Coronavirus: The dos, don’ts, and rules of social distancing

Many Americans in recent weeks have begun working remotely, if they haven’t been furloughed or laid off; schools have canceled classes for weeks; and restaurants, retail stores, bars, gyms, and other gathering places in dozens of states have shuttered. Major events were called off with a domino-like effect, including Coachella and South by Southwest, March Madness and virtually all national sporting events, and many religious services across the country.

These closures are all attempts to force social distancing, a crucially important public health intervention that can help stop transmission of the coronavirus. With Covid-19, “many people in the US will at some point, either this year or next, get exposed to this virus,” the Centers for Disease Control and Prevention’s immunization czar announced this month. Social distancing, health authorities argue, can dramatically slow the rate at which the infection spreads, helping to ease the burden on the health care system. Best practices require maintaining at least a 6-foot distance between yourself and others.

The closures nationally are largely preventive — in some places, no one from work or school may have even been sick — though increasingly, these decisions are being made in response to the rapidly ballooning number of cases of Covid-19; the risk that contact with large groups of people will exacerbate transmission of the virus; and the growing understanding that the disease can be transmitted by those who are asymptomatic or appear to be relatively healthy. (At least one study estimated that about 25 percent of coronavirus transmissions may have occurred in pre-symptomatic stages — meaning it can be spread by people who don’t yet know they have it.) In the United States, these efforts have taken on particular urgency: As of March 26, the US had the highest number of confirmed cases of the illness.

In New York, the epicenter of the America’s coronavirus crisis, social distancing reminders are now posted in public.
John Nacion/NurPhoto via Getty Images

To that end, the US government is warning against all gatherings of more than 10 people. But even with so many public places shuttered for now, simple acts in our daily lives — even a run in the park — raise questions about how social distancing works: How should social distancing affect your workouts? Your weekly manicure? Play dates for your kids? Are those risky for an ostensibly healthy person like yourself?

What do you — as a responsible, socially conscious human being — owe to your fellow men and women, particularly those who are sick, immunocompromised, and older? Are you breaking the social contract by going to the grocery store?

Or, by not going, are you overreacting and hurting the economy?

Vox spoke with six experts in public health, medicine, psychology, and bioethics for answers. (Please remember that as the Covid-19 landscape transforms week by week, so too will the advice; this story has been updated to reflect the latest closures.)

I feel healthy. Why shouldn’t I get out a little bit to make this time pass easier?

Vox’s Kelsey Piper makes a strong argument for choosing to stay home as much as possible, inconvenient as it may seem, to help your fellow human. “If you are young and healthy, you ought to take precautions because doing so can end up saving someone’s life,” she writes.

Leah Lagos, a New York City-based psychologist and author of the upcoming Heart, Breath, Mind: Train Your Heart to Conquer Stress and Achieve Success, agrees. “Now is the time to do something for your fellow community members,” she says. Staying home as much as possible, even if you believe you aren’t infected, is the type of altruistic decision that, when performed en masse, has the potential to slow the infection rate, Lagos added. It’s a term known as “flattening the curve,” and the way it works can be seen below:

An infographic that shows the goals of mitigation during an outbreak with two curves. The X-axis represents the number of daily cases and they Y-axis represents the amount of time since the first case. The first curve represents the number of cases when no protective measures during an outbreak are implemented and displays a large peak. The second curve is much lower, representing a much smaller rise in the number of cases if protective measures are implemented. Christina Animashaun/Vox

Considering — and prioritizing — the welfare of strangers is difficult, Lagos acknowledges, but it helps to think of them instead as someone else’s parent, grandparent, or child. “It can be an interesting experiment in compassion for people we don’t know.”

“A lot of us might be relatively healthy and think we might be able to withstand the rigors of an infection,” adds Jonathan Kimmelman, director of the Biomedical Ethics Unit at McGill University in Montreal, “but there’s the concern about spreading it to vulnerable individuals, as well as the pressure this outbreak will place on our health care system.”

Kimmelman invokes the idea of “social solidarity,” saying that “we have an ethical obligation to curtail activities, practice social distancing, and substitute activities with safer alternatives,” like teleconferencing instead of in-person work meetings or, even if you live in a city where bars are still open, changing a first date from a wine bar to a walk outside (or just FaceTime).

But should you even be going on dates, period?

If the messages are confusing, understand that “there are different levels of social distancing” in effect around the world, and that local health departments’ recommendations currently vary depending on known cases, says Syra Madad, an NYC-based pathogens specialist who was featured in Netflix’s docuseries Pandemic: How to Prevent an Outbreak.

Still, Madad notes, “It is better to operate under the pretense that there is transmission in your community already. There’s going to be disruption to daily life, but we want people to feel empowered by this. The decisions you make will ultimately affect the trajectory of this outbreak.”

An empty restaurant in New York City on March 13, 2020.
Jeenah Moon/Getty Images

If I have to go out, how can I do it in the safest way possible — to protect myself as well as others?

Kate Vergara, a public health and infectious disease specialist based in Chicago and New York City, has spent time fighting polio in Ethiopia and helping Ebola survivors in Sierra Leone (without contracting either disease). In order to even begin to approach the ethics of social distancing, she says, we must have a firm grip on how the virus is spreading.

“Covid-19 is not airborne,” she says. “It is transmitted through droplets — being coughed on or touching something that someone coughed on, for example, and then touching your face and allowing that pathogen to get into your system through your eyes, nose, or mouth.”

It’s important to practice good hygiene, like hand-washing — which protects not only you but also others. When considering the ethics of spending time out and about, Vergara suggests reframing your view of hand-washing in the following way: “Wash your hands before you go out to protect others, and wash them again after the activity to protect yourself.” That goes for visiting the ATM, the grocery store, and the like.

Should I feel guilty for wanting to go for a run or to a store?

Between the relentless news alerts, social media memes, and gossipy texts, it’s easy to feel overwhelmed, anxious, and scared. We need self-care more than ever, says LaMar Hasbrouck, a public health physician and former CDC medical epidemiologist. “It’s important during these times to hold fast to any sense of normalcy that you can.”

But try to find prudent ways to do so. Hasbrouck now picks off-peak hours to exercise to minimize contact with others; other options include walking, jogging, or biking outdoors, while making sure to maintain distance from others. The more ventilated an area, the lower the risk of transmission, plus, “If you cough, nobody is around, and the droplets just fall and hit the ground,” he says. Better yet: breaking a sweat at home with help from an app or online video.

Grocery shopping will need to happen, but instead of going at noon on a Saturday when the place is sure to be packed, try going really early on a weekday morning. If it’s still possible, order online. Wash your hands after handling any deliveries, just to be safe.

Should I keep using grocery delivery services … and ride-hailing companies … and restaurants?

Hasbrouck encourages those who have access to services such as Postmates, Grubhub, Lyft, and Instacart to use them. “It’s a good way to social distance,” he says, noting that two main factors when it comes to Covid-19 transmission are closeness of contact and duration. “The handoff is five seconds, you go inside and wash your hands. Or just have them leave it at your doorstep.” (Instacart, Uber Eats, and other delivery services are offering contactless delivery.)

This poses some ethical questions, however: Having milk and bread delivered is convenient for you, minimizing your exposure to the virus. But what about the person doing your grocery shopping or picking up your Thai food? Or the Uber driver ferrying you to your significant other’s apartment? Is it right to ask them to assume the risk of being out and about?

For now, many services continue, but some are questioning the ethics of ride-hailing in particular, both because of the impetus to stay home and the risk to drivers. If you are sick or feeling unwell, companies are urging you not to ride. If you do need to use such a service, remember that contaminated hands pose a risk to drivers and riders, so be ultra-diligent about hand hygiene, washing or sanitizing your hands before getting in the car and not touching your face at all. Cracking a window is a smart move for both you and the driver, as it promotes airflow.

If restaurants in your area reopen in coming weeks, or if they remain open, here are a few things to remember: “You mainly need to be mindful about the surfaces you touch: menus, the table, condiments, things that other patrons might have used,” says Benjamin Chapman, a professor and food safety extension specialist at North Carolina State University.

Chapman says that while he might not know who touched that soy sauce bottle or pepper shaker before him, “I do know I can break the pathway of transmission by using hand sanitizer or washing my hands.” With social distancing in mind, opt for establishments where it’s easy to keep 6 to 8 feet between yourself and other diners and feel free to be “a public health nerd” like Chapman and ask if they’re using Environmental Protection Agency-approved sanitizing products, which they should be.

Should I cancel play dates? What are the rules for my kids?

In Ireland, public health officials are encouraging a “no parties, no playdates, no playground” policy, per the Irish Times. Muireann Ní Chrónín, a consultant respiratory pediatrician at Cork University Hospital, told the paper: “Children will get through this no problem. [But] remember with corona, children are vectors, not victims. In most epidemics, young children are the transmitters.”

In the US, school closures are smart, Vergara says. “It’s a responsible practice for schools to shut down. That’s several hundred kids interacting in close quarters, and kids aren’t known for washing their hands very well.” But that leaves millions of working parents frantic about career responsibilities, and unsure of whether it’s appropriate to schedule play dates or try to split child care duties with friends.

Lagos worries that play dates during school closures are essentially “quasi-quarantines, defeating the purpose of social distancing.” Kimmelman concurs, and though he says no one knows the exact right answer, “we don’t know how things are going to unfold, and from my standpoint, the risks of underreaction are so much more catastrophic than the risks of overreaction.”

Alyssa F. Westring and Stewart D. Friedman, co-authors of Parents Who Lead, writing in the Harvard Business Review, recommended finding inventive ways for children to play together virtually. “While it may not be feasible to trade-off childcare responsibilities (depending on quarantine restrictions),” they wrote, “consider other ways in which you can make things easier for one another — whether it’s sharing creative activities to keep the kids entertained or taking turns grocery shopping. … Be open to new ways of doing things.”

When should I completely self-quarantine?

The CDC has issued recommendations for travelers arriving from dozens of countries with widespread cases to stay home for 14 days. The White House has also encouraged anyone who has been in New York in recent days and left to self-quarantine for 14 days because of the rapidly growing number of cases there.

But if you have a fever or receive new information — that someone you know was exposed — you’re also going to want to “radically change your assessment,” Hasbrouck says. That likely means self-quarantining, because that’s “the ethical decision and you don’t want to expose others. It’s a constant risk assessment, and it’s more of an art than a science. It’s about protecting yourself but also being socially responsible.”

How far should we take social distancing advice?

“Look at the trajectory of what’s happening in Italy. We’re 11 days behind Italy,” where a national lockdown that began March 10 has curtailed all travel and shuttered nearly all shops, schools, museums, movie theaters, and bars, says Madad. Some states and cities are observing less stringent measures than others, and a federal mandatory quarantine isn’t likely, but we can undertake distancing measures ourselves. “One of the things we’ve learned from the H1N1 pandemic is that if you educate people, they will listen. You have to give them the facts, and speak with one voice.”

Leslie Goldman has a master’s degree in public health and is a health writer based in Chicago. She is frequent contributor of feature stories and essays to Prevention, Women’s Health, O: The Oprah Magazine, Real Simple Parents, and more.

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