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Six feet can save lives in coronavirus outbreak

Gov. Andrew Cuomo elbow bumps Nassau County Executive

Gov. Andrew Cuomo elbow bumps Nassau County Executive Laura Curran to show a safe alternative to shaking hands during a news conference March 5. Credit: Newsday / Thomas A. Ferrara

Being anti-social can save lives. 

In an infectious disease outbreak like coronavirus, epidemiologists prescribe “social distancing”: Avoiding mass gatherings. Restricting movement. Staying out of places where people ordinarily meet, live or assemble, such as malls, theaters, stadiums, houses of worship and bars. You should keep a distance of about 6 feet from other people.

These measures are designed to “flatten the curve” — slow transmission and prevent surges of the infection that could deluge the health-care system, as happened in Italy.

The aim is to stop infected and healthy people from coming in contact with one another, including among those who don’t know yet they’re sick — and might never know. 

Droplets from a cough or sneeze can travel up to 6 feet “and land in the noses and mouths of people nearby or be inhaled into the lungs,” according to the U.S. Centers for Disease Control and Prevention. A cough or sneeze generates a “multiphase turbulent buoyant cloud,” according to a 2014 paper in the Journal of Fluid Mechanics. In the case of a cough, for instance, the horizontal range could exceed 8 feet, the paper found.

Social distancing keeps people out of the blast zone — if not out of the same place entirely.

It’s not known whether someone who’s asymptomatic can still spread the virus, including those under 20, who appear unlikely to get significant symptoms, the White House’s coronavirus coordinator, Dr. Deborah Birx, said Saturday at a news conference

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“Are they a group that are potentially asymptomatic and spreading the virus? Because of that, and because of that unknown, we don’t want to say that the risk is low when we don’t know how low the numbers are for people who are asymptomatic,” she said, adding: “We think it’s better for the entire American public to know that the risk of serious illness may be low, but they could be potentially spreading the virus to others. And that’s why we’re asking every American to take personal responsibility to prevent that spread.”

Social distancing can help minimize an outbreak, but only if practiced by nearly everyone.

On Sunday night, the CDC issued a nationwide recommendation: For the next eight weeks, any event bigger than 50 or more people should be postponed or canceled.

Gov. Andrew M. Cuomo last week banned gatherings of 500 people or more, shut down the Broadway Theater District and halved the maximum legal occupancy of most premises.

But some gathering spots nevertheless remained crowded over the weekend.

Gov. Phil Murphy of New Jersey, speaking Sunday on WBLS radio, said he received a report of bars and restaurants being crowded over the weekend. "They were packed, and people are on top of each other," he said.

Crowded places create a Petri dish of sorts to spread the virus to healthy people — who can go on to transmit the virus, including to those who are older and/or immunocompromised, the two categories for whom it’s most dangerous and potentially deadly. 

“The social isolation that we are putting in place is really only gonna work if New Yorkers change their behavior,” Dr. Oxiris Barbot, the city health commissioner, said Saturday at a City Hall news conference where reporters’ chairs have been spaced out beginning earlier in the week

In Italy, whose health care system is overwhelmed with 21,000 cases as of Sunday morning and counting, “[d]octors and officials … blame growth on people ignoring warnings to socially isolate,” wrote Andy Slavitt, who headed Medicare, Medicaid and Obamacare in the Obama Administration, in a tweet Sunday morning. “Major cities in the US are 10 days behind Italy and still have a chance to mitigate this.” 

School systems around the country, including on Long Island and in New York City, are being closed. 

Before deciding Sunday to close the schools, New York City Mayor Bill de Blasio had been planning to impose social distancing: putting more space between kids in the cafeteria and at gym class; moving mealtime to the classroom if the cafeteria can’t accommodate distancing; reorganizing gym class to reduce large groups in gymnasiums and recess, and move those activities outside as the weather gets warmer.  

Don’t shake hands, bro-hug, kiss or hug hello. Elbow-bump or find another noncontact greeting instead. 

Health experts have urged people to change greeting rituals, to minimize contact: no more shaking hands, for one. 

Still, even at a White House news conference in the Rose Garden about containing the coronavirus, President Donald Trump continued to shake hands, on camera — until one of the executives rebuffed Trump’s handshake, and the two elbow-bumped instead. 

The next day, asked why he's shaking hands still, Trump said: "It becomes a habit, and it's hard to get out of that habit," but "possibly that something that comes out of this, maybe people shouldn't be shaking hands in the long term." 

It gets lonely being socially distant. 

A study of quarantine — the total separation of a person from the outside world to contain an infection — has been found to have a “negative psychological effect,” according to an article in the medical journal The Lancet published Feb. 26

“If you care for someone in a nursing home, the last thing you want to do is endanger them."

Gov. Cuomo

“Confinement, loss of usual routine, and reduced social and physical contact with others were frequently shown to cause boredom, frustration, and a sense of isolation from the rest of the world,” the article said.

Social-distancing measures can be especially hard on people who were lonely before the outbreak, officials said in imposing those measures as a matter of life and death.

On March 12, Cuomo, citing the danger the virus poses to older people, banned visits to nursing homes.

“If you care for someone in a nursing home," Cuomo said, "the last thing you want to do is endanger them.”

According to an article published Thursday in Scientific American magazine: “People who do not feel connected to others are more likely to catch a cold, experience depression, develop heart disease, have lower cognitive function and live a shorter life. In fact, the long-term harm caused by loneliness is similar to smoking or obesity.”

But older adults face an immediate danger in the coronavirus. 

The answer, for those who have access to a computer, might be social media. 

An article last year in the journal Health Education & Behavior found that “routine use is associated with positive health outcomes,” but “emotional connection to social media use is associated with negative health outcomes.”

The 1918 Spanish flu outbreak has lessons for containing the coronavirus in 2020

More than 50 million people died worldwide in the 1918 outbreak of the Spanish flu, including more than 450,000 documented deaths in the United States. 

Social distancing is thought to have kept people alive.

Compare Philadelphia and St. Louis: The difference in mortality rates from Spanish flu are “striking,” according to a 2007 article in the Proceedings of the National Academy of Sciences, a scientific journal.

In Philly, “authorities downplayed their significance and allowed large public gatherings, notably a citywide parade on September 28, 1918, to continue.” Social distancing wasn’t imposed until later, “when disease spread had already begun to overwhelm local medical and public health resources.” But St. Louis imposed distancing soon after the first cases, and fewer people died there.

“Cities that put several measures in place early,” including curbing public gatherings and closing schools, “experienced peak death rates that were approximately half of those seen in cities that started their interventions later,” according to the journal.

Still, social distancing isn't a panacea. Even with rapid imposition of social distancing, the journal said, the efforts were seen to “significantly reduce influenza transmission, but that viral spread will be renewed upon relaxation of such measures.”

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