Covid-19: the virus is only six degrees of separation away from us all

For some healthcare workers covid-19 has crossed the boundary from their professional into their personal lives, affecting how they feel about their work, explains Sukhpreet Singh Dubb

The word “pandemic” originates from the Greek “pándēmos” meaning of “all people.” 

The six degrees of separation theory says that any one person is only six connections away from any other person.1 An alternative view I have found is that a patient with covid-19 may only be six spheres of relationships away from healthcare workers.

These six relationship spheres, as I see them, are the general public in the outer sphere, then members of the NHS, members of your department, your extended family, your immediate family, and finally yourself. 

As the covid-19 crisis became a pandemic, I heard about members of the public suffering from coronavirus, but beyond the compassion of empathising with another person’s suffering I continued my daily practice seemingly unaffected. 

Gradually rosters were reorganised, redeployment measures undertaken, and the world outside the hospital began to change as schools and nurseries were closed and social distancing measures became mandatory. The virus remained; however, in my very outermost sphere of relationships.

The impact of the virus became more pronounced when I heard that members of the NHS had become ill. Suddenly this infection was not in the world outside of the hospital, but had entered our workplace, despite all the measures we had supposedly put in place to keep patients and ourselves safe. Work emails, handovers, and professional conversations soon focused on the ongoing pandemic which had found itself on our doorstep.  

Next came members of my own department; my work family was now being affected. Despite the hand-sanitisers, the personal protective equipment (PPE) and keeping all but the most vital patients and staff members away, coronavirus had managed to penetrate deep within my sphere of relationships. 

I was constantly rechecking PPE protocols and obsessively hand washing and double-checking the importance of every patient encounter. The line between work and home was now blurred. Initially jovial telephone conversations with family on managing with the lockdown now became frantic daily checks to ensure safety. Hand hygiene, social distancing, and the most recent covid-19 updates became the common themes of every discussion with everyone, in both my professional or personal lives. 

It was not long after that I heard that both my extended and immediate family were affected and soon the death of a loved one brought covid-19 into my most intimate sphere of relationships. Gone was the protection afforded by the distance of outer spheres, this pandemic had transitioned easily from distant professional relationships into my personal relationships. 

This rapid succession of events took place in less than six weeks. Suddenly the normal safety nets against life events felt absent. The loss of social and physical connections, loss of freedom of movement, and the feeling of being unsafe all compounded the effect of suffering a bereavement. 

Grief is described as a cognitive process that we must work through in order to process a loss.2 However, covid-19 made this feel almost impossible because I was constantly faced with the pandemic at work. There was no leaving work at work, covid-19 respected no boundaries and recognised no distinction between personal or professional. 

Any loss suffered at any level is always devastating yet this was made more difficult by the fact that funerals were held remotely, denying the closure often felt through a simple embrace. Stories of similar losses shared on social media became more relatable, but were also painful to read and renewed those feelings of loss. 

Be it a self-defence mechanism or a way to cope, I compartmentalised my feelings in order to perform dispassionately at work. I made an active effort to treat each patient fairly and not see in them friends and family who had either suffered or fallen to this disease. However, my advice became more passionate and referrals that could be managed at home more stringent. 

Distancing while at work no longer became a source of humour, but adopted and normalised, every action constantly analysed to reduce any unnecessary contact between patients and between clinicians. It seemed the only way to halt covid-19’s relentless march through my spheres of relationships was to almost abandon them altogether. 

The importance and need for self care, however, became more evident to me as delaying the grief process served only to accentuate negative feelings and there was a risk of chronic grief taking over. 

Taking breaks and disconnecting from the pandemic became ever more important and helpful. Technology helped to overcome the physical barriers from friends, family, and colleagues providing an important outlet. Social media and digital platforms reformed the ever important links between myself, family, work and the outside world without exposing them. 

Peer support and mentorship was similarly important. My support network at work became a surrogate for the personal and physical support network that I was missing due to my staying in hospital accommodation. There are also many NHS supported bereavement helplines that provide a confidential but supportive place to share. 

Now that covid-19 has reached the centre of my six spheres of relationships, it is clear just how lonely and afraid it can make you feel. It has also highlighted the importance of reaching back through each of these circles and beyond for the support that is available and readily given.   

Sukhpreet Singh Dubb is an Oral and Maxillofacial Surgery trainee based in Cambridge. He was the UK Ambassador at the White House and United Nations and invited to speak at the House of Commons about social mobility in Medicine. Sukhpreet is also a non-executive director and advisor to technology companies.

Competing interests: None declared.


  1. Hautz WE, Krummrey G, Exadaktylos A, Hautz SC. Six degrees of separation: The small world of medical education. Med Educ. 2016;50(12):1274-1279.
  2. Reed E, Waghorn M, Gregory A, Vriens J, Sills E, Todd J. Exploring the experience of returning to work after personal bereavement. Int J Palliat Nurs. 2019;25(11):525-530.