A fair network-based approach to social distancing

The government should consider replacing social distancing & isolation strategies that are based on ‘household units’ and/or ‘social bubbles’ with a ‘managed network’ approach that treats all people equally. The current proposals do not achieve this as they treat couples and families that live together in a very privileged manner while imposing severe physical and social isolation on single people living alone. 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 proposals 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. However, even when ignoring the fact that the household-based approach promotes inequality it is also a poor choiced with regard to controlling the spread of the virus. Engaging in close physical contact or sexual activity within the household is a guaranteed way of passing on 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). The ‘secondary attack rate’ of the virus for people living at the same residential address is 19% (Jing et al. preprint). In contrast, people living alone or single parents who occasionally meet each other outside of the household are less likely to transmit the virus. There is also limited evidence that suggests that standard social distancing protocols are just as effective as police-enforced ‘stay at home’ lockdowns (Meunier, preprint).* Finally, the example of Germany shows that it is possible to achieve a low death rate per capita (five times lower than in the UK) while still permitting two people to meet outside of the household. It is therefore time to scrap the legal concept of a ‘household unit’ or static ‘social bubbles’ and instead implement a ‘managed network’ approach to social distancing system that treats all people equally. I propose that government officials & scientists investigate, model & test the following measures and (if successful) implements them accordingly: 1.) Everyone should be permitted to have physical and social contact with at least one other person of their choice, 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 x more people while observing social distancing. 3.) People should be allowed to change the nominated person/people every z weeks. 4.) The numbers x and z should be determined in a modeling exercise and can be dynamically adjusted to the current estimate for R0. 5.) Should these measures be insufficient then full physical distancing should be imposed again on all people, irrespective of whether they share a household or not. This means that couples living together would also have to obey physical distancing within their household (just like everyone else). Parents and their children should be exempt since physical contact is irreplaceable in child development. 6.) The concept of a ‘household unit’ or ‘social bubble’ should be abandoned and the same rules should apply equally to all people irrespective of their living arrangements. 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. Meunier, T. (preprint): Full lockdown policies in Western Europe countries have no evident impacts on the COVID-19 epidemic. https://doi.org/10.1101/2020.04.24.20078717

Why the contribution is important

• Social distancing rules must treat all people equally, irrespective of whether they share a household. The household & social bubble-based strategies contravene principles of equality by imposing unfair treatment on people living alone and single parents. • 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. • The ‘managed network’ approach will prevent the segregation and division that would be caused by static ‘social bubbles’. It will deliver significant benefits to the mental and physical well-being of all people. • The household-based approach to social distancing is flawed, causes inequality & is poorly supported by data.

by TimE on May 08, 2020 at 01:44PM

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Comments

  • Posted by Paul1953 May 08, 2020 at 13:59

    Certainly seems a proposal that needs further investigation. What is appealing about this proposal is the detail and backup provided. It is for others to argue or modify.
  • Posted by Elkie May 08, 2020 at 14:21

    I agree, this would be fairer than the social bubbles.
  • Posted by alisond May 08, 2020 at 17:38

    Agree that household and social bubble models are really discriminatory against people who live alone, lots of good points here. Only bit I disagree with is conclusion that those who live together should ever be asked to physically distance. Inhumane for anyone to be excepted to live that way. Including those who live alone, which is why I otherwise agree with this.
  • Posted by TimE May 08, 2020 at 23:40

    alisond On second thought, I agree with your critique of this particular point (which is not key to the overall idea). I guess it was more of a thought experiment to highlight what's wrong with the current thinking. In hindsight, I'd remove it from the proposal.
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