What is social distancing and home isolation and why are they important? Social distancing is a new term that has been birthed out of the COVID-19 pandemic. I like to refer to it as physical distancing or just distancing so that we don’t socially isolate. Physical distancing/home isolation is a recommended practice created to help “flatten the curve.” What does this mean? Well, the curve is the graphical representation of diseased individuals over time. If we do not isolate or distance ourselves from others, we will quickly spread the virus causing a steep upward spike. If this happens, too many people are sick and more will require hospitalization. Our healthcare system and hospitals are not set up to handle that many people all at one time. If we isolate and distance ourselves, less people become infected at any given time and instead of a steep spike, is a slow flat curve which our hospitals and healthcare system can handle without being overrun. We only have so many ventilators, doctors, nurses, respiratory therapists, etc. to care for these sick patients, so we need to slow the spread over time. At the end of the day, a virus is actually not a living thing by scientific criteria for reasons I won’t dive into today. It is not crawling around the streets outside, hunting its next victim like Jack the Ripper or a pack of rabid wolves. It is only within those who have been exposed or sick from it. Why does this matter? Well, if you have the virus inside of you and it can only live so long before your immune system kills it and you recover from the virus, then we can stop you from spreading it to other people. If you move, the virus moves. If you don’t move, the virus doesn’t move. So because of social distancing, we lock the virus up in our bodies, within our homes so that it can’t affect anyone else. THIS is why it is so important to continue social distancing.

I understand the economy is taking a hard hit, people have lost their jobs, businesses permanently closed, and people are struggling to put food on the table. Hopefully, the government (fingers crossed) will continue to help with the financial aspect of all of this. BUT, social distancing appears to be working. Projections initially stated that hundreds of thousands if not close to a million people would die from the coronavirus. Luckily, they were projections and simply that. They are just guesses based on limited information and do not predict the future. People are stating that it was not as bad as it was made out to be. Well that is mostly because people are listening and have stayed in their homes, stopping the spread of this virus. Those who claim that this was all a hoax and an agenda of some kind throw their hands up and say “look, you thought it was going to be a lot worse, and it’s not.” What I have been saying is that the surge you want, is the one you think is coming but never actually shows up. Our curve has flattened. Regretfully, tens of thousands have died, and unfortunately more will continue to do so, however, our efforts appear to be working. Lately, Sweden has been in the news because they did not enforce distancing and they are already passed their surge. 26% of their population (from when I last read) was infected. They lost lives unfortunately, and still had a curve similar to other Scandinavian countries. Sweden did not impose a strict social distancing order however most of its population voluntarily did it as public transit, stores, and restaurants have all seen a dramatic decline in patrons. Scientists still don’t know what this will mean for their future.

As of right now, distancing and isolation has appeared to be helping here in the US. Some are saying we did not need so many extra ventilators, the ship Comfort in NYC was unnecessary because it was virtually unused, and that the Boston Hope field-hospital here in the city with 1000-bed capacity is empty. Yes this may be true, but isn’t that a testament to our isolation measures we are taking? It is better to not have had to use these resources but still have them, rather than not have them and ultimately need them. Our hospitals are still seeing critically-ill patients larger than any other disease and are over their initial ICU capacity. However due to amazing emergency preparedness practices here in Boston, many areas of the various hospitals were converted into makeshift ICUs appropriately. So as you can see, it seems we have flattened the curve overall but it is not over yet. Boston is still seeing a surge and other places throughout the country may not have seen theirs yet.

Now, I have to bring something up because I have received countless messages on Facebook from friends asking for my opinion on an hour long YouTube video of two urgent care doctors out of California who held a “press briefing” speaking out against distancing and home isolation practices. I watched it and even discussed it with some colleagues to make sure I wasn’t just looking at it with biased eyes. Unfortunately, they used poor statistical practices to extrapolate their numbers (case fatality rate vs. infection fatality rate) and come to the conclusions they did. Without getting into the weeds with details and statistical mumbo-jumbo, their numbers were not accurately calculated and skewed mostly based on the quoted sampling of tested individuals. This was the first concern of the video. The second time I shook my head in disappointment was their recommendation that we need to get more people infected to build herd immunity, more specifically, young and healthy adults. I am not sure if they have been keeping up with the current literature, but there are increasing reports of rising death rates or critical hospital admissions for young, healthy patients with no risk factors for complications with COVID-19. A more frightening complication we are seeing increasingly is a rise in strokes or blood clots (especially in the lungs) in healthy patients who even show just moderate COVID-19 symptoms. My friends and colleagues working in the hospitals right now have told me what they are seeing anecdotally which aligns with these recent reports. I’ve had friends who are young and healthy without risk factors end up in the ICU from COVID-19. I don’t know about you, but I would rather forgo my social life for a few more months of isolation rather than even an improbable risk of being critically ill or having a stroke. To add to these doctors’ statements regarding herd immunity is exactly what I had mentioned above. WE DON’T KNOW IF IMMUNITY IS OBTAINED AFTER INFECTION!!! While we do know that existing coronaviruses offer some short term immunity after infection, this is a totally new virus we’ve never seen before and know nothing about. We can only hope to assume the same is true for COVID-19 but we aren’t sure; more research is needed.

These doctors also report that by using distancing measures, we are actually hurting our immune systems. This is not scientifically accurate. While social isolation (not distancing), depression, poor sleep, excess alcohol, poor diet, and limited exercise do cause alterations in our immune function, the simple measures of staying at home does not lower your immune system. They also bring up the projections of millions of infected and dying COVID-19 cases and called them “woefully inaccurate.” As I stated before, projections are not accurate predictions. They are our best guess as to what could happen based on the current information. They do not tell us the future. If a business has projections to make $1.3 million in sales in the coming year, does that guarantee they will make that profit? Not necessarily. It is a guess based on the current information and known evidence. The same applies here. We have distanced aggressively (for the most part) and likely have flatted the curve substantially. Until we have better and widespread testing, we will not be sure what the impact is and has been from this but it is our best tool.

There was mention of the flu in this video as there is by many who proclaim the virus is a hoax. THIS IS NOT THE FLU OR EVEN SIMILAR TO THE FLU. In the entire 2019-2020 flu season, it was estimated that 24,000-62,000 people died. Now in just about 8 weeks or so, COVID-19 has sadly claimed just north of 55,000 lives. The flu does not cause ICUs to run out of beds and ventilators every year. Bodies are not being stored in refrigerated trailers outside of hospitals because morgues are over capacity and funeral homes cannot keep up with demand as a result of the flu. This is very different and needs to be taken more seriously.

A good comment these doctors did have was that many patents are afraid to pursue medical treatment for non-COVID conditions such as strokes or heart attacks because they are afraid of getting sick. I know where I work, we are making sure to treat all of our patient’s conditions and evaluate them regularly to make sure they do not end up in the hospital. If they decompensated with their symptoms, we are encouraging them to seek help if absolutely necessary. In the past, I have had patients who did not want to go to the ED because they did not want to wait for hours despite having crushing chest pain or dragging their leg and arm behind them after a stroke. There are many reasons people don’t seek out acute treatment at a hospital, however this is probably the most credible one. I will say from my experience with the local Boston hospitals, extensive precautions are being taken to help treat those with non-COVID symptoms to prevent them from getting infected while getting the treatment they need. Don’t be afraid to go to the hospital if you feel it is medically appropriate!

Now I am not here to discredit any colleagues in medicine or create slander, but I want to make sure the correct information is out there. I don’t have all the answers, I am not a virologist or epidemiologist, however I am trained in nursing/medicine, have been in practice for long enough, and hold a background in molecular/cellular biology research to know when something is inaccurate. Like I have said before, words are dangerous. When two doctors are telling information like this to the general public and the information is not backed by scientific evidence, it becomes dangerous. I have seen this video posted hundreds of time on social medial and its spreading like wildfire (and could be just as dangerous). People may not take these distancing measures seriously and then the virus can spread straining our already exhausted healthcare system.

So remember, distancing appears to be working. Until we develop a vaccine and conduct more testing/research, this may be our best hope at slowing the spread of the virus and “flattening the curve.” Projections do not predict the future. THIS IS NOT THE FLU! And yes, sadly, young and healthy adults with no apparent risk factors are dying, experiencing critical illness requiring ICU-level care, and are even suffering from strokes with just mild COVID-19 symptoms. This may be a smaller percentage but we are learning every day what the risks may be.

Continue to physically distance but socially engage using the CDC guidelines. It is ok to go outside and exercise, just do so safely using the distancing measures. FaceTime or call your family, friends, or significant other to catch up and chat. Find creative ways to engage your loved ones if you cannot be with them physically.

Above all, stay safe and persevere! This will end…it may not be now, but it will. Nothing in life is permanent except death.