Skip to main content

Main menu

  • Home
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • COVID-19 Articles
  • Authors & Reviewers
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
    • Open access
    • Patient engagement
  • Members & Subscribers
    • Benefits for CMA Members
    • CPD Credits for Members
    • Subscribe to CMAJ Print
    • Subscription Prices
    • Obituary notices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2023
    • Avis de décès
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN

User menu

Search

  • Advanced search
CMAJ
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN
CMAJ

Advanced Search

  • Home
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • COVID-19 Articles
  • Authors & Reviewers
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
    • Open access
    • Patient engagement
  • Members & Subscribers
    • Benefits for CMA Members
    • CPD Credits for Members
    • Subscribe to CMAJ Print
    • Subscription Prices
    • Obituary notices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2023
    • Avis de décès
  • Visit CMAJ on Facebook
  • Follow CMAJ on Twitter
  • Follow CMAJ on Pinterest
  • Follow CMAJ on Youtube
  • Follow CMAJ on Instagram
Editorial

Social distancing to combat COVID-19: We are all on the front line

Kirsten Patrick, Matthew B. Stanbrook and Andreas Laupacis
CMAJ May 11, 2020 192 (19) E516-E517; DOI: https://doi.org/10.1503/cmaj.200606
Kirsten Patrick
Executive editor, (Patrick); deputy editor, (Stanbrook); Department of Medicine (Stanbrook), University of Toronto, Toronto, Ont.; editor-in-chief, (Laupacis)
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Matthew B. Stanbrook
Executive editor, (Patrick); deputy editor, (Stanbrook); Department of Medicine (Stanbrook), University of Toronto, Toronto, Ont.; editor-in-chief, (Laupacis)
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Andreas Laupacis
Executive editor, (Patrick); deputy editor, (Stanbrook); Department of Medicine (Stanbrook), University of Toronto, Toronto, Ont.; editor-in-chief, (Laupacis)
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Tables
  • Related Content
  • Responses
  • Metrics
  • PDF
Loading

See related research at www.cmaj.ca/lookup/doi/10.1503/cmaj.200457 and www.cmaj.ca/lookup/doi/10.1503/cmaj.200476

Self-isolation of people with mild coronavirus disease 2019 (COVID-19), quarantine of those exposed, and social distancing for the rest of us constitute Canada’s current reality. New research has modelled the probable effects of self-isolation1 and different approaches to social distancing2 on the demand for critical care services in Canada. The results are sobering.

Shoukat and colleagues find that without social distancing even faithful adherence to self-isolation directives for those infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) will not prevent critical care services from being overwhelmed in all Canadian provinces.1 Tuite and colleagues, modelling Ontario data and looking instead at the effects of social distancing, find that only strict social distancing measures of long duration will flatten the epidemiological curve.2 They modelled over 2 years both “fixed” social distancing, in which strict measures remain the same over time, and “dynamic” social distancing, in which strict measures are intermittently relaxed and reintroduced based on thresholds of intensive care unit (ICU) occupancy.

Dynamic social distancing amounts to gaming of the epidemiological curve, allowing COVID-19 case numbers to wax and wane over time so long as a manageable burden is maintained for critical care services. Tuite and colleagues consider that such an approach, while achieving the goal of not overwhelming our health systems, would also allow people some respite from the psychological and other adverse health effects of prolonged physical distancing and possibly mitigate some economic effects too.

Long-term social distancing will be tough, but current best estimates make it clear that if we don’t do it we will see Canada’s health systems buckle like those in Italy and New York. Not doing it well would mean too many avoidable deaths, national grief and health care workers being subjected to the terrible moral injury of having to choose who gets access to life-saving resources. The findings of the modelling studies underscore a point made many times in recent weeks: health care workers are not the front line; they are our last line of defence.

Although some of us have quickly adjusted to new normals, such as physical spacing at grocery stores and working from home, social distancing is already unbearable for people without a home in which to shelter, those who may be exposed to harm at home and those who have lost their employment. Communities will need to organize to support vulnerable people to self-isolate or practise social distancing.

Canada’s public health leaders and politicians, some of whom have been fierce adversaries, appear to be working well together to deliver consistent messaging. Given this new evidence, however, our leaders now need to communicate clearly that Canadians will likely need to embrace social distancing for much longer than previously indicated. If people in the community are the front line, then presenting evidence transparently and acknowledging uncertainties will be essential to maintain their trust.

All models are limited by their assumptions and the data available to run them. This is exemplified by the quite different assumptions made by the authors of the 2 modelling studies and their use of different sets of data available at different times. Enhanced capacity to test for SARS-CoV-2 in Canada might change the data feeding into models and result in different projections. Observed rates of illness among health care workers may lead to altered assumptions about ICU capacity. However, planning with the results of limited models is preferable to planning without them.

With a preventive vaccine unlikely to be widely available in the next couple of years3 and no antiviral treatment of certain effect currently available, COVID-19 is going to threaten Canada’s health systems for a long time. These 2 quite different models confirm that short-term public health measures, incompletely observed, will do nothing but delay the time until our critical care capacity is overwhelmed. That means it’s time for our leaders to trust the public with the truth about long-term measures and be explicit about what people need to anticipate. It’s time for governments to build on initiatives such as housing homeless people in hotel rooms and supplementing lost income to ensure that all people in Canada can practise social distancing safely and with as little hardship as possible. And it’s time for people practising social distancing to understand their immense responsibility at the front line. Health care workers, and future patients, are depending on all of us to slow the spread of SARS-CoV-2.

Footnotes

  • Competing interests: See www.cmaj.ca/site/misc/cmaj_staff.xhtml

References

  1. ↵
    1. Shoukat A,
    2. Wells CR,
    3. Langley JM,
    4. et al
    . Projecting demand for critical care beds during COVID-19 outbreaks in Canada. CMAJ 2020 Apr. 8 [Epub ahead of print]. doi: 10.1503/200457.
    OpenUrlCrossRef
  2. ↵
    1. Tuite AR,
    2. Fisman DN,
    3. Greer AL,
    4. et al
    . Mathematical modelling of COVID-19 transmission and mitigation strategies in the population of Ontario, Canada. CMAJ 2020 Apr. 8 [Epub ahead of print]. doi: 10.1503/200476.
    OpenUrlCrossRef
  3. ↵
    1. Lurie N,
    2. Saville M,
    3. Hatchett R,
    4. et al
    . Developing COVID-19 vaccines at pandemic speed. N Engl J Med 2020 Mar. 30 [Epub ahead of print]. doi: 10.1056/NEJMp2005630.
    OpenUrlCrossRefPubMed
PreviousNext
Back to top

In this issue

Canadian Medical Association Journal: 192 (19)
CMAJ
Vol. 192, Issue 19
11 May 2020
  • Table of Contents
  • Index by author

Article tools

Respond to this article
Print
Download PDF
Article Alerts
To sign up for email alerts or to access your current email alerts, enter your email address below:
Email Article

Thank you for your interest in spreading the word on CMAJ.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Social distancing to combat COVID-19: We are all on the front line
(Your Name) has sent you a message from CMAJ
(Your Name) thought you would like to see the CMAJ web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Social distancing to combat COVID-19: We are all on the front line
Kirsten Patrick, Matthew B. Stanbrook, Andreas Laupacis
CMAJ May 2020, 192 (19) E516-E517; DOI: 10.1503/cmaj.200606

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
‍ Request Permissions
Share
Social distancing to combat COVID-19: We are all on the front line
Kirsten Patrick, Matthew B. Stanbrook, Andreas Laupacis
CMAJ May 2020, 192 (19) E516-E517; DOI: 10.1503/cmaj.200606
Digg logo Reddit logo Twitter logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like

Jump to section

  • Article
    • Footnotes
    • References
  • Figures & Tables
  • Related Content
  • Responses
  • Metrics
  • PDF

Related Articles

  • Projecting demand for critical care beds during COVID-19 outbreaks in Canada
  • Mathematical modelling of COVID-19 transmission and mitigation strategies in the population of Ontario, Canada
  • Long-term social distancing during COVID-19: A social isolation crisis among seniors?
  • Éloignement social pour lutter contre la COVID-19: nous sommes tous en première ligne
  • PubMed
  • Google Scholar

Cited By...

  • Evaluating ten commercially-available SARS-CoV-2 rapid serological tests using the STARD (Standards for Reporting of Diagnostic Accuracy Studies) method
  • Evaluating 10 Commercially Available SARS-CoV-2 Rapid Serological Tests by Use of the STARD (Standards for Reporting of Diagnostic Accuracy Studies) Method
  • Long-term social distancing during COVID-19: A social isolation crisis among seniors?
  • Google Scholar

More in this TOC Section

  • Regard sur la santé des personnes noires et le racisme anti-Noirs dans les systèmes de santé au Canada
  • A focus on access to health care in Canada
  • L’avenir de la médecine est ici et vous en êtes la trame narrative
Show more Editorial

Similar Articles

Collections

  • Topics
    • Critical & intensive care
    • Emergency medicine
    • Health services
    • Infectious diseases
    • Infectious diseases: COVID-19
    • Public health
    • Vulnerable populations

 

View Latest Classified Ads

Content

  • Current issue
  • Past issues
  • Collections
  • Sections
  • Blog
  • Podcasts
  • Alerts
  • RSS
  • Early releases

Information for

  • Advertisers
  • Authors
  • Reviewers
  • CMA Members
  • CPD credits
  • Media
  • Reprint requests
  • Subscribers

About

  • General Information
  • Journal staff
  • Editorial Board
  • Advisory Panels
  • Governance Council
  • Journal Oversight
  • Careers
  • Contact
  • Copyright and Permissions
  • Accessibiity
  • CMA Civility Standards
CMAJ Group

Copyright 2023, CMA Impact Inc. or its licensors. All rights reserved. ISSN 1488-2329 (e) 0820-3946 (p)

All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association or its subsidiaries.

To receive any of these resources in an accessible format, please contact us at CMAJ Group, 500-1410 Blair Towers Place, Ottawa ON, K1J 9B9; p: 1-888-855-2555; e: cmajgroup@cmaj.ca

Powered by HighWire