Adopt an equality-focused approach to physical and social distancing

Household-based social distancing segregates society into those who are given the privilege of having physical contact with each other (families and couples living together) and those who (are) and will be denied these basic human needs for the foreseeable future for no reason other than their ‘household status’. From a scientific point of view there is no inevitable logic to ‘allowing’ asymptomatic spreading of the virus within the household (e.g. couples having sexual intercourse) while strictly prohibiting any form of physical contact between households (particularly if these households comprise of people living alone). The government should consider replacing social physical distancing rules which are based on ‘household units’ with a ‘managed network’ approach that treats all people equally and fairly. There is convincing scientific evidence that depriving people of direct physical & social contact puts them at increased risk of developing serious illnesses which can cause premature death (Valtorta et al. 2016, Hawkley & Cacioppo, 2013). The assumption underpinning the current approach appears to be that one cannot deprive couples living together of physical contact while it is perfectly acceptable to do this to single people living on their own for extended periods of time. The household-based approach does not only promote inequality but is also poorly supported by scientific data. Engaging in close physical contact or sexual activity within the household is in fact a guaranteed way of spreading of the virus. Epidemiological studies show that a ‘spouse relationship’ is a major risk factor for spreading the virus within the household (Li et al. 2019). In contrast, people living alone or single parents who only occasionally meet other people outside of the household are less likely to transmit the virus but are currently prohibited from having any form of physical contact with other adults. The ‘secondary attack rate’ of the virus for people living at the same residential address is 19% (Jing et al. preprint) which demonstrates that preventing spread within the household is just as relevant as preventing between spread between households. This raises the baffling question why governments stubbornly focus on the latter while ignoring the former.

In conclusion, it is time to scrap the legal concept of ‘household units’ and instead implement a ‘managed network’ approach to social distancing system that treats all people equally and fairly. The rules I propose are more straightforward than the complex web of regulations currently in place as they simply allow everyone to nominate a certain number of people they want to have physical contact with and a number of people they want to have social contact with. I propose that the government investigates & tests the following measures and (if successful) implements them accordingly:

1.) Everyone should be permitted to have physical and social contact with ‘b’ (none/one/two/three etc.) number people of their choice but (!) irrespective of whether they live together and/or happen to be married, a couple, family or a single person living alone.
2.) In addition, everyone is permitted to meet ‘c’ more people while observing physical distancing (2m rule).
3.) People should be allowed to change the nominated person/people at certain time intervals.
4.) The number b and c should be determined and adjusted based on a modelling exercise that takes other restrictions (e.g. on businesses), the R number, current prevalence of the virus, and other relevant metrics into account.
5.) Should these measures be insufficient then full physical distancing should be temporarily imposed again on all people, irrespective of whether they share a household or not (following basic principles of equality, however, exempting children).
6.) The concept of a ‘household unit’ should be abandoned and the rules should apply equally to all people, irrespective of their living arrangements.
7.) The test and trace system should be improved and expanded further to supress transmissions sufficiently. Large-scale testing at airports should be introduced to gain a better understanding of re-introduction of the virus and how to best manage this. These measures may allow the introduction of the suggested 'managed network-based approach'.

References:
Valtorta NK, Kanaan M, Gilbody S, et al (2016): Loneliness and social isolation as risk factors for coronary heart disease and stroke: systematic review and meta-analysis of longitudinal observational studies. Heart: 1002 (13):1009-1016.
Hawkley, LC & Cacioppo, JT: (2003): Loneliness and pathways to disease. Brain, Behavior, and Immunity,17 (15), 98-105
Wei Li, Bo Zhang, Jianhua Lu, Shihua Liu, Zhiqiang Chang, Peng Cao, Xinhua Liu, Peng Zhang, Yan Ling, Kaixiong Tao, Jianying Chen (preprint): The characteristics of household transmission of COVID-19, Clinical Infectious Diseases, ciaa450, https://doi.org/10.1093/cid/ciaa450
Qin-Long Jing, Ming-Jin Liu, Jun Yuan, Zhou-Bin Zhang, An-Ran Zhang, Natalie E Dean, Lei Luo, Meng-Meng Ma, Ira Longini, Eben Kenah, Ying Lu, Yu Ma, Neda Jalali, Li-Qun Fang, Zhi-Cong Yang, Yang Yang (preprint): Household Secondary Attack Rate of COVID-19 and Associated Determinants, doi: https://doi.org/10.1101/2020.04.11.20056010.

Why is this important?
• Household-based social distancing segregates society into those who are given the privilege of having physical contact with each other (families and couples living together) and those who will be denied these basic human needs for the foreseeable future for no reason other than their ‘household status’. An alternative must be found.
• Social distancing rules must treat all people equally, irrespective of whether they share a household or not. The household-based strategies contravene principles of equality and fairness.
• Scientific evidence shows that depriving people of direct physical & social contact puts them at increased risk of developing serious illnesses which can cause premature death. Depriving a large section of society of physical contact and touch for years to come (because of their household status) is likely to cause suffering and will exacerbate inequality.
• The rules I propose are simple in that they allow everyone to nominate a certain number of people they want to have physical contact with and an additional a number of people they want to have social contact with while observing physical distancing (depending on virus prevalence).
• This ‘managed network’ approach will prevent the segregation and division that is caused by static ‘household unit-based approaches’. It will deliver significant benefits to the mental and physical well-being of all people (not just a select few).