Social distancing sign, Tempe, Arizona. Credit: David H. Guston
Three potentially momentous changes may end up reshaping how the United States and world manage the COVID-19 pandemic in 2021.
First, vaccines. While vaccine roll-out has been logistically challenging and slowly implemented, the vaccines now available may begin to stem the tide of infection and death — about 25 million cases and more than 440,000 deaths in the US alone as we write. The US had administered more than 33.5 million doses as of February 2nd, with more capacity being added daily.
Second, leadership. The new administration of President Joe Biden and Vice President Kamala Harris plans important changes in how the federal government addresses the COVID-19 pandemic. Their proposed program includes $160 billion for a national vaccine program and $50 billion more for expanded testing, and they have emphasized experienced scientific leadership in key posts.
Third, mutations. SARS-CoV-2 is a relatively stable virus, with its own mechanisms for correcting genetic errors. Nevertheless, as it persists over time in a large population, it inevitably mutates. A new, more transmissible strain has arisen that the Centers for Disease Control and Prevention now think may become dominant in the US by March.
Even without new mutations, there are important reasons why the situation for most of us will still take time to change. No vaccine is 100% effective, we don’t fully know if the vaccines prevent transmission of the virus as well as infection, and we don’t fully know whether the vaccines will prevent infection by any new mutations. We thus need to continue to engage in appropriate behaviors, including new suggestions from the Biden administration, to reduce the toll of the pandemic and create the best opportunity for a return to robust social and economic activity.
Many of those appropriate behaviors have been reduced to the concept of “social distancing,” which usually means wearing a mask over mouth and nose and staying six feet apart, and the closure of facilities such as schools and bars in which these behaviors are unlikely. We fully support such practices. Indeed, unlike some Republicans in the House of Representatives who rejected “political” wearing masks while they were sheltering in close quarters, we see these practices as informed by the best public health knowledge.
We do, however, want people to reconsider using “social distancing” for such behavior. We have researched the origins of the term in sociology from the early 20th Century and the evolution of its use, and we think that the socially distant place that we have found ourselves one year into the COVID-19 pandemic may in important ways be a consequence of our being asked to “social distance” ourselves. Let us explain.
We can trace the term “social distance” back to 1924, when sociologist Robert E. Park used it to describe feelings of difference among people from different racial and class groups. Shortly thereafter, sociologist Emory S. Bogardus created what became known as the “Bogardus Social Distance Scale,” which measures degrees of social distance felt between people of different races. In related work, Bogardus argued that “social distance continues to exist after spatial distances have been eliminated.” These early creators of the term made a clear conceptual distinction between social distance, or a feeling of connectedness attenuated by race, class, and gender, and a more material, spatial, or physical distance between bodies. Later sociologists reconnected social and physical distance, especially in the context of race. In 1973, Earnest A. Bauer found that white participants stand further away from black participants than they do from other whites — suggesting that physical or spatial distance reflects social distance.
It took more time for the phrase to jump to medical contexts. One early use was in 1989 by Australian linguist Vera Henzl, who addressed how physicians interpret their social distance — in the earlier sense — from patients and use spoken language to reflect and communicate this status. More connections between social distance and public health topics, including HIV/AIDS, followed.
Nearly in parallel to these developments, statistical models of infectious disease incorporated the physical distance between people as an important element of their analyses. One of the simplest ways of modeling the spread of infectious diseases mathematically is to compartmentalize people into three basic categories: “susceptible” (uninfected or able to be re-infected), “infectious” (able to spread the disease to others), and “recovered” (no longer have the disease and cannot get it again). The simplest versions of these models reduce individuals to uniform units that move without friction among these categories, generating rough estimates of how a disease might spread among a population. More complicated models introduce factors like death, underlying health conditions, and the physical, measurable distance between individuals to refine these estimates.
This “social distance” as seen by the statistical modelers, however, is different than that discussed by the sociologists. In statistical modeling, a complicated factor like how far apart people stand in crowded rooms is impossible to capture precisely. Nuances like how physical distance is functionally rendered by the social distance among race, class, and gender get left out, even as such details are crucial in understanding how readily the virus might move from one to another.
In March 2004, the World Health Organization (WHO) embraced the term “social distance” as public health jargon to promote strategies to organize ourselves personally and collectively in physical space. WHO held a “consultation on priority public health interventions before and during an influenza pandemic,” during which one Dr. R. Lam (who we have not been able to identify) talked about non-medical interventions, including “measures to ‘increase social distance ‘ (such as cancellation of mass gatherings and closure of schools).” This statement may mark the earliest use of the term social distance in the context of contemporary public health measures, and the term then appears to have gone viral, appearing in multiple WHO documents and spreading to other public health organizations, including the US Human and Health Services Pandemic Influenza Plan issued in November 2004.
In March 2020, however, just as people were learning what social distancing was supposed to mean, WHO stepped away from the term. Dr. Maria Van Kerkhove, WHO’s technical lead on COVID-19 response, emphasized “keeping the physical distance from people so that we can prevent the virus from transferring from one another….But it doesn’t mean that socially we have to disconnect from our loved ones, from our family”. Yet this recommendation has not really taken hold, and people continue to be asked to keep “social distance.”
Sign asking for ‘a social distance’ at an outdoor restaurant in Tempe, AZ. Photo credit: David Guston
Limiting the contact of individuals by increasing their physical distance has been an effective strategy of infectious disease control since long before the term “public health” existed. During the Spanish Flu outbreak in 1919, US cities took now-familiar measures to shut down places of public gathering and limit contact between human bodies. Chicago and New York City were outliers in their decision to keep schools open, as many of their students were less safe with families who lived in cramped, tenement housing where indoor air quality and access to healthcare was poor.
Such decisions encompass many of the social and cultural issues that the term “social distance” currently abstracts from. While we are all safer in the pandemic with more physical distance between us, we are not all equally capable of refraining from social gatherings like families, schools, health care, religious institutions and even some commercial establishments which are provide support, growth, and even a needed safety net for vulnerable populations. We clearly see a disparate impact of COVID-19 regarding race and class in the US, which we may reflexively explain with reasons related to medicine or genetics. We have forgotten, even while using the term social distance, how important race and class are for long-term pandemic management.
So we join with Dr. Van Kerkhove and WHO in attempting to turn the language of social distance into physical distance. She emphasizes how contemporary technologies, presumably information and communication technologies, can help overcome physical distance to permit social proximity. But it is also true that social media can increase feelings of isolation, so such an approach has important limits. President-elect Biden’s plan contains not only public health investments but also $130 billion to help K-12 schools to reopen safely. Such resources should help them innovate toward resilient ways of keeping students, teachers and staff safe while learning together.
Physical distance is the point, as is maintaining social connections. We can’t let this pandemic continue to fracture our social bonds. So let’s stop calling for social distancing, and instead call for — and invest in — both physical distancing and social connections.
1. Bogardus, E. S. (1925). Social distance and its origins. Journal of Applied Sociology, 9(2), 216–226.
2. Bauer, E. A. (1973). Personal space: A study of blacks and whites. Sociometry, 402–408.
3. Henzl, V. M. (1989). Linguistic means of social distancing in physician-patient communication. Doctor-Patient Interaction, 77–91.
4. WHO (2004). Consultation on priority public health interventions before and during an influenza pandemic, 16–18 Mar 2004
5. WHO (2020). Press Briefing on COVID 19, 20 Mar 2020.
6. Aimone F. (2010 ) The 1918 Influenza Epidemic in New York City: A Review of the Public Health Response. Public Health Reports. 71–79.