Swine flu: thoughts on social distancing

by revere, cross-posted from Effect Measure

I am thinking out loud here. Since that’s never a pretty sight, you might wish to avert your eyes. With that merest of advance warning, the school closure problem has gotten me to think more generally about social distancing. The term itself is a kind of oxymoron. “Social” emphasizes togetherness, intercourse between people, relations. “Distancing” is negation of the social. We have examples: canceling school, prohibiting mass gatherings, telecommuting, but the underlying idea is straightforward. With a contagious disease that passes from person to person (details still to be worked out, of course), we decrease transmission by minimizing person to person contacts, i.e., we distance people from each other — social distancing. Decreasing transmission has benefits, even in the case where the total number of people infected is the same over the long run. If we flatten out the epidemic curve (the graph that shows how many new cases appear each day); and move its peak which is now lower to a later point, we have bought time and stretched out demand, easing the burden on health services. Those are the benefits.

There are also costs. Not only the costs related to lost school days, missed work and all the rest of the obvious consequences. But the loss of social relationships which are key to a community’s resilience and ability to get through an event which affects everyone at once. We can see this if we take the objective of social distancing to its logical conclusion: what if we all hid away, each from everyone else. No medical care, no family member caring for a loved one, no worker picking up the slack of a sick colleague. No one at work, no one at school, no one in government offices. Each person hiding under the bed with a month’s supply of water and tins of tunafish. Travel on air, sea and land shut down. Individuals traveling in cars couldn’t get gas because that might put them in contact with others and supplies couldn’t get anywhere either because our supply chains aren’t set up to run in a completely automated way, with no human contact anywhere. Anyway, where would they go? And why?

Of course it’s infeasible, but assuming everyone had prepped by laying in a personal supply of necessities, it would work. Disease transmission would stop within days. The pandemic would be over and many lives possibly saved. Of course not everyone would be better off. Many people would also die that would otherwise have survived had care been available. How would it net out? Let’s say that on balance the same number of lives would be saved as lost. They wouldn’t be the same lives, of course. Just the numbers would be the same. In one case, it would be those who had fallen sick and needed some help from others to survive that would be saved. In the other case it would be those who won’t get sick and subsequently die regardless of what care was available who would be saved. Nor do we know it would even net out positively, given the sacrifices that would have to be made.

The point is obvious, once stated. The strategy of social distancing involves a risky choice of what kinds of social ties to break, how to break them and how to keep them broken for a length of time that is not certain. Some kinds of ties might be obvious. Mass rallies and gatherings, athletic events, concerts all would seem expendable (not if your livelihood depended on them, of course; everything is a trade-off). When we get to mass transit and schools, things get dicier. Let’s take schools. The effect on students can be finessed most easily. They can make up the work in a variety of ways. But the loss of public childcare (which is one function that public school serves) is another matter. Parents send sick students to school and want well students to go there even if it means risking getting flu because it is an economic necessity. School’s are a breeding ground and source of disease spread in a flu pandemic. They are kept open longer than necessary mainly because the economic consequences of closing them are so severe. The major place to look in managing the school closing problem is in sick and family leave policies. Instead we argue about triggers for school closings, ignoring the major impediment. This is a general feature of interfering with social relationships. It often has widespread unintended consequences.

There is something else about breaking social relationships that requires caution. In every pandemic people have simultaneously shunned their neighbors out of fear and helped their neighbors out of an innate sense of responsibility and empathy. Both are likely hard wired into human behavior because of their survival advantages. Both behaviors can be suppressed or amplified by public policy and planning. We could, for example, set up efficient ways to allow people to volunteer and place those who wish to do so in the most advantageous and useful places. Or we could make it difficult for them to do it by instituting blind quarantines and rigid public curfews.

There’s still time to think some of these things through, and the investment will pay off handsomely I have no doubt. But I also have no doubt that in a crisis, we will also figure out all sorts of work arounds and clever solutions. Since this will be neither the last pandemic nor the worst we’ve ever seen (at least I hope so), we should be prepared to harvest our experience of what works and what doesn’t.

Just another thing to add to the planning protocol: recording what we do.

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