I want to commend to your attention Lionel Shriver’s polemic in The Spectator, particularly this passage:
I am steeped in dread. I foresee months, if not years, of inane gesturing towards ‘safety’ that makes no appreciable difference to the nation’s health, but does manage to 1) ruin everyone’s enjoyment; 2) perpetuate the socially poisonous notion that one’s neighbour is a threat to one’s very life; 3) maintain an atmosphere of the extraordinary, in which the state may violate civil rights at will; 4) lay waste to what little might otherwise have remained of this country’s economy. The lockdown has been bad enough. Post-lockdown could be worse.
Is there any real science behind this two-metre rule? Or is it an arbitrary convention we’re now stuck with? Recent research suggests that Covid is surprisingly nosocomial (what a wonderful word): spread in the healthcare settings of care homes and hospitals. We’ve also learned that most infections result from the close-up, sustained exposure that we never get with strangers in supermarkets. Yet the two-metre rule that’s consigned us to half-mile queues for Tesco will soon make everywhere else unbearable, too.
concluding
I predict that few of the tedious, costly, time-consuming measures about to be levied on the British public in the coming months will be based on science. We’ll be obliged to make loud gestures of showy compliance, most of which will make no difference to who sickens and who dies, but which will nevertheless irretrievably deep-six this country’s economy and make our daily lives an unremitting misery.
Let me answer his question. The empirical evidence supporting the “two-metre rule” is scanty at best. It’s based on modeling. It has been criticized for being far too lenient (an 8-metre rule has been proposed) or too strict. I suspect it was arrived at as a compromise between no social distancing and the obviously unworkable 8 metres.
I have no idea what policies are best suited for the United Kingdom’s circumstances and won’t offer any suggestions. Here in the U. S. it appears that the number of new cases of COVID-19 reported daily has been declining since April 24 while the number of new deaths due to the virus reported daily has been declining since April 21.
It remains the case that the New York City metropolitan area accounts for fully half of all cases and all deaths due to COVID-19 and that the majority of those have been in nursing homes and other care facilities.
Here in Illinois the number of new cases or the number of new deaths seem more closely related to vagaries in reporting than to any underlying disease activity. I think you either must conclude that the measures adopted to oppose the spread of the disease have been a flop or that other changes are obscruing what is actually going on.
The measures adopted have been because of erroneous computer modeling, virtue signaling references to “science,†and having a mind-numbing barrage of ads, public announcements, government mandated guidance imposed on people for growing lengths of time. This has become the country’s reality, and with public compliance comes greater audacity from local and state governments to keep it going.
Let me correct some things. Not everything since it will take too long.
“Covid is surprisingly nosocomial (what a wonderful word): spread in the healthcare settings of care homes and hospitals.”
Nursing homes yes. There is little documented spread in hospitals.
“Is there any real science behind this two-metre rule? ”
Why yes, glad you asked. The 6 foot rule (we are Americans not Europeans so lets dispense with meters) has been the rule used to lessen spread of airborne disease that was adopted many years ago. It has some research behind it, it has lab experience behind it (no modeling of which I am aware) and even better, from my POV as someone who deliberately exposes himself to these pts, a long history of working pretty well. Poor Lionel apparently doesnt know any infectious disease/control people or she could have asked them. Is it really too much to ask a journalist to do something like that?
I predict that Lionel Shriver will continue to be too lazy or incapable of finding out basic facts for herself and will continue to write emotional based polemics against anything that seems remotely supported by people on the left. (Lionel is a she BTW. She has no training in anything remotely like a science, she is a journalist. Not to say she couldn’t be an expert or have expertise in epidemiology, infectious disease, medicine and economics, all of which she implies having, but much more likely just someone with a platform.)
Query- Why are we still debating opening up vs lockdowns? We are clearly opening up everywhere. Everyone who is serious about this knew that lockdowns were temporary. Only ideologues claimed that people wanted to lockdown forever or that people were working towards that end.
Steve
I have read a half dozen studies of the issue. None identified empirical evidence, instead pointing to modeling. Take this one, for instance:
The WHO Fong study, on which much of the policy seems to be based, was not empirical. It relied on simulations and modeling.
Not in Illinois. Pritzker seems to be doubling down. I’ll take your word for it that Pritzker is not serious. Mayor Lightfoot, too, seems to be taking a hard line.
You arent going nearly far enough back. Since the 30s people thought that 3 feet was far enough to distance. That was based upon some work with TB. (Might be able to find this papers, but think all are behind paywalls.) It was increased to 6 feet after the linked paper was published after the SARS outbreak.
https://www.nejm.org/doi/full/10.1056/nejmoa031349
Steve,
An airplane is a pretty specific case though – you have many people in close very close proximity in a confined space for an extended period of time breathing the same air and probably using the same toilet. It wasn’t merely close proximity, time and other factors were also present.
I’m not sure the experience on an airplane can be extrapolated to standing outside of a Home Depot for 5 minutes waiting to get inside, or most of the normal interactions people have during the course of a day, especially if people are wearing masks and greatly reducing the spread of droplets in the air.
This is problematic as well (from the cited study):
The size of the SARS-CoV virus has been reported as about a third of the size that can be filtered by an aircraft’s ventilation system.
If they’re wearing masks and 6 ft apart, it’s safe, right?
https://www.yahoo.com/news/pole-dancing-hand-sanitizer-wyoming-125908187.html
Dave, at the size scale of HEPA filters (and even water sand filters) the removal mechanism is not mechanical screening, as in window screens. Water and air filters generally work by physical adsorption of the particle to the surface of the filter. This is a chemical process. If mechanical screening were the mechanism, masks would be utterly useless.
Andy- The question was where did the 6 foot rule come from and was there any science behind it. We had used the 3 foot rule for many years and it was effective. There are a lot of older studies on this. A mask plus 3 feet and people working with others who had a respiratory illness and we weren’t seeing disease being transmitted. So not only was there literature on this there was practical experience. After this paper the recommendation was changed to 6 feet. Again, we are finding that keeping 6 feet apart and wearing masks and we arent seeing disease transmission.
There are also lots of studies in the lab photographing with high speed cameras the spread generated by a cough, talking, sneeze, etc. When wearing a mask 6 feet seems to be a pretty good compromise distance. Spacing farther provides some extra margin of safety, but at the cost of not being practical. So there are trade offs just like everything else. The good news is that our experience is pretty positive.
Strippers? Who looks at the face? Masks are fine.
Steve
Dave- I don’t follow Illinois that closely. Was this article incorrect?
https://www.nbcchicago.com/news/coronavirus/these-are-the-places-that-can-now-reopen-under-illinois-modified-stay-at-home-order/2265033/
Steve
There has been no material change in the “stay at home” directive in Illinois. A few more businesses were designated essential. Businesses are allowed to take telephone or electronic orders. They were always allowed to take telephone or electronic orders.
I wouldn’t say the article was incorrect so much as misleading.
The UK expects to be the last European nation to open due to the government’s restrictive guideline policy (based on R0) and refusal to consider regional approaches. (The devolved administrations are, however, taking different approaches, but possibly more restrictive — writer Neil Gaiman is being chastised today for coming back to his home in Scotland from New Zealand.)
@steve, half of Scottish hospitals were reported as being a source of Covid infection for patients being treated for an unrelated matter. There was an outcry for more details, but I don’t know if any surfaced. Hospitals are not being treated the same way in terms of publicity.
I’m not familiar at all with the UK experience or events there.
However, I did run across this report on a new study of Covid and masks which is particularly interesting since it doesn’t rely on modeling:
https://news.sky.com/story/coronavirus-wearing-surgical-masks-can-reduce-covid-19-spread-by-75-study-claims-11990381
Illinois is on a five-step program, with Step One being the most stringent and Step Five being freedom. Currently, Illinois is on Step Two, hoping to be allowed to enter Step Three at the end of the month, while all of the neighboring states, are essentially moving to Step Four, which in Illinois allows restaurants, bars, travel, schools and childcare to reopen under TBA regulations.
Andy:
The studies to which steve has linked in the past are sufficient evidence to suggest to me that face masks are effective in reducing the spread of the virus in close quarters, e.g. in nursing homes, other health care facilities, and in the home. Maybe they’re effective on crowded city streets, too. Considering that so few of the cases have been determined to have been contracted out-of-doors (something like .001%), I am less convinced that they are effective outside. Their use is probably warranted in Chinese, South Korean, and other Asian cities due to their poor air quality regardless of their effects in slowing the spread of viruses; the situation is different in the U. S. I don’t believe that the directive to “wear face masks whenever you go out” produces a measurable reduction in transmission. The directive should probably be to “wear face masks whenever you go in” but that would likely be ignored.
I think your study is a reproduction of “close quarters”.
I hope I have been clear on that. I agree that if you are just going outside and not having lots of close contact, outdoor mud wrestling would probably be bad, then the risk would be very small. That said I think a lot of people are going “out” with the intention of going someplace to go “in”, like a store, restaurant, etc. (Wish they had a picture of the hamster set up.)
Dont know if you saw this one. I think the worrying about beaches was not merited, but then the disease is still new and people weren’t certain. This kind of data will help us figure out which interventions matter the most. One of the areas where I think Sweden was probably correct, supported by this study, is that keeping schools open probably would have been OK. Of course this study was before PIMS, or whatever the name is this week.
https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2020.00608
Steve
That’s an interesting report, steve, although I would quibble with some of their conclusions. For example, I think they’re finessing “flattening the curve” a bit. The report focuses on number of cases but there is no straightline relationship between reducing the number of cases and preventing a catastrophic failure of the health care system. Rather, reducing the number of cases that require ICU intervention should be the objective.
I think that we can stipulate that shutting the entire society down forever will absolutely minimize the spread of the virus but, as you acknowledge, that was never on the table. That should be stipulated as well which necessarily means that the objective cannot be to minimize the number of cases absolutely but that’s the obvious assumption behind the strategy that’s been used.
I am in long term mode. How do we balance safety vs maintaining economic activity? Studies like these, which need to be replicated of course, can help. Shutting down schools is a big economic damper. If it doesnt really stop virus spread, then there isn’t much of a trade off and lets open them. The really tough part will be if/when we find that certain activities are definitely high risk. What do we do if we find that restaurants and bars are the major commercial areas of spread? (Just an example.) Not just what, if any, govt response, but what will people do on their own? As has been noted many times most restaurants work on thin margins.
Steve
“That said I think a lot of people are going “out†with the intention of going someplace to go “inâ€, like a store, restaurant, etc.”
That’s been my experience. We have our masks in the car and I only put them on right before going into a store. Since the Pandemic started, I’ve only been to four places – Home Depot, Costco, our local grocer and our dog groomers.
Dog groomers but no barber for you? People do love their dogs.
Steve
steve,
I’m “follicly challenged” so I cut my own hair with clippers. My wife does the boy’s hair and can trim the daughter when needed. So we can exist for quite a while without professionals and not get that feral look. The dog, by contrast, has fur that mats easily. We have dog clippers at home but just aren’t competent enough yet to replace a pro.
I was going to go look for a Flowbie, but one of our nurses offered to cut my hair. We contribute to a local animal shelter. Never forget one day when wife and I took lunch over for everyone when they were shaving a matted Bichon. The woman volunteer was a dog groomer in her regular job. The dog seemed a lot happier after shaved, though a naked Bichon looks pretty funny. I think she said dogs with an undercoat were the ones most difficult to care for if they got too matted. (We are cat people so dont have grooming issues.)
Steve