key: cord-0750075-slcez4yt
authors: Bhadoria, Ajeet Singh; Mishra, Surabhi; Mohapatra, Archisman; Singh, Anjana; Kant, Ravi; Nundy, Samiram
title: Physical distancing amidst social connectivity: time to re-visit ‘social distancing’ as India fights COVID-19
date: 2020-05-26
journal: Curr Med Res Pract
DOI: 10.1016/j.cmrp.2020.05.008
sha: 4e537bfb2176341d64fa585317dbab5e033a3dfe
doc_id: 750075
cord_uid: slcez4yt

nan

On the 30 January 2020 [1] the World Health Organization (WHO) declared the present 2019-novelCorona virus (2019-nCoV) disease (COVID-19) epidemic to be a Public Health Emergency of International Concern (PHEIC). Coincidentally, on same day India reported its first index COVID-19 case in Kerala in someone who had recently been in China [2] . Since then, India has been on a 'war-footing' against a possible manor 2019-nCoV outbreak to prevent its community transmission and a possible spike in cases. In this regard, the central Government(GoI) has been implementing multiple concurrent countermeasures in coordination with State Governments. [3, 4] This includes active airport screening, quarantining, 'working from home', and case detection with contact tracing. The country has been under a nationwide lockdown. [3, 4] since 24 th March 2020 and efforts are being scaled-up to create public awareness to practice 'social distancing'. [5] [6] [7] [8] 'Social distancing' is a broad term referring to a set of multiple nonpharmaceutical interventions that are clubbed together under a common umbrella. [9] These include prohibition of mass gatherings, maintaining a one metre safe physical distance between individuals, voluntarily staying-at-home, avoiding physical contact and touching any inanimate object that might have a potential fomite. [9] It helps to prevent a sharp peak of infections or, in other words, 'flattens the epidemic curve', and thus, prevents the risk of our healthcare system becoming overwhelmed. The Prime Minister (PM) of India in his addresses to the nation regarding COVID-19 situation has repeatedly emphasized the importance of 'social distancing' in our fight against this deadly pandemic. [10, 11] Yet, there have been violations.

We here, consider four such instances that have left country concerned, and have potentially threatened, if not compromised our efforts at containment a) Migrant exodus: The nation-wide lockdown has been an exceptionally tough decision. We cannot recall a similar example in history when 1.3 billion people have been forced to stay in their respective homes for such a long period. In a democratic country like India, this requires collective accountability. It has also implied that a large number of people lost their reason to stay where they were asked to stay! In a week after lockdown was declared, various parts of country reported a massive exodus of migrant workers from urban to rural areas. [12, 13] It created chaos at the inter-state fringes and lead to a more stringent sealing of borders. [7, 14, 15] Workers were sprayed with disinfectants in a desperate effort to sanitize them as all the guidelines of 'social distancing' appear to have been flouted. [16] Photographs of heavily crowded Anand Vihar bus terminus will stay in our country's memory for a long time. [12] b) Tablighi Jamaat epicentre: Little did the Delhi administration know that thousands of religious delegates from several countries, including those affected by COVID-19, had arrived in the national capital despite stringent restrictions on mass congregation. [17] The ceremonies continued for some days just before the country went under a lockdown resulting in several delegates being stranded at the congregation venue while others spread themselves across this country and abroad. [17, 18] Consequently, it has soon turned out to be a nightmare for our COVID-19 surveillance and contact tracing efforts. [19] The Tablighi Jamaat today is being considered to be the biggest single source for 2019-nCoV in South Asia with several cases and deaths linked to those who attended the congregation while many participants vanished elsewhere or merged into India's huge population. [19] c) Janata curfew and 'Go Corona!' rallies: On March 22 2020, India observed a '14-hour self-quarantine' (Citizen's 'Janata curfew'). [20] Three days ago, our Prime Minister had urged his fellow countrymen to practice 'social distancing' amidst restriction of outdoor movement while lauding our dedicated health workers. [20] Although most of the country responded favourably to his call for solidarity [20] , there were incidents where people in their excitement thronged the streets in a celebratory mood shouting slogans of "Go Corona!''. [21, 22] These ignorant and irresponsible acts posed serious health risks to hundreds of people and defeated the very philosophy of 'social distancing'. It has also meant that our country has far to go before 'social distancing' gets embedded into our psyche -because the war against COVID-19 is poised to be a long drawn one. d) Long queues and panic purchasing: Despite reassurances of the door-step availability of essential goods, people anxiously lined up near corner shops immediately after the lockdown was announced. [23, 24] Shopkeepers from different parts of India later came with their own innovative ways to ensure physical distancing as customers queued up to buy goods in the market. [25, 26] Some drew circles that were 1 metre apart from one another while others put up barricades near their counters to ensure a safe distance between vendors and their customers. [25, 26] Today, when the country is under a lockdown this implies that everyone has to 'stayat-home compulsorily' [27, 28] , and automatically rules out any 'mass gatherings'. Even if the lockdown is later implemented in a mild-to-moderate intensity or eased-off slightly, the practice of 'social distancing' must continue. Physical contact like handshakes, hand-holding or hugs, must be avoided. [9] The World Health Organization adds that physical distancing shall continue to play a central role even when the country has reached Level 3 of COVID-19 transmission, i.e. the time when it will be almost impossible to identify all cases and contacts, and everybody must maintain a safe physical distance from everybody else as being the only feasible remedial measure. [29] However, worryingly, a report from the Centre for Diseases Control and Prevention (CDC) in the USA on aerosol distribution characteristics of 2019-nCoV, indicates that its transmission distance might be 4 metres (>13 feet) -more than twice currently recommended safe physical distancing guidelines. [30] Effective implementation of preventive interventions requires societal efforts and commitment. Today as we Indians exhibit solidarity despite anxiety, seeking social connectivity with family members, neighbours, and friends can help maintain positive mental health. Restricted at home, technology has come to our rescue. Internet and social media are keeping people socially connected via a virtual world without even sharing the same physical space. Even the WHO [29] and Government of India [31] are using these platforms to increase public access to reliable information on COVID-19 through different media, like, WhatsApp, Facebook, and Twitter,. We have also realized that the buzzword 'social distancing' may be misinterpreted with some people misunderstanding its connotations and drawing themselves away from all forms of social connectedness? 'Physical distancing' is being suggested to be a more 'clear' term. More important than changes in our technical vocabulary our people have to imbibe certain behavioural changes -spanning realms of equity (migrant labourers), religion (Tablighi Jamaat), nationalism ("Go Corona!") and mundane living pursuits (like panic purchases). It seems COVID-19 and social distancing are both here to stay for the foreseeable future.

Rolling updates on coronavirus disease (COVID-19)

Government of India. Government of India issues orders prescribing lockdown for containment of COVID19 Epidemic in the country

Ministry of Home Affairs. Press Information Bureau. MHA writes to States to ensure Smooth Harvesting and Sowing Operations, while maintaining Social Distancing, during 21-day Lockdown to fight COVID-19

Display nation's collective spirit against COVID-19 by lighting up diyas: PM Modi. National News

Advisory on Social Distancing Measure in view of spread of COVID-19 disease. Government of India

As per the directions of the Prime Minister, Government commits all support to Migrant Workers during lockdown period: ShriAmit Shah. Government of India

Delhi coronavirus health bulletin: 53 TablighiJamaat attendees test positive from NizamuddinMarkaz

Coronavirus: Nizamuddin'sTablighiJamaat has doubled cases in India. Livemint. New Delhi. Updated: 05

India embraces social distancing to fight novel coronavirus

Indians come out in hordes to celebrate Modi's call for social distancing

Ahmedabad Mirror. Social distancing turns 'anti-social

People rush to stock up on essentials amid Covid-19 outbreak

The Economic Times. Social distancing: Circles, squares drawn outside Maharashtra shops

Fighting Coronavirus With Squares, Circles: Social Distancing At Stores

Government of India. Ministry of Home Affairs. Consolidated guidelines of MHA on lockdown measures on containment of COVID-19

The coronavirus spreads at least 13 feet, travels on shoes: CDC

Government of India. COVID-19.#Indiafightscorona. New Delhi. India. Available at