health and welfare. When people are getting ready to face
tremendous personal and national economic loss in fighting the disease, a
temporary curtailment of individual liberty for broader community benefit is
not a big price. ---INFA
(Copyright, India News & Feature Alliance)
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