The rule stipulating a single specific physical distance of one or two meters between individuals to reduce the spread of COVID-19 is based on outdated science and experiences of past viruses, researchers argue in The British Medical Journal, The BMJ.
This is coming as another rare research on the effects of the pandemic undertaken during an ongoing disaster shows that COVID-19 has severely affected people’s daily emotional lives and mental health, increasing their stresses the longer lockdowns, fear of getting sick and financial strains continue.
Having a lower education level and speaking English as a second language further reduced resilience and hindered people’s ability to cope, suggests new University of California, Davis, research-based on surveys that began in April—just a few weeks after lockdowns started in the United States.
Assistant Professor in the Department of Human Ecology at UC Davis and co-author on the study, Clare Cannon, says “this is some of the first information we have on resilience in the face of COVID-19. Our hypothesis, for our continuing research, is that it’s getting worse. The longer this goes on, the less resilient we are going to be.”
Cannon and researchers at Tulane University surveyed 374 people online, using social media, websites and other outlets, mostly in the United States, over a 10-week period beginning in April. More research is planned as the pandemic progresses.
Those surveyed were asked about previous disaster experience, their resilience, their perceived stress, their current situation as it relates to COVID-19, and personal and household demographics. The online Qualtrics survey took an estimated 10 minutes to complete.
Respondents in the current study had filled out questionnaires before masks were mandatory, before closures were prolonged before large job losses had occurred and prior to full realisation that the world was experiencing a global economic recession and deadly public health crisis, she added.
Additionally, fewer people, at the time of the survey, had experienced family illness and loss to COVID-19 as would be the case now and in future surveys, Cannon said.
The study’s authors sought to look at the role of perceived stress, assess demographic variables and add to the literature on disasters, infectious disease and resilience. Their article was published this month in the journal Sustainability.
Historically, in environmental disasters (such as hurricanes), people find comfort in asking for and getting help from neighbours and friends. However, this kind of dependence and interaction increased stress for people in the survey, Cannon said. That’s because, in a pandemic, contact with others increases their risks and fears of getting sick, she said.
“There seems to be a real fear of contagion. There’s something unique about it being an infectious disease in that people pose a risk to each other. If we need things from other people, it increases our stress”, Cannon said, adding, “the more that people perceive stress the less resilient they are.”
Research on pandemics and their effects on people are scant, given that it’s been a century since a pandemic the size of COVID-19 has occurred. Additionally, very little research has taken place during a pandemic, researchers said.
The findings showed that just 28 days, on average, into the pandemic two-thirds of survey respondents reported moderate to high levels of stress. Most of the respondents were female (75 percent), well-educated, white and employed at the time.
“It begs the question”, researchers wrote in their article, “of whether populations with less social capital and fewer financial resources would be reporting even higher levels of stress and lower levels of resilience.”
The authors said the research points to the need for solutions for a population facing so much uncertainty.
“Given the findings from the study, governments must mitigate the associated risks of a pandemic by providing the needed resources for individuals, households, and communities to maintain resilience over a long period of time”, the authors concluded.
“The uncertain end of COVID-19 requires governments to offer a buffer against the pandemic impact and to ultimately reduce stress to create optimal health and well-being for citizens facing adversity.”
In the meantime, The BMJ is defined by its mission: to work towards a healthier world for all. It shares that global endeavour with millions of readers working in clinical practice, research, education, government, and with patients and the public too.
Nicholas Jones at the University of Oxford and colleagues say such rules are based on an over-simplistic dichotomy describing viral transfer by either large droplets or small airborne droplets emitted in isolation without accounting for the exhaled air.
In reality, transmission is more complex, involving a continuum of droplet sizes and an important role of the exhaled air that carries them, they explain.
Evidence suggests that smaller airborne droplets laden with COVID-19 can travel more than two meters by activities such as coughing and shouting, and may spread up to 7-8 meters concentrated in exhaled air from an infected person.
As such, they say distancing rules need to take account of the multiple factors that affect risk, including type of activity, indoor versus outdoor settings, level of ventilation and whether face coverings are worn.
Viral load of the emitter, duration of exposure, and susceptibility of an individual to infection are also important, they add.
“This would provide greater protection in the highest risk settings but also greater freedom in lower risk settings, potentially enabling a return towards normality in some aspects of social and economic life”, they write.
To facilitate this, they discuss how transmission risk may vary with setting, occupancy level, contact time, and whether face coverings are worn.
For example, in the highest risk situations, such as a crowded bar or nightclub, physical distancing beyond two meters and minimizing occupancy time should be considered, while less stringent distancing is likely to be adequate in low risk scenarios.
They say further work is needed to examine areas of uncertainty and extend the guide to develop specific solutions to classes of indoor environments occupied at various usage levels.
Concluding, they declared, “physical distancing should be seen as only one part of a wider public health approach to containing the COVID-19 pandemic.
“It should be used in combination with other strategies to reduce transmission risk, including hand-washing, regular surface cleaning, protective equipment and face coverings where appropriate, strategies of air hygiene, and isolation of affected individuals.”