We have all been hearing a lot about social distancing recently. But what does social distancing actually mean and what does social distancing for family units actually entail?
If you ask different people what that term means, you get a lot of different answers. Some will say it means no gatherings over 10 people. Some will say stay 6 feet away from people, while others say it is ok to have indoor gatherings with 3 or 4 friends. Some will say that they are only socializing with their non-cohabiting significant other. Some people allow their children to have playdates or sleepovers with that one special friend. Others don’t.
Everyone you ask has a different definition of social distancing. With Governor Scott’s recent announcement of a Stay Home/ Stay Safe order (and many other states having Shelter in Place orders, which are similar), I wanted to explore what all this means and how we each, individually, can work together to stay safe from COVID-19 and keep our family and friends safe, and also make these restrictions be lifted as soon as it is safe to do so.
I would like to explain the theory behind social distancing so that we can examine what it should look like, while still acknowledging the profound downsides and difficulties with putting social distancing for family units into action.
Social distancing is the act of physically separating “family units” over the long haul of this pandemic. Family units don’t actually need to be related, but they need to be a group of people who live together, sharing a space with one another. Each family unit is physically separate from ALL OTHER family units, which limits the virus’ ability to spread BETWEEN family units.
Sounds simple. Stay away from people. Stay at least 6 feet away from anyone outside your family unit (because 6 feet is the distance the respiratory droplets can travel). Stay (as much as possible) away from anything people outside your family unit might have touched (door handles, elevator buttons, tables, ATM keypad, countertops, furniture, money, gas pump handles, etc.) In theory, this is easy. In practice, it is MUCH harder and there are a lot of complicated factors that no one is really talking about.
There are some infectious diseases like the flu or most stomach bugs where the illness can mostly only be spread by a person who feels sick. If that is the case, the illness is relatively easy to contain by quarantining, or separating, those who are sick.
The COVID-19 virus is different. There are a large number of people who do not feel sick or feel mildly sick, but can still easily infect other people with the virus. Additionally, people who develop severe symptoms are contagious to others several days BEFORE they feel sick.
All of this, combined with the fact that none of us have immunity to this new coronavirus, AND the fact that virus is able to live on surfaces for prolonged periods of time, allows very easy spread between individuals who are feeling well, and going about their business, and uninfected people.
People who interpret social distancing loosely are making major mistakes.
Maybe they are letting their kids have that playdate with a family you know and trust. Maybe they join a friend for coffee in their kitchen, while staying 6 feet apart. Maybe they drive with their friend to go for a walk. Maybe they have a date with their significant other who lives with a couple of housemates and shares custody of her kids with her ex (who is also seeing a partner who also shares custody of kids.) We might go to work, go to the gym, go to the grocery store.
These actions all seem so limited, so reasonable, so safe, and so innocent. It’s not like we’re out at a bar or going to a packed movie theater. At this point, at least one person in the above scenarios has COVID-19. They may not look or feel sick, but they are able to infect others. The virus has shown us that it will multiply logarithmically without strict social distancing and immaculate hand and surface hygiene. In this way, COVID-19 sickness will quickly overwhelm and incapacitate all hospitals. Hospitals will be overrun by critically ill patients in a matter of weeks.
Ventilators, hospital beds, and personal protective equipment will be in short supply sooner than you can even imagine. If not today, in two weeks, for sure. Unprotected or improperly protected health care providers will get sick and die, and then they too will be in short supply (health care workers have the highest infection rate of any group, and tend to have more severe disease, possibly due to high levels of exposure, lack of personal protective equipment, and frequency of high-risk procedures which aerosolize the virus, as well as very close contact required for intubation (putting someone on a ventilator)).
Healthcare workers are risking their lives for the good of society.
Nationally, in areas with Personal Protective Equipment (PPE) shortages, healthcare workers like myself are being sent into battle with no weapons or protective equipment. We are quarantining ourselves from our loved ones, renting separate living quarters to protect our families, and we are spending hundreds of dollars on our own personal protective equipment, only to have hospital administrators threaten to fire us if we don’t wear the “hospital-issued” homemade cloth face mask we are given by well-meaning, thoughtful volunteers. We are told we are scaring patients when we wear full, appropriate protective equipment.
Well, guess what? Healthcare providers are scared too. Working in this pandemic is hard, lonely, and tiring. We have to listen to our children cry and implore us not to go to work. They are scared too. We are asked to make impossible decisions about who lives and who dies. We are forced to abandon our patients because the health care system is overwhelmed. We are forced to provide substandard care because the system is overwhelmed.
Then we see the neighbors’ kids having a playdate, or college students on spring break, or our friends cavorting with their significant other, or teens playing basketball in the park. And we get mad and frustrated. Some medical care providers talk of a walkout or of quitting medicine. Others are resigned to their fate.
But we are all frightened, exhausted, sad, and frustrated. Frustrated with humanity’s unwillingness to suffer a little for the good of society. We post about the horrors of COVID-19 on social media, we write, we tell our friends, and we try to educate. We are called “fear mongers,” told we are “over the top” and still, the small parties and gatherings continue.
This is what the doctors and nurses and physician assistants and the entire medical team staff from the janitors to the receptionists want you to do right now. Today. This instant.
We want you to hunker down with ONLY the people you live with. We need you to practice strict social distancing for family units. This means no visits from people you don’t live with unless you are outside, six feet apart at all times, and not touching anything the other person touched when at all humanly possible. We all need to shop for groceries so we can eat. Some have essential jobs that can’t be done from home. The economic hardship is real. So is the death rate from COVID-19. I get it- none of us can totally isolate. But to the extent that it is possible, we must.
- Stay 6 feet apart from people outside your family unit.
- Work from home if possible.
- Do not go to public spaces like grocery stores or pharmacies frequently. Do everything you can do to limit those trips to once or twice a month. ABSOLUTELY NO VISITS INSIDE THE HOME FROM FRIENDS OR SIGNIFICANT OTHERS WHO DON’T LIVE WITH YOU.
- DO NOT GO INTO ANYONE ELSE’S HOME
- No visits from grandparents or elderly relatives
- No birthday parties or special small gatherings.
- No riding in someone’s car unless you live together
- Don’t let people pet your dog when out on a walk (the virus can live on hair)
Are you getting the idea yet? DON’T PHYSICALLY INTERACT with humans outside of your own family unit or touch anything humans outside of your family unit have touched unless you absolutely have to. And then, if you do, wash your hands and sanitize surfaces. Stay home unless you absolutely have to leave.
Be strict about social distancing for family units. Act as though your life depends on it, because it does. Additionally, the lives of literally hundreds of thousands of people depend on YOU, as an individual, making good choices. If you do not follow these rules, COVID-19 will spread, and we will all have to be isolated for longer and will suffer more social, emotional, and economic impact.
It is hard to understand how simple, innocent little things like being with one special friend can undermine an entire society’s attempt to control a virus, but time and again, in epidemiological studies, this has been shown to be the case. We MUST DO A BETTER JOB AT ISOLATING OURSELVES or this pandemic will last MUCH MUCH longer and have more impact not only emotionally as we lose loved ones, and give up activities we love, but also economically.
Wash your hands any time you could have touched something someone outside of your family unit could have touched. For a full 20 seconds, with soap. Use hand sanitizer if you don’t have access to soap. Disinfect your steering wheel, door handles, and anything you could have touched in your car. Treat everything you bring into your home as though it is covered in coronavirus germs. Which means you should isolate mail, and groceries for 3 days.
You should also disinfect the outside of any food packages you must keep (like shrinkwrap around meat.) Cooked veggies are safe, but raw food that has been touched needs to be vigorously washed with water.
I also want to “touch” on a touchy subject: families with kids in two households.
I don’t have one clear recommendation for this. There are extenuating circumstances in many families, like the ability to cooperatively co-parent, work schedules, and health variables- one parent could be immune-compromised. I want these families to understand that if children continue to go between two households during this pandemic, it will increase the spread of the virus in society and increase the risk to both family units (and more than two family units if each partner has kids going between both households then we are dealing with 4 family units).
If there is a perfectly closed loop where two family units don’t see anyone else, and every member in both family units agrees to uphold the same strict standards of social distancing, then sharing children between two homes could be a possibility. But if each family unit can’t control potential exposure to the virus (say, if the parent is a health care worker of any sort) then the best and safest solution is to have the kids stay in one home.
This is especially true if only one or neither family unit is practicing very strict levels of social distancing as I strongly recommend above.
So, is social distancing for family units happening for parents who have kids that live in two homes? What should they be doing?
To me, this depends on who is in the family, how capable the two families are of working together and co-parenting through difficult times, and how capable two-family units are of establishing common ground rules around playdates, small gatherings, and other social interactions. Is one of the adults in the two family unit scenario an essential worker who must continue working outside the home? Is one of the adults in the two-family unit a medical care provider? Both of these scenarios increase the risk of coronavirus transmission.
Realistically, what works for one family might not work for another, and generally, in the absence of a global pandemic, the best thing for kids is to have access to both parents. Having said that, we are in a global pandemic so I would like to give parents and co-parents with children who live in two homes some topics to discuss:
- Is anyone in any of the households a high-risk individual due to age or immune status?
- Is anyone capable of working from home and thus limiting their exposure?
- Are you able to agree on ground rules around strict social distancing measures, and act accordingly?
- Can you be flexible in your custody agreement to minimize risk to everyone?
- Can you work together to do what is right for not only your family but also society?
From a PURELY disease control standpoint, the safest thing to do is for kids to stay in one household with one family unit. This is not an easy choice to make. It is not the choice that is right for every family, but if it is a choice that your family can live with, it is the best available choice for controlling the spread of the virus.
This is not an easy choice to make. But it is, I believe, the best available choice. I am a single parent of my high school senior who lives exclusively with me, but given that I am a doctor and see sick patients, I have made the difficult decision to send him indefinitely to live with another family that is capable of strict social distancing. I have not seen my son, except by facetime, in a couple of weeks. I don’t expect to see him, in person, other than outside and 6 feet apart until this pandemic is over. The parent who is not living with his or her kids can still connect with them outdoors and 6 feet apart (obviously this doesn’t work well for infants, toddlers, and preschool-age children).
This is a choice no family should have to make. Yet, it is something we do have to all talk about, and consider what we can do to keep ourselves healthy, and try to not add to the overburdened medical care system. Even so, this is a tremendously difficult and painful choice.
Now is a great time for families who have a difficult time co-parenting to try to put aside their anger and their differences and work cooperatively together to try to find a solution that is safe and works for everyone. If you are able to do this, it will not only help you through the pandemic, it will help your family and children in the long run, well after the pandemic is over.
The court system does have some statements or guidance about custody and visitation, and petitions to change custody or visitation can be filed, but it is unclear when judgments will be made on these given the current Stay at Home order. As with all things having to do with our children in two households, the best solution is to try to work together to find a solution that is right for YOUR families. Breaking legal arrangements may cause legal problems when the pandemic is under control, but spreading infections will also cause grievous trouble.
I’ve presented a lot of information and food for thought here. I hope that this knowledge, combined with a profound respect for the horrors of what this global pandemic can do to our society if not stopped immediately, will allow you, as an individual, to make the incredibly painful sacrifices that each and every one of us needs to make in order to defeat this foe. Do your best and act in the spirit of love by staying home to protect us all.
Be well, connect online, stay home, and wash your hands. Give those of us in health care the time we need to help you. This is your chance. Be a hero.
Guest Author: Mario Trabulsy, MD
Mario Trabulsy, MD is a board-certified emergency physician with over 27 years experience in the field. She has been a renowned and award-winning Educator at University of Vermont Larner College of Medicine, and University of Vermont College of Nursing and Health Sciences. She is a fierce breast cancer survivor, lover and creator of joy, single mother of 3 young adult or teenage boys, a dear friend, advocate for, and mentor to many, an avid outdoor exercise enthusiast and single track mountain biker.