By Michael J. Rigby
The COVID-19 pandemic poses a serious challenge to our existing healthcare infrastructure. Rapid spread of SARS-CoV-2 can easily overwhelm healthcare capacity, which can exceed the number of intensive care unit beds and ventilators. Once this threshold is surpassed, any serious yet treatable disease becomes life-threatening.
Without a vaccine or other preventive measures, control of the COVID-19 pandemic is best achieved by conventional epidemiologic techniques such as case quarantining, contact tracing, and social distancing. While COVID-19 is most detrimental to those with preexisting conditions and older persons, serious infection and death can occur at any age. Due to the ability to transmit virus even asymptomatically, we all have a shared responsibility to engage in social distancing to avoid a rapid surge in cases that could overwhelm our healthcare capacity. These measures have successfully suppressed of spread of SARS-CoV-2 in countries like South Korea and China.
An expected yet important consequence of these drastic social distancing measures includes suppression of other transmissible respiratory viruses like influenza, parainfluenza, and respiratory syncytial virus. Many of these respiratory viruses circulate every year in seasonal pattern, which may be significantly mitigated by well-timed social distancing measures. However, these actions are rarely considered. For influenza, there is a vaccine available that is relatively effective depending on the year. Additionally, there are antiviral medications like oseltamivir available for post-exposure prophylaxis and treatment of active influenza infection. Regardless of these measures, on average, the United States reports 9-45 million cases and 12,000-16,000 deaths from influenza each season since 2010.
Technically speaking, there is a cost to social contact with the existence of these easily transmissible viruses – that cost is human life. As a result, if we were to practice social distancing measures for seasonal respiratory viruses, lives could be saved. In fact, with social distancing measures put in place for COVID-19 in the United States, there was a precipitous drop in influenza cases; this may have been a direct effect of the precautions, suppressing influenza virus transmission in the community. There may have also been decreases in transmission of other respiratory viruses that are causative for croup and bronchiolitis, which could mean fewer hospitalizations and deaths associated with these pediatric diseases.
The unique features of SARS-CoV-2 that separate it from other respiratory viruses include high transmissibility, high mortality rate without any existing immunity, and potential to overwhelm the healthcare system. These are seldom the case for seasonal respiratory viruses except in the rare circumstance of genetic shift in the influenza virus, which can cause pandemic-worthy strains. The asymptomatic transmission is also relevant, which may be more prevalent for SARS-CoV-2 compared to other respiratory viruses.
The important consideration is which of these viral characteristics are sufficient to meet a threshold to enact social distancing measures. Whether it is the mortality of the viral-induced disease, the potential to surpass the healthcare system capacity, or the target population of the disease are all to be pondered. Due to the potential to save lives, perhaps the characteristics that invoke strict containment measures such as social distancing ought to be considered for less severe viruses like non-pandemic influenza strains. Beyond mortality, reduced viral transmission may also prevent hospitalization, which can both save healthcare dollars and potential spread of nosocomial disease.
Social distancing has other health benefits beyond the suppression of viral transmission, such as a reduction in air pollution from decreased travel and manufacturing. Air pollution is a well-characterized trigger for asthma, and improvements in air quality can decrease the frequency and severity of asthma exacerbations. Reduced automobile travel can also reduce injuries and deaths from motor vehicle accidents. These all could be additional lives and hospitalization events saved as a result of social distancing.
The social distancing measures considered here would not have to be as drastic as those for the COVID-19 pandemic. Well-timed school closures and at-home work on the time scale of weeks could be enough to save lives. There is an important balance to strike as long periods of social distancing can be detrimental to both the economy and mental health. The balance would need to maximize benefit, such as significantly reduce viral transmission, while minimize harm to individuals through loss of pay or productivity. It would be imperative to ensure that social distancing does not restrict access to healthcare such as through the loss of wages or employer-based insurance.
In order to make periodic social distancing measures practical, the government would have to be well-prepared to quickly enact and lift restrictions based on advice from local public health officials. Conveniently, the COVID-19 pandemic has forced various industries to adapt with social distancing measures, such as elementary school teachers creating virtual lesson plans. These changes in operating procedures would have to be well-refined in order to become acceptable for periodic use. Additionally, communities would have to be willing to adapt to periods of social distancing as cooperation is imperative for effectiveness.
The COVID-19 pandemic is a wakeup call. While not overwhelmingly popular, we can save lives with social distancing measures beyond the current pandemic. Perhaps we should consider some degree of well-timed social distancing during seasonal respiratory virus epidemics to save lives.
Author(s): Michael J. Rigby
Affiliations: University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
Competing interests: None.
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