As an infectious disease epidemiologist, at this point feel morally obligated to provide some information on what we are seeing from a transmission dynamic perspective and how they apply to the social distancing measures.
Like any good scientist I have noticed two things that are either not articulated or not present in the “literature” of social media.
Specifically, I want to make two aspects of these measures very clear and unambiguous.
First, we are in the very infancy of this epidemic’s trajectory. That means even with these measures we will see cases and deaths continue to rise globally, nationally, and in our own communities in the coming weeks.
Our hospitals will be overwhelmed, and people will die that didn’t have to.
This may lead some people to think that the social distancing measures are not working.
They may feel futile. They aren’t.
You will feel discouraged. You should.
This is normal in chaos. But, this is also normal epidemic trajectory.
This enemy that we are facing is very good at what it does; we are not failing. 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.
We know what will happen; 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.
Second, although social distancing measures have been (at least temporarily) well-received, there is an obvious-but-overlooked phenomenon when considering groups (i.e. families) in transmission dynamics.
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 sounds silly, it’s not.
This is not a joke or a hypothetical.
We as epidemiologists see it borne out in the data time and time again and no one listens.
Conversely, any break in that chain breaks disease transmission along that chain.
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 ‘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.
Until we get a viable vaccine this unprecedented outbreak will not be overcome in grand, sweeping gesture, rather only by the collection of individual choices our community makes in the coming months.
This virus is unforgiving to unwise choices.
My goal in writing this is to prevent communities from getting ‘sucker-punched’ by what the epidemiological community knows will happen in the coming weeks.
It will be easy to be drawn to the idea that what we are doing isn’t working and become paralyzed by fear, or to ‘cheat’ a little bit in the coming weeks.
By knowing what to expect, and knowing the importance of maintaining these measures, my hope is to encourage continued community spirit, strategizing, and action to persevere in this time of uncertainty.”
Epidemiologist, Yale University.
Jonathan Smith, an award-winning lecturer in Epidemiology of Microbial Diseases and Global Health at Yale University School of Public Health. His research focuses on infectious disease transmission dynamics and he is an affiliate of the Yale Global Health Leadership Institute and founding director of Visual Epidemiology, a non-profit organization seeking to combine academic discourse with personal narratives through filmmaking.
Cases and deaths to peak this week don’t believe the hype!
Deaths will always lag behind cases numbers because it takes days to weeks for COVID-19 to cause death.
Fantastic and very clear article. I wish there was a way to simplify your amazingly simple message so that the morons who don’t social distance, could see the harm of their actions.
In response to David Hurst, I quote a friend’s favourite saying: ‘Never overestimate the intelligence of the electorate’.
Ha ha. I have been guilty for too long. Keep safe & well in these crazy times
Excellent, very clear
Thank you very much David Hurst
It’s very depressing too
People I know are
losing their jobs,
winding up their businesses,
dealing with big pay cuts,
desperately trying to get business,
trying to persuade customers about online service,
running short of money for food,
running short of money for rent,
going crazy in one-room homes with their families,
It is massively depressing. I would actually go further than that and say the economic and social effects are catastrophic. However, I do think we will come through this – I am not sure yet in what form – but we will come through this.
I genuinely hope that the social priorities will change. I hope that people will remember why certain types of employment were deemed ‘essential services’. They are essential – ALL of these essential services. And, unfortunately, most are underpaid, overworked and undervalued, (certainly in our pre Covid19 world)
However, I’m also the wrong side of 50 and have seen social inequalities for too long.
I’m also 12 months post Round 2 of Lemtrada, with a sub-standard immune system. I am wheelchair living full time, (have been for 4-5 years). I am self-isolating with my wonderful, caring family.
Despite having a healthy level of cynicism, and challenge, for most Government proclamations for most of my adult life, I genuinely fear that if I caught Covid19, I would become one of the daily death statistics. I don’t hide behind some pillow in blind fear. I just believe this is fated to be my reality, as the health ‘deck’ is stacked too much against me.
For some reason, (massive level of sarcasm here), I don’t wish this to happen yet. I’d like to see my kids succeed in their life choices. I’d like to see the social and financial worth of employees in essential services finally appropriately recognised.
This is why I am prepared to listen to epidemiologists and other appropriately qualified individuals, and sincerely wished that more people would do the same. I’m a Chartered Surveyor. I know about buildings but what do I know about virus spread and social healthcare? That’s correct. I know nothing in this regard so I listen to the experts.
I am eternally grateful for those people in the essential services and fully expect the number and types of essential services to expand over the coming months as we move to a new form of ‘normal’ and people are allowed to go back to work, kids to school etc.
But I genuinely do class as morons those people that cannot follow a simple message of social distancing. Unfortunately there have been too many examples shown on various media forms over the last week or so, of non-compliance. You could only have missed this message if you have lived as a hermit for the last 2-3 months.
I make no apology for expressing my feelings on this subject. But I will apologise for ranting.
This is the Anonymous who wrote comment about ‘People I know are …’
There was a typo in my comment – the original Thank You was for the epidemiologist Jonathan Smith who wrote the blog post
It almost convinced me that the hardship will be worthwhile
Thank you too David Hurst. Your comment has reinforced that message. (In many respects I am in the same situation as you are. Not in a wheelchair though)
Ha ha 😀. Apologies for my rant, but thanks for reading it. Keep safe and well in these very interesting times. David
Haha. Apologies for my rant, but thanks for reading it. Keep safe and well in these very challenging times
But I do think the govt could have done much better at communicating that message and I also disagree that (beyond stating the obvious reason for social distancing) that the message IS that simple. I can understand why a flat-dwelling family group can’t see the difference between sitting in a park and sitting in a garden, as long as they don’t go near anyone else. So only garden owners are permitted to relax. outside ….Why people resent being told they can’t drive to the beginning of their proposed walk… Yes, there are good reasons why neither of these can be allowed and they should have been part of the govt information. As should a noddy-said-to-big-ears guide to precautionary measures regarding virus transmission on cardboard etc. Finally, they missed a trick not having a ‘youth message’ early on. If they’d penetrated the psyche of the under 30s, we might not have seen as much daftness. Hope I’m forgiven for ranting, too.
Hi Kay. Everyone is allowed a rant 😂 And it was a very polite rant, so it was even better received.
I agree with you completely that the Government’s messaging could have been better. I think it always can be, looked at after the event, in any situation. But I suspect that no amount of contingency planning could have thrown up all possible scenarios for Covid-19 and how it is playing out.
As a non-Tory, but a business adviser for the last 20+ years, it surprises me to say that I think, on the whole, the Government are doing a pretty decent job – frontline PPE excepted. And without getting too political in this forum, I hope the new Labour Shadow team will make some sensible, thought-through challenges to the current strategy.
The scenarios that this outbreak has thrown up, need to be learned and incorporated into current and future messaging because, (I think), these outbreaks will keep coming until we have a vaccine. And I can’t think of a better way than a ‘Janet & John’ guide – do you remember the ‘Charlie says…’ public information cartoons from the early 70s? ‘Janet & John’ guides I love.
Missed a trick with the under 30s? I can’t agree more. I only hope that our response to the virus hasn’t driven too much of a wedge between those currently coming through in life and those heading out.
Don’t all shout, but I think our Queen has been amazing over the years, and with her recent message being viewed by 24+ million people she still has the ability to ‘draw a crowd’. I also hope that she continues to be amazing for longer yet. But I do wonder the relevance of a 93 year old’s message to a Millennial audience.
I agree, David and think the Queen’s message would have had even more resonance without all the media spoilers! I’m keeping everything crossed that the Guardian’s prediction report today is hyped. It had me seriously rattled this morning and has again convinced me to read nothing but this blog! Best wishes to you and yours.