In the past few weeks, you may have heard a few new terms regarding our healthcare and the global pandemic. Terms like isolation and quarantine may be somewhat familiar, but what about social distancing? What is it, why does it work, and what should I be doing right now?

Through social distancing, a large population can affect the spread of a contagious disease by using social distancing to reduce the points of contact between infected persons. It’s important to understand social distancing as a powerful public health tool.

“Without getting too bogged down in the science, there is a fundamental benefit to being ‘overly proactive’ early on instead of needing to be ‘overly reactive’ when disease really starts to pile up,” says Dr. Alistair Brown, professor of Advanced Issues in Environment and Human Health at the University of Manitoba. “The type of proactive things that we do drastically affect the outcomes in our families and communities.”

The Government of Manitoba held a news conference on March 17 to provide the latest COVID-19 update and recommendations. At that time, Manitoba had nine cases of COVID-19 and Chief Provincial Health Officer Dr. Brent Roussin explained that the vast number of cases in Canada are related to international travel, as they are in Manitoba.

“We still have not seen community-based transmission in our province, but… we need to keep focusing on our social distancing efforts now if we want to reduce the impact of this virus on Manitobans starting now. We should all understand our roles and look for ways to implement these in our day to day activities. This is not the time to go out in large groups of people. We will be getting back to those times. But now is not that time.”

Later on March 17, the province updated its number of cases to 15 and was looking into the travel information on the new cases. It now seems that a majority of those cases are travel-related, but perhaps not all.

At the news conference, Premier Brian Pallister used an illustration most Manitobans would be familiar with, saying that preparing for this disease to hit our communities is very much like a flood.

“The question isn’t whether or not the waters are coming,” Pallister said. “The question is whether they arrive at the same time or not. That’s why [social distancing] measures are being put in place… making sure we’re not inundated all at one time. Clearly, it’s in our best interests to work together and I believe Manitobans are up to that challenge.”

“To a certain extent, he’s right,” says Dr. Brown about Pallister’s analogy. “We have scientists who forecast spring conditions using a variety of factors and determine when we’re going to operate the floodway, how many areas require sandbagging, when we’re going to close the ring-dikes around towns, etc. We go through a ton of preparatory efforts in order to stand our ground and protect the greatest amount of people in the most efficient amount of time. But we won’t see the fruits of those labours until the river rises and the crest silently creeps its way up day after day. Manitobans are used to this kind of seasonal possibility and we’ve become really proud over how we handle this routine and how we look after one another’s needs.”

However, Dr. Brown points out the metaphor breaks down eventually. In a flood, there safe areas away from the crisis where people can flee, but COVID-19 is very contagious; it cannot be contained like a major flood. Nowhere is safe from its spread.

“We can’t outrun it, nor can we hide in the midst of it,” says Dr. Brown. “If we put ourselves in harm’s way, and it becomes too much to bear, the only area of refuge is the ICUs in the hospitals… [and those] beds are not dedicated to coronavirus, they are for all issues. Doing everything we can to not overload our healthcare infrastructure is the single most important thing that we are doing, and it requires earlier action, not later.”

Instead of a flood, Harry Stevens, a graphics reporter for The Washington Post who works on data-driven investigations, depicts the spread of COVID-19 using mathematics. Stevens wrote an article posted on March 14 on why outbreaks like coronavirus spread exponentially, and how to “flatten the curve.”1

Stevens’s graphics use moving dots to create a visual representation of how a virus spreads. He shows different simulations like quarantine, moderate social distancing, and extensive social distancing. The graphics are compelling and easily demonstrate the power of what nonpharmaceutical infection control actions can do.

“The spread can be slowed, public health professionals say, if people practice ‘social distancing’ by avoiding public spaces and generally limiting their movement,” wrote Stevens. “Moderate social distancing will usually outperform the attempted quarantine, and extensive social distancing usually works best of all.”

Dr. Brown compares two of Stevens’s graphic simulations. One shows 75 percent social distancing, where one in four people are still moving about conducting business and travelling, and visiting others for a variety of reasons.

“This drastically reduces the burden on healthcare in an immediate sense,” says Dr. Brown, “but prolongs how long we have to deal with this epidemic on a local scale. Eventually almost everyone gets sick, but more people recover, and there’s still a portion of the population that stays healthy the whole time.”

The next graphic shows a scenario where seven out of eight people choose to practice extensive social distancing.

“The reason 88 percent social distancing works so well is because there’s a personal buy-in, that we are contributing to the solution and my efforts need to be self-regulated instead of being told what to do,” Dr. Brown says. “That being said, there will always be people who don’t agree.”

Public health officials continue to recommend social distancing measures for all Manitobans. New actions announced include suspending daycare centres along with schools beginning March 23, immediately suspending adult day programs, and avoiding visitation to long-term care facilities (except for compassionate reasons or end of life, at the discretion of facility managers).

Urgent and life-saving surgeries and procedures will continue at healthcare facilities, but some surgeries may be delayed to protect patients who may be impacted by COVID-19. Affected patients will be contacted by their surgeon’s office directly.

Families with parents who provide essential services, such as frontline healthcare providers, will be offered access to childcare services by contacting 1-888-213-4754 (toll-free) or cdcinfo@gov.mb.ca as soon as possible.

The government has also said it is lobbying for early morning shopping hours for senior citizens.

“For restaurant and bar owners, strong recommendations from Manitoba Health are to reduce the impact on Manitobans,” said Dr. Roussin. “Groups of 50 or more should not be occurring. We could move to more enforcing abilities, but for right now it is a strong recommendation.”

The community-wide efforts on an individual level have been heavily stressed by the government. Anyone with flu-like symptoms or symptoms of COVID-19 are asked to call Health Links (204-788-8200 or 1-888-315-9257). Interactive voice response is being introduced to handle the high volume of calls. You can also use the new online screening service available at the Government of Manitoba website.

It is important not to use a walk-in clinic or show up at a screening site without receiving instruction from Manitoba Health to do so. Healthcare practitioners are trained in how to diagnose COVID-19 and will limit testing by necessity.

“If you do not have symptoms of COVID-19, you do not need to be tested,” said Dr. Roussin. “Healthcare practitioners do not test people who do not have symptoms. We are not helpless against this virus… these social distancing actions will reduce the impact of coronavirus in Manitoba.”

Dr. Brown strongly supports Dr. Roussin’s advice, saying, “The easiest thing to say is that we have never seen or faced anything like this before. I know that isn’t particularly helpful, but it’s the best way to describe how important it is to listen to authorities of public health and logistics. What is really important right now is to encourage people to do the right things in spite of not being able to see the fruits of these efforts for a while. The moral of the story is our ancestors were called to the front lines to fight wars so we could be free. In this war, we are called sit on our backsides and watch Netflix, and spend time with our families… I think we got this.”