As World War I neared its end, a new and deadly threat emerged. The Spanish flu pandemic of 1918, caused by the H1N1 influenza virus, infected over a quarter of the world’s population and resulted in an estimated death toll of between 50 and 100 million people. This made it one of the deadliest pandemics in human history. During this time, cities across the United States were planning parades to promote liberty bonds to support the war effort in Europe.

In September 1918, Philadelphia, Pennsylvania, despite knowing that 600 soldiers were already infected with the flu virus, decided to proceed with their parade. Meanwhile, Saint Louis, Missouri, chose to cancel their parade and implement measures to limit public gatherings. One month later, Philadelphia had more than 10,000 deaths from the Spanish flu, while Saint Louis had fewer than 700 fatalities. Although the parade was not the sole factor in the difference in death rates, it highlighted the importance of measures now known as “social distancing” during pandemics.

Fast forward a little over 100 years, the world faces another pandemic caused by the COVID-19 coronavirus. With the global population six billion higher than in 1918, and despite the differences in the viruses, the lesson remains clear: social distancing can make a significant difference in controlling the spread of disease.

The Science of Social Distancing

Social distancing aims to reduce interactions between people to prevent the spread of infections through a population. Unlike self-isolation, which focuses on individuals who are infected or have been in contact with infected people, social distancing applies to the broader population to minimize the overall risk of transmission.

Evidence suggests that staying at home and maintaining a safe distance from others can slow the spread of infections. According to the World Health Organization (WHO), the basic reproduction number (R0) for the new coronavirus hovers around 2 to 2.5. Research in Wuhan showed that large-scale control measures reduced the R0 from 2.35 to nearly one. When R0 is around one, the number of cases stabilizes because each infected person is only passing the virus to one other person.

The basic reproduction number, R₀, is defined as the expected number of secondary cases produced by a single (typical) infection in a completely susceptible population. It describes what would happen if an infectious person were to enter a fully susceptible community, and therefore is an estimate based on an idealised scenario.

Historical Practices of Isolation

The concept of isolating the sick to prevent the spread of disease is not new. For instance, Lord Jagannath, a deity in the Jagannath Temple in Puri, Odisha, undergoes a period of isolation annually after a ceremonial bath to recover from illness. This tradition has been observed for about a thousand years. During this period, the deities are treated with specific Ayurvedic medicines and are only offered fruits and water.

During the bathing festival (Snana Purnima) the Deities of the temple have a bath with 108 pots of cold water to fight the heat of summer. After this royal bath ceremony, the three Deities fall sick and are taken to ”Anasar Ghar” (isolation room) where they undergo treatment and recover after 14 days. During the stay of deities inside the Anasar Ghar, the deities are offered only fruits and water mixed with cheese and Dashamula medicines to cure fever and are treated by the Raj Vaidya with specific medicines. Dashamula (in English it means ten roots) is an Ayurvedic medicine practised in India for ages to cleanse and treat various types of health issues. The devotees are not allowed to have a darshan of the Holy Trinity. This period is known as the ‘Anasara’ or ‘Anavasara’ period commences from Jyestha Purnima and ends with Ashadha Amavasya of the Hindu calendar.

Similarly, in his seminal work, ‘The Canon of Medicine,’ published in 1025, the Persian polymath Ibn Sina advocated for a 40-day quarantine to curb the spread of contagious diseases. This ancient wisdom underscores the effectiveness of isolation and quarantine, principles that are being revisited in the fight against COVID-19.

Modern Social Distancing

Social distancing today involves measures such as avoiding large gatherings, working from home, and maintaining a physical distance from others in public spaces. These measures aim to “flatten the curve,” reducing the number of simultaneous infections and preventing the healthcare system from becoming overwhelmed.

The incubation period for COVID-19, the time between infection and the appearance of symptoms, is around five days but can extend up to 14 days. If infected individuals continue to socialize normally, they can pass the virus to multiple others, leading to exponential growth in cases. By limiting social interactions, we can significantly reduce this spread.

The Role of Technology and Community

Despite the physical separation required by social distancing, technology allows us to stay connected. Social media, messaging apps, and video calls enable us to maintain relationships and support networks while adhering to public health guidelines.

A Collective Responsibility

Coronavirus is a socially transmitted disease, and we all share a responsibility to prevent its spread. Although cancelling events, moving activities online, and altering our daily routines may be inconvenient, these actions are crucial for the greater good. By listening to public health authorities and adapting our behaviour, we can protect our communities, ensure that healthcare systems remain functional, and ultimately save lives.

Conclusion

The concept of social distancing is rooted in historical practices and proven scientific principles. By applying these measures, we can effectively combat the spread of COVID-19, protect vulnerable populations, and uphold our social contract to care for one another. Stay safe, practice social distancing, and help flatten the curve to break the chain of infection.