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Don't Cut Corners On Coronavirus

This post shares and comments on quotes from Hold the line, a coronavirus article by an infectious disease epidemiologist.

First, we are in the very infancy of this epidemic’s trajectory. That means even with these [social distancing] measures we will see cases and deaths continue to rise globally, nationally, and in our own communities in the coming weeks. This may lead some people to think that the social distancing measures are not working. They are. They may feel futile. They aren’t. [...] We need everyone to hold the line as the epidemic inevitably gets worse. This is not my opinion; this is the unforgiving math of epidemics for which I and my colleagues have dedicated our lives to understanding with great nuance, and this disease is no exception. I want to help the community brace for this impact. Stay strong and with solidarity knowing with absolute certainty that what you are doing is saving lives, even as people begin getting sick and dying. You may feel like giving in. Don’t.

I agree.

While social distancing decreases contact with members of society, it of course increases your contacts with group (i.e. family) members. This small and obvious fact has surprisingly profound implications on disease transmission dynamics. Study after study demonstrates that even if there is only a little bit of connection between groups (i.e. social dinners, playdates/playgrounds, etc.), the epidemic trajectory isn’t much different than if there was no measure in place. The same underlying fundamentals of disease transmission apply, and the result is that the community is left with all of the social and economic disruption but very little public health benefit. You should perceive your entire family to function as a single individual unit; if one person puts themselves at risk, everyone in the unit is at risk. Seemingly small social chains get large and complex with alarming speed. If your son visits his girlfriend, and you later sneak over for coffee with a neighbor, your neighbor is now connected to the infected office worker that your son’s girlfriend’s mother shook hands with.

This is a key point. If a family is staying home together, then if anyone in the family takes a risk, it's similar to your whole family taking the risk. That’s because one infected family member is likely to infect the rest of the family.

Also, if everyone in your family individually thinks they can get away with small risks, the risks will add up. Suppose you have 5 people each taking 3 tiny risks in a month. That's less than one risk per week. And suppose they’re 2% risks (1 in 50 odds of getting infected). Then the total risk for the family is a 26% chance of getting infected. That means over 1 in 4 families get infected from taking those tiny risks – every month. It doesn’t take many families doing this to keep the disease spreading. People acting anything like this scenario are part of the problem, not part of the solution.

In contrast to hand-washing and other personal measures, social distancing measures are not about individuals, they are about societies working in unison. These measures also take a long time to see the results. It is hard (even for me) to conceptualize how on a population level ‘one quick little get together’ can undermine the entire framework of a public health intervention, but it does. I promise you it does. I promise. I promise. I promise. You can’t cheat it. People are already itching to cheat on the social distancing precautions just a “little”- a playdate, a haircut, or picking up a needless item at the store, etc. From a transmission dynamics standpoint, this very quickly recreates a highly connected social network that undermines all of the work the community has done so far.

He's right. Don't cut corners.

Elliot Temple on March 23, 2020


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