Dissecting physical versus social distancing

Greg Nash

As a doctor who has devoted my career to public health, I know the intended meaning of “social distancing” as a strategy to reduce transmission of the COVID 19 virus until vaccines and improved treatments are available. But the term “social distancing” mis-states what we are trying to accomplish to help us exit from this continuing crisis. Physical, not social distancing is essential to prevent transmission of the virus. And ironically we need to couple that with “social connectivity” the opposite of “social distancing.”

Humans are social animals and we have an emotional need to interact with each other. Right now, despite the public health necessity of physical distancing, there are serious mental and physical health consequences caused by isolating-in-place. At the macro level, it is clear that prolonged social isolation affects lifespan. A recent meta-analysis of studies involving 308,849 individuals, followed for an average of 7.5 years, found that those with good social relationships have a 50 percent greater likelihood of survival compared to those who were socially isolated.

I wrote in The Hill in 2018 about the health impacts of isolation and that meaningful, face-to-face interactions decrease loneliness. Those with active social lives generally report better health. Strong social affiliations — being part of a religious group, hobbyist circle or exercise group —all have positive effects. Doctors in the UK even make “social prescriptions,” specifying patients take part in structured social activity to fight loneliness. 

Many preliminary studies are showing that the prolonged isolation we are currently enduring increases fear, anxiety, loneliness, depression, and thoughts of suicide. A study assessing changes in mental-health Google searches after stay-at-home measures found a dramatic increase in topics related to anxiety, negative thoughts, sleep disturbances, and suicidal ideation. A qualitative study assessing early stages of social distancing measures found isolation resulted in significant negative impacts on mental health and well-being within only days, especially in those with low-paid or precarious employment, leading to demotivation, and decreased self-worth.

In the UK, the Royal College of Psychiatrists reports a 43 percent increase in the number of emergency appointments starting at the beginning of social distancing. The Institute of Fiscal Studies, surveying 12,000 UK patients, reported their mental health worsened within the first two months of the pandemic. There is evidence that these impacts may be even stronger in developing countries.

The negative impacts of COVID-19 isolation are taking many forms. For some, prolonged isolation is fraught with danger from intimate partner violence, caregiver abuse, or neglect. In the U.S., we experienced a 7.5 percent increase in calls to the police reporting domestic violence during March, April and May 2020 over the same period in 2019, according to a new study released in late August by the Council on Criminal Justice. By the end of March, the first month of lockdown, the National Sexual Assault Hotline experienced a 22 percent increase in calls received from people younger than 18 over February; half of all incoming calls were from minors.

Increases in domestic violence following social distancing implementation have also been observed overseas. The Financial Times reports that calls to domestic abuse helplines, mainly from women, have gone up by 33 percent or more in Cyprus, Singapore and elsewhere. In Hubei, China, reports of domestic violence doubled when the lockdown was mandated. The first three weeks of social distancing in the UK saw the highest number of killings of women of any 21-day period in the past decade. Additionally, France indicated a 30 percent increase in domestic violence and Brazil estimates a 40–50 percent increase. Numbers may be higher since victims, trapped with their abusers, may be unable or too scared to report.

The pandemic may also be making it more difficult for people trying to recover from addiction and may lead to others becoming addicted. Research firm Nielsen reports that in the month following the beginning of social isolation, alcohol sales were up 55 percent from the same period in 2019, ready-to-drink cocktails rose by 75 percent, purchases of 24- to 30-packs of beer grew by 90 percent, and wine sales increased by 66 percent.

Before the pandemic, the impact of social isolation fell disproportionately on the elderly and young adults. In the U.S., approximately 25 percent of seniors 65 and older are considered to be socially isolated and 43 percent report feeling lonely. Such isolation is associated with increased risk of heart disease and stroke, dementia, high cholesterol, diabetes, and poor health in general. People who are lonely are also more likely to use tobacco and to exercise less.

But with social distancing, the impacts of isolation have likely become more severe. Health policy experts warned about the likely impacts of COVID-19 on seniors’ mental health, and new studies are examining lockdown’s impact on the mental health of seniors. There is emerging evidence that COVID-19’s social-distancing measures could also be associated with mental health problems in young people. Almost half of the 18-24-year-olds in one study reported feeling lonely during lockdown and children under 18 in enforced isolation from quarantine were five times more likely to require mental-health services and also experienced higher levels of post-traumatic stress.

The evidence base for interventions to combat loneliness is less robust than we would like. While researchers design better studies that recommend medically designed interventions to combat adverse effects of social isolation, experts are encouraging the public to find new ways to feel connected. 

There are steps we can take to be socially connected and physically distanced. We should get together with loved ones and friends, safely: wearing masks, staying at least six feet apart and limiting the number of people at social gatherings. Arranging and taking physically distanced walks contribute to physical and emotional health. In addition, the amount of time we stay in actual isolation should be kept short

Digital interaction helps. As you may be seeing in your own online conversations, it can’t take the place of close human contact, but Zoom, Skype, FaceTime, and other technologies have their place. It’s possible to keep socially active, digitally, creating a sense of belonging. For example:

  • Create interactive online discussion groups or join virtual book clubs. 

  • Take group classes or group exercise or yoga via Zoom.

  • Join online concerts or sporting events with friends and family also dialing-in.

  • For the technology-averse, such as older relatives and friends, stay in touch via telephone.

  • Take advantage of the fact that appointments with many mental health professionals have moved online. Talking about the stresses you’re feeling in these interactions can decrease loneliness and improve mental wellbeing.

The Centers for Disease Control and Prevention (CDC) has good recommendations for dealing with stress from COVID-19-created isolation, which include taking good physical care of yourself, unwinding with activities you love, and — importantly — staying in contact with friends, family, and your local community or religious groups.

Despite the emotional and physical downsides of isolation, it is abundantly clear that lockdowns and strict observance of distancing requirements reduce disease transmission. Ignoring these measures risk the health of friends and neighbors, but by being careful, we can both minimize transmission risk and preserve our social bonds and our concern for each other that are so critical to our health and wellbeing.

Jonathan Fielding, M.D., who headed public health for Massachusetts and Los Angeles County, is a UCLA professor of Health Policy and Management. 


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