Social distancing#Avoiding physical contact

File:Social distancing video by California State Parks.ogg.]]

The American Centers for Disease Control and Prevention (CDC) have described social distancing as a set of "methods for reducing frequency and closeness of contact between people in order to decrease the risk of transmission of disease". During the 2009 swine flu pandemic the WHO described social distancing as "keeping at least an arm's length distance from others, [and] minimizing gatherings".{{Cite web |title=Pandemic influenza prevention and mitigation in low resource communities |date=2 May 2009 |publisher=World Health Organization |url=https://www.who.int/csr/resources/publications/swineflu/PI_summary_low_resource_02_05_2009.pdf?ua=1 |access-date=29 March 2020 |archive-date=23 July 2020 |archive-url=https://web.archive.org/web/20200723085904/https://www.who.int/csr/resources/publications/swineflu/PI_summary_low_resource_02_05_2009.pdf?ua=1 |url-status=live }} During the COVID-19 pandemic, the CDC defined social distancing as "remaining out of congregate settings, avoiding mass gatherings, and maintaining distance (approximately {{convert|6|ft|m|sigfig=1|spell=on|sp=us|disp=or}}) from others when possible".{{Cite web |title=What is social distancing and how can it slow the spread of COVID-19? |author-last=Pearce |author-first=Katie |date=13 March 2020 |website=The Hub |publisher=Johns Hopkins University |url=https://hub.jhu.edu/2020/03/13/what-is-social-distancing/ |access-date=29 March 2020 |url-status=live |archive-url=https://web.archive.org/web/20200329184144/https://hub.jhu.edu/2020/03/13/what-is-social-distancing/ |archive-date=29 March 2020 }}{{Cite web |title=Risk Assessment and Management |date=22 March 2020 |publisher=Centers for Disease Control and Prevention |url=https://www.cdc.gov/coronavirus/2019-ncov/php/risk-assessment.html |access-date=29 March 2020 |url-status=live |archive-url=https://web.archive.org/web/20200304230223/https://www.cdc.gov/coronavirus/2019-ncov/php/risk-assessment.html |archive-date=4 March 2020 }}

Social distancing, combined with the use of face masks, good respiratory hygiene and hand washing, is considered the most feasible way to reduce or delay a pandemic.{{cite web|title=Winning together: Novel coronavirus (COVID-19) infographic|url=https://www.researchgate.net/publication/340025544|access-date=16 May 2020|website=ResearchGate}}

File:20200403 Flatten the curve animated GIF.gif") to help healthcare services deal with demand, and extends time for healthcare services to be increased and improved.{{cite web |author-last=Wiles |author-first=Siouxsie |author-link=Siouxsie Wiles |title=The three phases of Covid-19 – and how we can make it manageable |date=9 March 2020 |work=The Spinoff |location=Morningside, Auckland, New Zealand |url=https://thespinoff.co.nz/society/09-03-2020/the-three-phases-of-covid-19-and-how-we-can-make-it-manageable/ |access-date=9 March 2020 |url-status=live |archive-url=https://web.archive.org/web/20200327120015/https://thespinoff.co.nz/society/09-03-2020/the-three-phases-of-covid-19-and-how-we-can-make-it-manageable/ |archive-date=27 March 2020}}{{cite web |author-last=Wiles |author-first=Siouxsie |author-link=Siouxsie Wiles |title=After 'Flatten the Curve', we must now 'Stop the Spread'. Here's what that means |date=14 March 2020 |work=The Spinoff |location=Morningside, Auckland, New Zealand |url=https://thespinoff.co.nz/society/14-03-2020/after-flatten-the-curve-we-must-now-stop-the-spread-heres-what-that-means/ |access-date=13 March 2020 |url-status=live |archive-url=https://web.archive.org/web/20200326232315/https://thespinoff.co.nz/society/14-03-2020/after-flatten-the-curve-we-must-now-stop-the-spread-heres-what-that-means/ |archive-date=26 March 2020}}{{cite journal |author-last1=Anderson |author-first1=Roy Malcom |author-link1=Roy Malcolm Anderson |author-last2=Heesterbeek |author-first2=Hans J. A. P. |author-last3=Klinkenberg |author-first3=Don |author-last4=Hollingsworth |author-first4=T. Déirdre |date=9 March 2020 |title=How will country-based mitigation measures influence the course of the COVID-19 epidemic? |journal=The Lancet |volume=395 |issue=10228 |pages=931–934 |doi=10.1016/S0140-6736(20)30567-5 |issn=0140-6736 |pmid=32164834 |pmc=7158572 |quote=A key issue for epidemiologists is helping policy makers decide the main objectives of mitigation—e.g., minimising morbidity and associated mortality, avoiding an epidemic peak that overwhelms health-care services, keeping the effects on the economy within manageable levels, and flattening the epidemic curve to wait for vaccine development and manufacture on scale and antiviral drug therapies.|doi-access=free }}{{Cite journal|last1=Islam|first1=Nazrul|last2=Sharp|first2=Stephen J|last3=Chowell|first3=Gerardo|last4=Shabnam|first4=Sharmin|last5=Kawachi|first5=Ichiro|last6=Lacey|first6=Ben|last7=Massaro|first7=Joseph M|last8=D'Agostino|first8=Ralph B|last9=White|first9=Martin|date=15 July 2020|title=Physical distancing interventions and incidence of coronavirus disease 2019: natural experiment in 149 countries|url= |journal=BMJ|language=en|volume=370|pages=m2743|doi=10.1136/bmj.m2743|pmid=32669358|issn=1756-1833|pmc=7360923}}]]

Several social distancing measures are used to control the spread of contagious illnesses. Research indicates that measures must be applied rigorously and immediately in order to be effective.{{cite journal |author-last1=Maharaj |author-first1=Savi |author-last2=Kleczkowski |author-first2=Adam |date=2012 |title=Controlling epidemic spread by social distancing: Do it well or not at all |journal=BMC Public Health |volume=12 |issue=1 |page=679 |doi=10.1186/1471-2458-12-679 |pmid=22905965 |pmc=3563464 |doi-access=free }}

File:Covid-19-Handshake-Alternatives-v3.gif, hug, or hongi; this New Zealand illustration offers eight alternatives.]]

Keeping a set physical distance from each other and avoiding hugs and gestures that involve direct physical contact, reduce the risk of becoming infected during outbreaks of infectious respiratory diseases (for example, flu pandemics and the COVID-19 pandemic of 2020.){{cite web |title=Guidance on Preparing Workplaces for an Influenza Pandemic |url=https://www.osha.gov/Publications/influenza_pandemic.html |url-status=live |archive-url=https://web.archive.org/web/20200325141049/https://www.osha.gov/Publications/influenza_pandemic.html |archive-date=25 March 2020 |access-date=18 March 2020 |work=Occupational Safety and Health Act of 1970 |publisher=United States Department of Labor |id=OSHA 3327-02N 2007}} [https://web.archive.org/web/20200319163737/https://www.osha.gov/Publications/OSHA3327pandemic.pdf] These distances of separation, in addition to personal hygiene measures, are also recommended at places of work.{{Cite web |title=Social Distancing |publisher=Department of Safety & Security, The University of Chicago |date=2015 |website=safety-security.uchicago.edu |url=https://safety-security.uchicago.edu/emergency_management/all_hazard_safety_procedures/social_distancing/ |access-date=29 March 2020 |url-status=live |archive-url=https://web.archive.org/web/20200324150358/https://safety-security.uchicago.edu/emergency_management/all_hazard_safety_procedures/social_distancing/ |archive-date=24 March 2020}} Where possible, remote work may be encouraged.{{cite web|title=The 2019–2020 Novel Coronavirus (Severe Acute Respiratory Syndrome Coronavirus 2) Pandemic: A Joint American College of Academic International Medicine‑World Academic Council of Emergency Medicine Multidisciplinary COVID‑19 Working Group Consensus Paper|url=https://www.researchgate.net/publication/340903626|access-date=16 May 2020|website=ResearchGate}}

The distance advised by authorities varies. During the COVID-19 pandemic, for example, the World Health Organization recommends that a distance of {{convert|1|m|ft|abbr=on}} or more is safe. Subsequently, China, Denmark, France, Hong Kong, Lithuania and Singapore adopted a 1 m social distancing policy. South Korea adopted {{convert|1.4|m|ft|abbr=on}}. Australia, Belgium, Germany, Greece, Italy, Netherlands, Portugal and Spain adopted {{convert|1.5|m|ft|abbr=on}}. The United States adopted {{convert|6|ft|m|adj=on|abbr=on}}, and Canada adopted {{convert|2|m|ft|adj=on|abbr=on}}. The United Kingdom first advised 2 m, then on 4 July 2020 reduced this to "one metre plus" where other methods of mitigation such as face masks were in use.{{Cite news|last=Shukman|first=David|date=23 June 2020|title=Is it safe to relax the 2m rule?|language=en-GB|work=BBC News|url=https://www.bbc.com/news/science-environment-52522460|access-date=1 July 2020}}

The WHO's one-metre recommendation stems from research into droplet-based transmission of tuberculosis by William F. Wells, which had found that droplets produced by exhalation, coughs, or sneezes landed an average of {{convert|3|ft|m|1|abbr=on}} from where they were expelled.{{Cite web|last=Foley|first=Katherine Ellen|title=Where does the six-foot guideline for social distancing come from?|url=https://qz.com/1831100/where-does-the-six-feet-social-distancing-guideline-come-from/|access-date=4 August 2020|website=Quartz|date=15 April 2020|language=en|archive-date=7 August 2020 |archive-url=https://web.archive.org/web/20200807160537/https://qz.com/1831100/where-does-the-six-feet-social-distancing-guideline-come-from/|url-status=live}}{{Cite journal|last=Riley|first=R. L.|date=22 January 1983|title=The contagiosity of tuberculosis|journal=Schweizerische Medizinische Wochenschrift|volume=113|issue=3|pages=75–79|issn=0036-7672|pmid=6338584}}{{Cite journal|last=Wells|first=W. F.|date=1 November 1934|title=On Air-borne Infection Study II. Droplets and Droplet Nuclei|url=https://academic.oup.com/aje/article/20/3/611/280025|journal=American Journal of Epidemiology|language=en|volume=20|issue=3|pages=611–618|doi=10.1093/oxfordjournals.aje.a118097|issn=0002-9262|access-date=16 August 2024 |archive-date=11 March 2021 |archive-url=https://web.archive.org/web/20210311162210/https://academic.oup.com/aje/article/20/3/611/280025|url-status=live}} Quartz speculated that the U.S. CDC's adoption of {{convert|6|ft|m|adj=on|abbr=on}} may have stemmed from a study of SARS transmission on an airplane, published in The New England Journal of Medicine. When contacted, however, the CDC did not provide any specific information.{{Cite journal|last1=Olsen|first1=Sonja J.|last2=Chang|first2=Hsiao-Ling|last3=Cheung|first3=Terence Yung-Yan|last4=Tang|first4=Antony Fai-Yu|last5=Fisk|first5=Tamara L.|last6=Ooi|first6=Steven Peng-Lim|last7=Kuo|first7=Hung-Wei|last8=Jiang|first8=Donald Dah-Shyong|last9=Chen|first9=Kow-Tong|last10=Lando|first10=Jim|last11=Hsu|first11=Kwo-Hsiung|date=18 December 2003|title=Transmission of the Severe Acute Respiratory Syndrome on Aircraft|journal=New England Journal of Medicine|volume=349|issue=25|pages=2416–2422|doi=10.1056/NEJMoa031349|issn=0028-4793|pmid=14681507|doi-access=free}}

Some have suggested that distances greater than {{convert|1|-|2|m|ft|abbr=on}} should be observed.{{Cite journal|last1=Setti|first1=L.|last2=Passarini|first2=F.|last3=De Gennaro|first3=G.|date=23 April 2020|title=Airborne Transmission Route of COVID-19: Why 2 Meters/6 Feet of Inter-Personal Distance Could Not Be Enough|journal=Int. J. Environ. Res. Public Health|volume=17|issue=8|pages=2932|doi=10.3390/ijerph17082932|pmc=7215485|pmid=32340347|doi-access=free}}{{Cite news|last1=Reynolds|first1=G.|date=15 April 2020|title=For Runners, Is 15 Feet the New 6 Feet for Social Distancing? When we walk briskly or run, air moves differently around us, increasing the space required to maintain a proper social distance.|work=New York Times|url=https://www.nytimes.com/2020/04/15/well/move/running-social-distancing.html|access-date=1 April 2020|archive-date=9 August 2023 |archive-url=https://web.archive.org/web/20230809220039/https://www.nytimes.com/2020/04/15/well/move/running-social-distancing.html|url-status=live}}{{Cite news|last1=Sheikh|first1=K.|last2=Gorman|first2=J.|last3=Chang|first3=K.|date=14 April 2020|title=Stay 6 Feet Apart, We're Told. But How Far Can Air Carry Coronavirus? Most of the big droplets travel a mere six feet. The role of tiny aerosols is the 'trillion-dollar question.'|work=New York Times|url=https://www.nytimes.com/2020/04/14/health/coronavirus-six-feet.html|access-date=1 April 2020|archive-date=21 May 2023 |archive-url=https://web.archive.org/web/20230521190109/https://www.nytimes.com/2020/04/14/health/coronavirus-six-feet.html|url-status=live}}{{Cite news|last1=Huang|first1=S.|date=26 March 2020|title=Why we should all wear masks – There is new scientific rationale.|work=Medium|url=https://medium.com/@Cancerwarrior/covid-19-why-we-should-all-wear-masks-there-is-new-scientific-rationale-280e08ceee71|access-date=1 April 2020|archive-date=23 February 2021 |archive-url=https://web.archive.org/web/20210223020802/https://medium.com/@Cancerwarrior/covid-19-why-we-should-all-wear-masks-there-is-new-scientific-rationale-280e08ceee71|url-status=live}}{{Cite news|last1=Letzter|first1=R.|date=31 March 2020|title=Is 6 feet enough space for social distancing? Not everyone thinks that's enough distance.|work=Live Science|url=https://www.livescience.com/coronavirus-six-feet-enough-social-distancing.html|access-date=1 April 2020|archive-date=31 May 2023 |archive-url=https://web.archive.org/web/20230531110130/https://www.livescience.com/coronavirus-six-feet-enough-social-distancing.html|url-status=live}}{{Cite news|last1=Thoelen|first1=J.|date=8 April 2020|title=Belgian-Dutch Study: Why in times of COVID-19 you should not walk/run/bike close behind each other.|work=Medium|url=https://medium.com/@jurgenthoelen/belgian-dutch-study-why-in-times-of-covid-19-you-can-not-walk-run-bike-close-to-each-other-a5df19c77d08|access-date=1 April 2020|archive-date=5 October 2023 |archive-url=https://web.archive.org/web/20231005042251/https://medium.com/@jurgenthoelen/belgian-dutch-study-why-in-times-of-covid-19-you-can-not-walk-run-bike-close-to-each-other-a5df19c77d08|url-status=live}} One minute of loud speaking can produce oral droplets with a load of 7 million SARS-CoV-2 virus per milliliter that can remain for more than eight minutes,{{cite journal | vauthors=Tang S, Mao Y, Jones RM, MacIntyre CR, Shi X | title=Aerosol transmission of SARS-CoV-2? Evidence, prevention and control | journal=Environment International | volume=144 | pages=106039 | year=2020 | doi =10.1016/j.envint.2020.106039 | pmc= 7413047 | pmid=32822927| bibcode=2020EnInt.14406039T }} a time-period during which many people could enter or remain in the area. A sneeze can distribute such droplets as far as {{convert|7|m|ft|abbr=on}} or {{convert|8|m|ft|abbr=on}}.{{cite web |last1=Culver |first1=Jordan |title=2 meters enough for social distancing? MIT researcher says droplets carrying coronavirus can travel up to 8 meters |url=https://medicalxpress.com/news/2020-04-meters-social-distancing-mit-droplets.html |website=Medical Xpress |access-date=28 August 2020 |date=1 April 2010 |archive-date=30 September 2023 |archive-url=https://web.archive.org/web/20230930221348/https://medicalxpress.com/news/2020-04-meters-social-distancing-mit-droplets.html |url-status=live }} Social distancing is less effective than face masks at reducing the spread of COVID-19.{{cite journal | vauthors=Zhang R, Li Y, Zhang AL, Wang Y, Molina MJ | title=Identifying airborne transmission as the dominant route for the spread of COVID-19 | journal=Proceedings of the National Academy of Sciences of the United States of America | volume=117 | issue=26 | pages=14857–14863 | year=2020 | doi = 10.1073/pnas.2009637117 | pmc= 7334447 | pmid=32527856| bibcode=2020PNAS..11714857Z | doi-access=free }}

Various alternatives have been proposed for the tradition of handshaking. The gesture of namaste, placing one's palms together, fingers pointing upwards, drawing the hands to the heart, is one non-touch alternative. During the COVID-19 pandemic in the United Kingdom, this gesture was used by Prince Charles upon greeting reception guests, and has been recommended by the Director-General of the WHO, Dr. Tedros Adhanom Ghebreyesus, and Israeli Prime Minister Benjamin Netanyahu.{{Cite web |title=Joined palms, hands-on hearts, Vulcan salutes: Saying hello in a no-handshake era |author-last1=Barajas |author-first1=Julia |author-last2=Etehad |author-first2=Melissa |date=13 March 2020 |website=Los Angeles Times |url=https://www.latimes.com/world-nation/story/2020-03-13/coronavirus-namaste-greetings-handshakes-noncontact |access-date=18 March 2020 |url-status=live |archive-url=https://web.archive.org/web/20200327064424/https://www.latimes.com/world-nation/story/2020-03-13/coronavirus-namaste-greetings-handshakes-noncontact |archive-date=27 March 2020}} Other alternatives include the popular thumbs up gesture, the wave, the shaka (or "hang loose") sign, and placing a palm on one's heart, as practiced in parts of Iran.

File:Islamic Congregational Prayer with Physical Distancing during the Covid-19 Pandemic.jpg while imposing to strict physical-distancing protocols during the COVID-19 pandemic. During the pandemic, Mosques in Indonesia has also removed the indoor rugs and has ordered worshipers to bring their own personal prayer rugs to prevent the spreading of the virus. Some mosques which are located in the most infected regions even are ordered to be closed for worship]]

File:Social Distancing in a Computer Lab.jpg|In this computer lab, every other workstation has been closed off to increase the distance between people working, and screens between workstations are also in place.

File:Social Distancing Sign @ London Drugs (49684963711).jpg|alt=Floor markings for social distancing|Floor markings can help people maintain distance in public places, especially when queueing.

File:Pissoirs während der COVID-19-Pandemie.png|Urinals adjusted in a way close contacts are less likely

[[Image:Swineflu uk hpa model.svg|thumb|right|upright=1|

Swine flu cases per week in the United Kingdom in 2009; schools typically close for summer in mid-July and re-open in early September.{{cite web |title=2009 Press Releases |date=24 December 2009 |publisher=Health Protection Agency |url=http://www.hpa.org.uk/HPA/NewsCentre/NationalPressReleases/2009PressReleases/ |access-date=24 December 2009 |archive-url=http://webarchive.nationalarchives.gov.uk/20100303155122/http://www.hpa.org.uk/HPA/NewsCentre/NationalPressReleases/2009PressReleases/ |archive-date=3 March 2010 }}]]

Mathematical modeling has shown that transmission of an outbreak may be delayed by closing schools. However, effectiveness depends on the contacts children maintain outside of school. Often, one parent has to take time off work, and prolonged closures may be required. These factors could result in social and economic disruption.{{Cite book |author-last1=Zumla |author-first1=Alimuddin |author-link1=Alimuddin Zumla |title=Emerging Respiratory Infections in the 21st Century, An Issue of Infectious Disease Clinics |author-last2=Yew |author-first2=Wing-Wai |author-last3=Hui |author-first3=David S. C. |date=31 August 2010 |publisher=Elsevier Health Sciences |volume=24 |number=3 |isbn=978-1-4557-0038-7 |pages=614 |url=https://books.google.com/books?id=c9CQn9C4JaQC&pg=PA614 |access-date=29 March 2020 |url-status=live |archive-url=https://web.archive.org/web/20200329195321/https://books.google.de/books?id=c9CQn9C4JaQC&pg=PA614&redir_esc=y |archive-date=29 March 2020}}{{cite journal |author-last1=Cauchemez |author-first1=Simon |author-last2=Ferguson |author-first2=Neil Morris |author-link2=Neil Ferguson (epidemiologist) |author-last3=Wachtel |author-first3=Claude |author-last4=Tegnell |author-first4=Anders |author-last5=Saour |author-first5=Guillaume |author-last6=Duncan |author-first6=Ben |author-last7=Nicoll |author-first7=Angus |title=Closure of schools during an influenza pandemic |journal=The Lancet Infectious Diseases |volume=9 |issue=8 |date=August 2009 |pages=473–481 |issn=1473-3099 |doi=10.1016/S1473-3099(09)70176-8 |pmid=19628172 |url= |pmc=7106429 }}

Modeling and simulation studies based on U.S. data suggest that if 10% of affected workplaces are closed, the overall infection transmission rate is around 11.9% and the epidemic peak time is slightly delayed. In contrast, if 33% of affected workplaces are closed, the attack rate decreases to 4.9%, and the peak time is delayed by one week.{{cite journal |author-last1=Rousculp |author-first1=Matthew D. |author-last2=Johnston |author-first2=Stephen S. |author-last3=Palmer |author-first3=Liisa A. |author-last4=Chu |author-first4=Bong-Chul |author-last5=Mahadevia |author-first5=Parthiv J. |author-last6=Nichol |author-first6=Kristin L. |date=October 2010 |title=Attending Work While Sick: Implication of Flexible Sick Leave Policies |journal=Journal of Occupational and Environmental Medicine |volume=52 |issue=10 |pages=1009–1013 |doi=10.1097/jom.0b013e3181f43844 |pmid=20881626|s2cid=11591504 }}{{cite journal |author-last1=Kumar |author-first1=Supriya |author-last2=Crouse Quinn |author-first2=Sandra |author-last3=Kim |author-first3=Kevin H. |author-last4=Daniel |author-first4=Laura H. |author-last5=Freimuth |author-first5=Vicki S. |title=The Impact of Workplace Policies and Other Social Factors on Self-Reported Influenza-Like Illness Incidence During the 2009 H1N1 Pandemic |date=January 2012 |journal=American Journal of Public Health |volume=102 |issue=1 |pages=134–140 |doi=10.2105/AJPH.2011.300307 |pmid=22095353 |pmc=3490553}} Workplace closures include closure of "non-essential" businesses and social services ("non-essential" means those facilities that do not maintain primary functions in the community, as opposed to essential services).{{cite web |title=Social Distancing Support Guidelines For Pandemic Readiness |publisher=Colorado Department of Public Health and Environment |date=March 2008 |url=https://www.colorado.gov/pacific/sites/default/files/OEPR_Guidelines-for-Social-Distancing-Pandemic-Readiness.pdf |access-date=13 February 2017 |archive-url=https://web.archive.org/web/20170213001535/https://www.colorado.gov/pacific/sites/default/files/OEPR_Guidelines-for-Social-Distancing-Pandemic-Readiness.pdf |archive-date=13 February 2017}}

File:Socially distanced street party for the 75th Anniversary of VE Day, Montagu Road, Wetherby (8th May 2020) 003.jpg celebrations in 2020 took place under lockdown; here a socially distanced street party is taking place on Hallfield Estate, Wetherby.]]

Cancellation of mass gatherings includes sports events, films or musical shows.{{cite journal |author-first1=Robert |author-last1=Booy |author-first2=James |author-last2=Ward |title=Evidence compendium and advice on social distancing and other related measures for response to an influenza pandemic |journal=Paediatric Respiratory Reviews |date=2015 |volume=16 |issue=2 |pages=119–126 |publisher=National Centre for Immunisation Research and Surveillance |doi=10.1016/j.prrv.2014.01.003 |pmid=24630149 |url=https://www.health.gov.au/internet/main/publishing.nsf/Content/519F9392797E2DDCCA257D47001B9948/$File/Social.pdf |access-date=15 May 2015 |archive-url=https://web.archive.org/web/20150515032806/https://www.health.gov.au/internet/main/publishing.nsf/Content/519F9392797E2DDCCA257D47001B9948/$File/Social.pdf |archive-date=15 May 2015}} (13 pages) Evidence published in 2006 suggesting that mass gatherings increase the potential for infectious disease transmission is inconclusive.{{cite journal |author-first1=Thomas V. |author-last1=Inglesby |author-first2=Jennifer B. |author-last2=Nuzzo |author-first3=Tara |author-last3=O'Toole |author-link3=Tara O'Toole |author-first4=Donald Ainslie |author-last4=Henderson |author-link4=Donald Ainslie Henderson |doi=10.1089/bsp.2006.4.366 |title=Disease Mitigation Measures in the Control of Pandemic Influenza |journal=Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science |date=2006 |volume=4 |issue=4 |pages=366–375 |pmid=17238820 |citeseerx=10.1.1.556.2672|s2cid=10745529 }} Anecdotal evidence suggests certain types of mass gatherings may be associated with increased risk of influenza transmission, and may also "seed" new strains into an area, instigating community transmission in a pandemic. During the 1918 influenza pandemic, military parades in Philadelphia{{cite magazine |author-first=Kenneth C. |author-last=Davis |author-link=Kenneth C. Davis |title=Philadelphia Threw a WWI Parade That Gave Thousands of Onlookers the Flu |magazine=Smithsonian Magazine |date=21 September 2018 |url=https://www.smithsonianmag.com/history/philadelphia-threw-wwi-parade-gave-thousands-onlookers-flu-180970372/ |access-date=27 March 2020 |url-status=live |archive-url=https://web.archive.org/web/20200327222425/https://www.smithsonianmag.com/history/philadelphia-threw-wwi-parade-gave-thousands-onlookers-flu-180970372/ |archive-date=27 March 2020}} and Boston{{cite news |title=The Flu in Boston |work=American Experience |publisher=WGBH Educational Foundation |url=https://www.pbs.org/wgbh/americanexperience/features/influenza-boston/ |access-date=28 March 2020 |url-status=live |archive-url=https://web.archive.org/web/20200320142051/https://www.pbs.org/wgbh/americanexperience/features/influenza-boston/ |archive-date=20 March 2020}} may have been responsible for spreading the disease by mixing infected sailors with crowds of civilians. Restricting mass gatherings, in combination with other social distancing interventions, may help reduce transmission.{{cite journal |author-last1=Ishola |author-first1=David A. |author-last2=Phin |author-first2=Nick |date=December 2011 |title=Could Influenza Transmission Be Reduced by Restricting Mass Gatherings? Towards an Evidence-Based Policy Framework |journal=Journal of Epidemiology and Global Health |volume=1 |issue=1 |pages=33–60 |doi=10.1016/j.jegh.2011.06.004 |pmid=23856374|pmc=7104184 |doi-access=free }} A 2020 peer-reviewed study in the British Medical Journal (The BMJ) also suggested it as one of the key components of an effective strategy in reducing the burden of COVID-19.

Border restrictions or internal travel restrictions are unlikely to delay an epidemic by more than two to three weeks unless implemented with over 99% coverage.{{cite journal |author-last1=Ferguson |author-first1=Neil Morris |author-link1=Neil Ferguson (epidemiologist) |author-last2=Cummings |author-first2=Derek A. T. |author-last3=Fraser |author-first3=Christophe |author-last4=Cajka |author-first4=James C. |author-last5=Cooley |author-first5=Philip C. |author-last6=Burke |author-first6=Donald S. |author-link6=Donald S. Burke |date=2006 |title=Strategies for mitigating an influenza pandemic |journal=Nature |volume=442 |issue=7101 |pages=448–452 |doi=10.1038/nature04795 |pmid=16642006 |pmc=7095311 |bibcode=2006Natur.442..448F}} Airport screening was found to be ineffective in preventing viral transmission during the 2003 SARS outbreak in Canada{{cite journal |author-last=Bell |author-first=David M. |date=2004 |title=Public health interventions and SARS spread, 2003 |journal=Emerging Infectious Diseases |volume=10 |issue=11 |pages=1900–1906 |doi=10.3201/eid1011.040729 |pmid=15550198 |pmc=3329045 |url=https://www.cdc.gov/ncidod/EID/vol10no11/04-0729.htm |archive-url=https://web.archive.org/web/20091105074656/https://www.cdc.gov/ncidod/EID/vol10no11/04-0729.htm |archive-date=5 November 2009}} and the U.S.{{cite book |author-first=Martin |author-last=Cetron |chapter-url=https://www.ncbi.nlm.nih.gov/books/NBK92450/ |chapter=Isolation and Quarantine: Containment Strategies for SARS, 2003 |title=Learning from SARS: Preparing for the Next Disease Outbreak |publisher=National Academy of Sciences |date=2004 |isbn=0-30959433-2 |access-date=23 April 2017 |archive-date=1 November 2020 |archive-url=https://web.archive.org/web/20201101045209/https://www.ncbi.nlm.nih.gov/books/NBK92450/ |url-status=live }} Strict border controls between Austria and the Ottoman Empire, imposed from 1770 until 1871 to prevent persons infected with the bubonic plague from entering Austria, were reportedly effective, as there were no major outbreaks of plague in Austrian territory after they were established, whereas the Ottoman Empire continued to suffer frequent epidemics of plague until the mid-nineteenth century.{{cite book |editor-first=George Childs |editor-last=Kohn |title=Encyclopedia of Plague and Pestilence: From Ancient Times to the Present |publisher=Infobase Publishing |series=Facts On File – Library Of World History |date=2008 |orig-date=2001, 1998 |page=30 |isbn=978-1-43812923-5 |edition=3 |location=New York |url=https://books.google.com/books?id=tzRwRmb09rgC&pg=PA30 |access-date=29 March 2020 |url-status=live |archive-url=https://web.archive.org/web/20200329120426/https://books.google.com/books?id=tzRwRmb09rgC&pg=PA30 |archive-date=29 March 2020}}{{cite book |title=Encyclopedia of Pestilence, Pandemics, and Plague |editor-first=Joseph P. |editor-last=Byrne |date=2008 |publisher=Greenwood Publishing Group, Inc. / Greenwood Press |location=Westport, Connecticut / London |lccn=2008019487 |volume=1&2 |isbn= |id=978–0–313–34102–1 (vol 1), 978–0–313–34103–8 (vol 2) |url=http://www.academia.dk/MedHist/Sygdomme/PDF/Encyclopedia_of_Pestilence_Pandemics_and_Plagues.pdf |access-date=29 March 2020 |url-status=live |archive-url=https://web.archive.org/web/20200215143932/https://www.academia.dk/MedHist/Sygdomme/PDF/Encyclopedia_of_Pestilence_Pandemics_and_Plagues.pdf |archive-date=15 February 2020}}

A Northeastern University study published in March 2020 found that "travel restrictions to and from China only slow down the international spread of COVID-19 [when] combined with efforts to reduce transmission on a community and an individual level. ... Travel restrictions aren't enough unless we couple it with social distancing."{{cite news |author-first=Emily |author-last=Arntsen |title=Closing borders can delay, but can't stop the spread of COVID-19, new report says |work=News@Northeastern |publisher=Northeastern University |date=6 March 2020 |url=https://news.northeastern.edu/2020/03/06/to-slow-the-spread-of-covid-19-close-doors-not-borders-new-report-says/ |access-date=28 March 2020 |url-status=live |archive-url=https://web.archive.org/web/20200323063603/https://news.northeastern.edu/2020/03/06/to-slow-the-spread-of-covid-19-close-doors-not-borders-new-report-says/ |archive-date=23 March 2020}} The study found that the travel ban in Wuhan delayed the spread of the disease to other parts of mainland China only by three to five days, although it did reduce the spread of international cases by as much as 80 percent.{{cite journal |title=The effect of travel restrictions on the spread of the 2019 novel coronavirus (COVID-19) outbreak |author-last1=Chinazzi |author-first1=Matteo |author-last2=Davis |author-first2=Jessica T. |author-last3=Ajelli |author-first3=Marco |author-last4=Gioannini |author-first4=Corrado |author-last5=Litvinova |author-first5=Maria |author-last6=Merler |author-first6=Stefano |author-last7=Pastore y Piontti |author-first7=Ana |author-last8=Mu |author-first8=Kunpeng |author-last9=Rossi |author-first9=Luca |author-last10=Sun |author-first10=Kaiyuan |author-last11=Viboud |author-first11=Cécile |author-link11=Cécile Viboud|author-last12=Xiong |author-first12=Xinyue |author-last13=Yu |author-first13=Hongjie |author-last14=Halloran |author-first14=M. Elizabeth |author-last15=Longini, Jr. |author-first15=Ira M. |author-link15=Ira M. Longini, Jr. |author-last16=Vespignani |author-first16=Alessandro |author-link16=Alessandro Vespignani |journal=Science |date=6 March 2020 |volume=368 |issue=6489 |doi=10.1126/science.aba9757 |pages=395–400 |pmid=32144116 |pmc=7164386 |bibcode=2020Sci...368..395C }}

Shielding measures for individuals include limiting face-to-face contacts, conducting business by phone or online, avoiding public places and reducing unnecessary travel.{{cite journal |author-last1=Glass |author-first1=Robert J. |author-last2=Glass |author-first2=Laura M. |author-last3=Beyeler |author-first3=Walter E. |author-last4=Min |author-first4=H. Jason |doi=10.3201/eid1211.060255 |title=Targeted Social Distancing Designs for Pandemic Influenza |journal=Emerging Infectious Diseases |publisher=Centers for Disease Control and Prevention |date=November 2006 |volume=12 |issue=11 |pages=1671–1681 |pmid=17283616 |pmc=3372334 |url=https://wwwnc.cdc.gov/eid/article/12/11/06-0255_article |access-date=29 March 2020 |url-status=live |archive-url=https://web.archive.org/web/20200323042313/https://wwwnc.cdc.gov/eid/article/12/11/06-0255_article |archive-date=23 March 2020}}{{cite web |title=Social Distancing Guidelines (for workplace communicable disease outbreaks) |date=2017 |publisher=Society for Human Resource Management |url=https://www.shrm.org/resourcesandtools/tools-and-samples/policies/pages/cms_016204.aspx |access-date=23 April 2017 |archive-url=https://web.archive.org/web/20170423071438/https://www.shrm.org/resourcesandtools/tools-and-samples/policies/pages/cms_016204.aspx |archive-date=23 April 2017}}{{Cite web|url=https://www.bhf.org.uk/informationsupport/heart-matters-magazine/news/coronavirus-and-your-health/whats-the-difference-between-shielding-self-isolation-and-social-distancing|title=What's the difference between shielding, self-isolation and social distancing?|website=www.bhf.org.uk|access-date=29 March 2020|archive-url=https://web.archive.org/web/20200329185017/https://www.bhf.org.uk/informationsupport/heart-matters-magazine/news/coronavirus-and-your-health/whats-the-difference-between-shielding-self-isolation-and-social-distancing|archive-date=29 March 2020|url-status=live}}

During the COVID-19 pandemic in the United Kingdom, shielding referred to special advisory measures put in place by the UK Government to protect those at the highest risk of serious illness from the disease. This included those with weakened immune systems (such as organ transplant recipients), as well as those with certain medical conditions such as cystic fibrosis or severe asthma. Until 1 June 2020, those shielding were strongly advised not to leave home for any reason at all, including essential travel, and to maintain a {{convert|2|m|ft|abbr=on}} distance from anyone else in their household. Supermarkets quickly made priority grocery delivery slots available to those shielding, and the Government arranged for food boxes to be sent to those shielding who needed additional assistance, for example elderly people shielding on their own. This was gradually relaxed from June to allow shielders to spend more time outside, before being suspended indefinitely from 1 August.{{Citation needed|date=August 2024}}

{{main|Quarantine}}

During the 2003 SARS outbreak in Singapore, approximately {{val|8000}} people were subjected to mandatory home quarantine and an additional {{val|4300}} were required to self-monitor for symptoms and make daily telephone contact with health authorities as a means of controlling the epidemic. Although only 58 of these individuals were eventually diagnosed with SARS, public health officials were satisfied that this measure assisted in preventing further spread of the infection.{{cite journal |author-first=Chorh-Chuan |author-last=Tan |author-link=Tan Chorh Chuan |url=http://www.srmuniv.ac.in/sites/default/files/downloads/sars_outbreak_lessons.pdf |pmid=16830002 |title=SARS in Singapore – Key Lessons from an Epidemic |journal=Annals Academy of Medicine |date=May 2006 |volume=35 |number=5 |pages=345–349 |access-date=23 April 2017 |archive-url=https://web.archive.org/web/20170424174153/http://www.srmuniv.ac.in/sites/default/files/downloads/sars_outbreak_lessons.pdf |archive-date=24 April 2017 }} Voluntary self-isolation may have helped reduce transmission of influenza in Texas in 2009.{{cite journal |author-last1=Teh |author-first1=Benjamin |author-last2=Olsen |author-first2=Karen |author-last3=Black |author-first3=Jim |author-last4=Cheng |author-first4=Allen C. |author-last5=Aboltins |author-first5=Craig |author-last6=Bull |author-first6=Kirstin |author-first7=Paul D. R. |author-last7=Johnson |author-first8=M. Lindsay |author-last8=Grayson |author-first9=Joseph |author-last9=Torresi |title=Impact of swine influenza and quarantine measures on patients and households during the H1N1/09 pandemic |date=2012 |orig-date=2011-11-22, 2011-09-26, 29 June 2011 |journal=Scandinavian Journal of Infectious Diseases |volume=44 |issue=4 |pages=289–296 |doi=10.3109/00365548.2011.631572 |pmid=22106922|s2cid=24255689 }} Short and long-term negative psychological effects have been reported.{{Cite journal |author-last1=Brooks |author-first1=Samantha K. |author-last2=Webster |author-first2=Rebecca K. |author-last3=Smith |author-first3=Louise E. |author-last4=Woodland |author-first4=Lisa |author-last5=Wessely |author-first5=Simon |author-link5=Simon Wessely |author-last6=Greenberg |author-first6=Neil |author-link6=Neil Greenberg |author-last7=Rubin |author-first7=Gideon James |date=14 March 2020 |title=The psychological impact of quarantine and how to reduce it: rapid review of the evidence |url= https://www.thelancet.com/action/showPdf?pii=S0140-6736%2820%2930460-8|journal=The Lancet |volume=395 |issue=10227 |pages=912–920 |doi=10.1016/S0140-6736(20)30460-8 |issn=0140-6736 |pmid=32112714 |pmc=7158942 |archive-url=https://web.archive.org/web/20200313220120/https://www.thelancet.com/action/showPdf?pii=S0140-6736%2820%2930460-8 |archive-date=13 March 2020 |url-status=live }}

{{Main|Stay-at-home order}}

The objective of stay-at-home orders is to reduce day-to-day contact between people and thereby reduce the spread of infection{{Cite web|url=https://www.gov.uk/government/publications/full-guidance-on-staying-at-home-and-away-from-others|title=Staying at home and away from others (social distancing)|website=GOV.UK|date=11 May 2020|access-date=16 August 2024 |archive-date=30 September 2023 |archive-url=https://web.archive.org/web/20230930221309/https://www.gov.uk/government/publications/full-guidance-on-staying-at-home-and-away-from-others|url-status=live}} During the COVID-19 pandemic, early and aggressive implementation of stay-at-home orders was effective in "flattening the curve" and provided the much needed time for healthcare systems to increase their capacity while reducing the number of peak cases during the initial wave of illness. It is important for public health authorities to follow disease trends closely to re-implement appropriate social distancing policies, including stay-at-home orders, if secondary COVID-19 waves appear.

{{main|Cordon sanitaire (medicine)}}

In 1995, a cordon sanitaire was used to control an outbreak of Ebola virus disease in Kikwit, Zaire.{{cite news |author-first=Laurie |author-last=Garrett |author-link=Laurie Garrett |url=https://newrepublic.com/article/119085/ebola-cordon-sanitaire-when-it-worked-congo-1995 |title=Heartless but Effective: I've Seen 'Cordon Sanitaire' Work Against Ebola |magazine=The New Republic |date=14 August 2014 |access-date=5 June 2017 |archive-url=https://web.archive.org/web/20170910125151/https://newrepublic.com/article/119085/ebola-cordon-sanitaire-when-it-worked-congo-1995 |archive-date=10 September 2017 |url-status=live }}{{cite news |url=https://www.cdc.gov/mmwr/preview/mmwrhtml/00037078.htm |title=Outbreak of Ebola Viral Hemorrhagic Fever – Zaire, 1995 |newspaper=Morbidity and Mortality Weekly Report |date=19 May 1995 |volume=44 |number=19 |pages=381–382 |access-date=5 June 2017 |archive-url=https://web.archive.org/web/20190825065821/https://www.cdc.gov/mmwr/preview/mmwrhtml/00037078.htm |archive-date=25 August 2019 |url-status=live }}{{cite journal |author-first1=Rachel |author-last1=Kaplan Hoffmann |author-first2=Keith |author-last2=Hoffmann |title=Ethical Considerations in the Use of Cordons Sanitaires |journal=Clinical Correlations |publisher=New York University |location=NYU Langone, New York |eissn=1944-0030 |date=19 February 2015 |url=https://www.clinicalcorrelations.org/2015/02/19/ethical-considerations-in-the-use-of-cordons-sanitaires/ |access-date=29 March 2020 |url-status=live |archive-url=https://archive.today/20200329101936/https://www.clinicalcorrelations.org/2015/02/19/ethical-considerations-in-the-use-of-cordons-sanitaires/%23 |archive-date=29 March 2020 }} President Mobutu Sese Seko surrounded the town with troops and suspended all flights into the community. Inside Kikwit, the World Health Organization and Zaire's medical teams erected further cordons sanitaires, isolating burial and treatment zones from the general population and successfully containing the infection.{{cite book |author-first=Laurie |author-last=Garrett |author-link=Laurie Garrett |title=Betrayal of Trust: The Collapse of Global Public Health |publisher=Hachette Books |date=2011 |isbn=978-1-40130386-0}}

{{main|Protective sequestration}}

During the 1918 influenza epidemic, the town of Gunnison, Colorado, isolated itself for two months to prevent an introduction of the infection. Highways were barricaded and arriving train passengers were quarantined for five days. As a result of the isolation, no one died of influenza in Gunnison during the epidemic.{{cite web |url=http://chm.med.umich.edu/research/1918-influenza-escape-communities/gunnison/ |title=Gunnison: Case Study |publisher=University of Michigan Medical School |work=Center for the History of Medicine |access-date=6 June 2017 |archive-url=https://web.archive.org/web/20180615215642/https://chm.med.umich.edu/research/1918-influenza-escape-communities/gunnison/ |archive-date=15 June 2018 |url-status=live }} Several other communities adopted similar measures.{{cite journal |title=Nonpharmaceutical Influenza Mitigation Strategies, US Communities, 1918–1920 Pandemic |author-last1=Markel |author-first1=Howard |author-link1=Howard Markel |author-last2=Stern |author-first2=Alexandra Minna |author-link2=Alexandra Minna Stern |author-last3=Navarro |author-first3=J. Alexander |author-last4=Michalsen |author-first4=Joseph R. |author-last5=Monto |author-first5=Arnold S. |author-last6=DiGiovanni, Jr. |author-first6=Cleto |journal=Emerging Infectious Diseases |date=December 2006 |volume=12 |issue=12 |pages=1961–1964 |pmid=17326953 |pmc=3291356 |doi=10.3201/eid1212.060506 |url=https://wwwnc.cdc.gov/eid/article/12/12/pdfs/06-0506.pdf |access-date=6 June 2017 |archive-url=https://web.archive.org/web/20170216162104/https://wwwnc.cdc.gov/eid/article/12/12/pdfs/06-0506.pdf |archive-date=16 February 2017 |url-status=live }}

Other measures include shutting down or limiting mass transit{{Cite news |author-last=Taylor |author-first=Kate |title=No Bus Service. Crowded Trains. Transit Systems Struggle With the Virus. U.S. cities with public transit systems are being forced to adapt to the risks posed by the coronavirus, implementing new sanitation protocols while contending with fewer riders and workers. |date=20 March 2020 |orig-date=2020-03-17 |newspaper=The New York Times |issn=0362-4331 |url=https://www.nytimes.com/2020/03/17/us/coronavirus-buses-trains-detroit-boston.html |access-date=25 March 2020 |url-status=live |archive-url=https://web.archive.org/web/20200325024853/https://www.nytimes.com/2020/03/17/us/coronavirus-buses-trains-detroit-boston.html |archive-date=25 March 2020}} and closure of sport facilities (community swimming pools, youth clubs, gymnasiums).{{cite web |title=Flu Pandemic Mitigation – Social Distancing |website=globalsecurity.org |url=http://www.globalsecurity.org/security/ops/hsc-scen-3_flu-pandemic-distancing.htm |access-date=23 March 2020 |archive-url=https://web.archive.org/web/20200322163703/https://www.globalsecurity.org/security/ops/hsc-scen-3_flu-pandemic-distancing.htm |archive-date=22 March 2020}} Due to the highly interconnected nature of modern transportation hubs, a highly contagious illness can achieve rapid geographic spread if appropriate mitigation measures are not taken early. Consequently, highly coordinated efforts must be put into place early during an outbreak to proactively monitor, detect, and isolate any potentially infectious individuals. If community spread is present, more aggressive measures may be required, up to and including complete cessation of travel in/out of a specific geographic area.

Public health messaging, gaining the public's trust (countering misinformation), ensuring community involvement and two-way exchange of ideas can affect the uptake, adherence, and effectiveness of best-evidence social distancing approach to preventing disease spread.{{Cite journal |last1=Ryan |first1=Rebecca E |last2=Silke |first2=Charlotte |last3=Parkhill |first3=Anne |last4=Virgona |first4=Ariane |last5=Merner |first5=Bronwen |last6=Hurley |first6=Shauna |last7=Walsh |first7=Louisa |last8=de Moel-Mandel |first8=Caroline |last9=Schonfeld |first9=Lina |last10=Edwards |first10=Adrian GK |last11=Kaufman |first11=Jessica |last12=Cooper |first12=Alison |last13=Chung |first13=Rachel Kar Yee |last14=Solo |first14=Karla |last15=Hellard |first15=Margaret |date=9 October 2023 |editor-last=Cochrane Consumers and Communication Group |title=Communication to promote and support physical distancing for COVID-19 prevention and control |journal=Cochrane Database of Systematic Reviews |language=en |volume=2023 |issue=10 |pages=CD015144 |doi=10.1002/14651858.CD015144 |pmc=10561351 |pmid=37811673 }} The communication approaches, messaging, and delivery mechanisms need to be flexible so that they can be changed as both the best-evidence social distancing measures change and as the community needs change.

Leper colonies and lazarettos were established as a means of preventing the spread of leprosy and other contagious diseases through social distancing,{{cite CE1913|wstitle= Leprosy |volume= 9 |last= Souvay |first= Charles Léon |author-link=|pages=182-185|short=1}} until transmission was understood and effective treatments invented.

File:Mole2.JPG|The Lazzaretto of Ancona was constructed in the 18th century on an artificial island to serve as a quarantine station and leprosarium for the port town of Ancona, Italy.

File:Leprosorium.jpg|Two lepers denied entrance to town. Woodcut by Vincent of Beauvais, 14th century

File:Popular science monthly (1872) (14596283227).jpg|New York City parks and playgrounds were closed during a 1916 polio epidemic.{{Cite book |url=https://archive.org/details/popularsciencemo89newyuoft/page/400/mode/2up/search/flexner |title=Popular science monthly |date=1916 |location=New York |publisher=D. Appleton |page=400}}

File:Tram operator refuses man without mask detail, from- 165-WW-269B-11-trolley-l (cropped).jpg |Passenger without mask being refused boarding of a streetcar amid 1918 flu pandemic. (Seattle, Washington, 1918)

During the 1916 New York City polio epidemic, when there were more than 27,000 cases and more than 6,000 deaths due to polio in the United States, with more than 2,000 deaths in New York City alone, movie theaters were closed, meetings were cancelled, public gatherings were almost non-existent, and children were warned not to drink from water fountains, and told to avoid amusement parks, swimming pools and beaches.{{Cite book |title=The Patient as Victim and Vector: Ethics and Infectious Disease |author-last1=Pabst Battin |author-first1=Margaret |author-link1=Margaret Pabst Battin |author-last2=Francis |author-first2=Leslie P. |author-last3=Jacobson |author-first3=Jay A. |author-last4=Smith |author-first4=Charles B. |date=2009 |publisher=Oxford University Press |isbn=978-0-19-533583-5 |page=351 |url=https://books.google.com/books?id=bXDnCwAAQBAJ&pg=PA351 |access-date=28 March 2020 |url-status=live |archive-url=https://web.archive.org/web/20200328174235/https://books.google.de/books?id=bXDnCwAAQBAJ&pg=PA351&redir_esc=y |archive-date=28 March 2020}}{{cite journal |author-last=Melnick |author-first=Joseph L. |author-link=Joseph L. Melnick |title=Current Status of Poliovirus Infections |url= https://cmr.asm.org/content/cmr/9/3/293.full.pdf|journal=Clinical Microbiology Reviews |publisher=American Society for Microbiology |volume=9 |issue=3 |pages=293–300 |date=1 July 1996 |pmid=8809461 |pmc=172894 |doi=10.1128/CMR.9.3.293 |url-status=live |archive-url=https://web.archive.org/web/20190430072527/https://cmr.asm.org/content/cmr/9/3/293.full.pdf |archive-date=30 April 2019}}

File:Parties Despite Influenza.png, October 19, 1918. Named violators include Joan Pinkerton Chalmers, daughter of Pinkertons private police founder Allan Pinkerton.{{cite web|url=https://digitaledition.chicagotribune.com/tribune/article_popover.aspx?guid=d9a265d7-8b18-447a-8bdb-40121fae5c10 |title=The History of Pandemics in Chicago |publisher=Chicago Tribune |accessdate=2025-03-17}}]]

{{See also|1918 Spanish flu quarantine in Portland, Oregon}}

During the influenza pandemic of 1918, Philadelphia saw its first cases of influenza on 17 September.{{cite journal |author-last1=Hatchett |author-first1=Richard J. |author-last2=Mecher |author-first2=Carter E. |author-last3=Lipsitch |author-first3=Marc |editor-first=Burton H. |editor-last=Singer |title=Public health interventions and epidemic intensity during the 1918 influenza pandemic |journal=Proceedings of the National Academy of Sciences of the United States of America |volume=104 |issue=18 |pages=7582–7587 |date=1 May 2007 |orig-date=2007-04-06, 2007-02-14, 9 December 2006 |pmid=17416679 |doi=10.1073/pnas.0610941104 |pmc=1849867 |bibcode=2007PNAS..104.7582H |doi-access=free }}{{Cite book |author-last=Ryan |author-first=Jeffrey R. |title=Pandemic Influenza: Emergency Planning and Community Preparedness |chapter=Chapter 6.3.3. Response and Containment: Lessons from the 1918 Pandemic Can Help Communities Today |date=1 August 2008 |publisher=CRC Press |isbn=978-1-4200-6088-1 |pages=123–133 [133] |chapter-url=https://books.google.com/books?id=t13C_eWhOX4C&pg=PA133 |access-date=29 March 2020 |url-status=live |archive-url=https://web.archive.org/web/20200329073524/https://books.google.com/books?id=t13C_eWhOX4C&pg=PA133&redir_esc=y |archive-date=29 March 2020}} The city continued with its planned parade and gathering of more than {{val|200000}} people on 28 September and over the subsequent three days, the city's 31 hospitals became fully occupied. During the week ending 16 October, over {{val|4500}} people died.{{Cite journal |title=Influenza in 1918: Recollections of the Epidemic in Philadelphia |author-first=Isaac |author-last=Starr |author-link=Isaac Starr |journal=Annals of Internal Medicine |date=1 October 1976 |volume=85 |issue=4 |pages=516–518 |doi=10.7326/0003-4819-85-4-516 |pmid=788585}} Social distancing measures were introduced on 3{{nbsp}}October, on the orders of St. Louis physician Max C. Starkloff,{{cite journal |last1=McKinsey |first1=David S. |last2=McKinsey |first2=Joel P. |last3=Enriquez |first3=Maithe |title=The 1918 Influenza in Missouri: Centennial Remembrance of the Crisis |journal=Missouri Medicine |volume=115 |issue=4 |date=Jul–Aug 2018 |pages=319–324 |pmid=30228752 |pmc=6140242 |issn=0026-6620 |oclc=7850378090}} more than two weeks after the first case. Unlike Philadelphia, St. Louis experienced its first cases of influenza on 5{{nbsp}}October and the city took two days to implement several social distancing measures, including closing schools, theatres, and other places where people get together. It banned public gatherings, including funerals. The actions slowed the spread of influenza in St. Louis and a spike in cases and deaths, as had happened in Philadelphia, did not occur.{{Cite journal |author-last=Smith |author-first=Richard |author-link=Richard Smith (editor) |date=30 June 2007 |title=Social measures may control pandemic flu better than drugs and vaccines |journal=British Medical Journal |volume=334 |issue=7608 |page=1341 |doi=10.1136/bmj.39255.606713.DB |issn=0959-8138 |pmc=1906625 |pmid=17599996 }} The final death rate in St. Louis increased following a second wave of cases, but remained overall less than in other cities.{{Cite journal |author-last=Kalnins |author-first=Irene |date=September 2006 |title=The Spanish influenza of 1918 in St. Louis, Missouri |journal=Public Health Nursing |location=Boston, Massachusetts |volume=23 |issue=5 |pages=479–483 |doi=10.1111/j.1525-1446.2006.00586.x |issn=0737-1209 |pmid=16961567}} Bootsma and Ferguson analyzed social distancing interventions in sixteen U.S. cities during the 1918 epidemic and found that time-limited interventions reduced total mortality only moderately (perhaps 10–30%), and that the impact was often very limited because the interventions were introduced too late and lifted too early. It was observed that several cities experienced a second epidemic peak after social distancing controls were lifted, because susceptible individuals who had been protected were now exposed.{{cite journal |author-link2=Neil Ferguson (epidemiologist) |date=1 May 2007 |orig-date=2007-03-13, 13 December 2006 |editor-last=Singer |editor-first=Burton H. |title=The effect of public health measures on the 1918 influenza pandemic in U.S. cities |journal=Proceedings of the National Academy of Sciences of the United States of America |volume=104 |issue=18 |pages=7588–7593 |bibcode=2007PNAS..104.7588B |doi=10.1073/pnas.0611071104 |pmc=1849868 |pmid=17416677 |doi-access=free |author-last1=Bootsma |author-first1=Martin C. J. |author-last2=Ferguson |author-first2=Neil Morris}} [https://web.archive.org/web/20200324115254/https://www.pnas.org/content/pnas/104/18/7588.full.pdf] (6 pages)

School closures were shown to reduce morbidity from the Asian flu by 90% during the 1957–1958 pandemic,{{cite journal |author-last1=Chin |author-first1=Tom D. Y. |author-last2=Foley |author-first2=John F. |author-last3=Doto |author-first3=Irene L. |author-last4=Gravelle |author-first4=Clifton R. |author-last5=Weston |author-first5=Jean |date=February 1960 |title=Morbidity and mortality characteristics of Asian strain influenza |journal=Public Health Reports |publisher=Sage Publications, Inc. |volume=75 |issue=2 |pages=149–158 |doi=10.2307/4590751 |pmid=19316351 |pmc=1929395 |jstor=4590751}} (19 pages) and up to 50% in controlling influenza in the U.S., 2004–2008.{{cite journal |author-last1=Wheeler |author-first1=Colleen C. |author-last2=Erhart |author-first2=Laura M. |author-last3=Jehn |author-first3=Megan L. |date=November–December 2010 |title=Effect of School Closure on the Incidence of Influenza Among School-Age Children in Arizona |journal=Public Health Reports |volume=125 |issue=6 |pages=851–859 |doi=10.1177/003335491012500612 |pmid=21121230 |pmc=2966666}} Similarly, mandatory school closures and other social distancing measures were associated with a 29% to 37% reduction in influenza transmission rates during the 2009 flu epidemic in Mexico.{{cite web |url=https://www.nih.gov/news-events/nih-research-matters/flu-pandemic-study-supports-social-distancing |title=Flu Pandemic Study Supports Social Distancing |work=NIH Research Matters |publisher=National Institutes of Health |date=6 June 2011 |access-date=22 April 2017 |archive-url=https://web.archive.org/web/20170423064820/https://www.nih.gov/news-events/nih-research-matters/flu-pandemic-study-supports-social-distancing |archive-date=23 April 2017 |url-status=live }}

The 2009 swine flu pandemic caused social distancing to rise in popularity, most notably in Mexico, with the country's Ministry of Health advising people to avoid handshakes and kissing as ways of greeting people.{{Cite news|last=Wong|first=Grace|date=1 May 2009|title=Flu virus sparks 'social distancing' trend|work=CNN|url=https://www.cnn.com/2009/HEALTH/05/01/swine.flu.etiquette/index.html|access-date=30 March 2021|archive-date=16 August 2024 |archive-url=https://web.archive.org/web/20240816053629/https://www.cnn.com/2009/HEALTH/05/01/swine.flu.etiquette/index.html|url-status=live}} A mandatory nationwide school closure enacted in Mexico, which lasted for 18 days from late April 2009 to early May 2009, was a form of social distancing aimed at reducing the transmission of Swine flu.{{Cite news|date=6 June 2011|title=Flu Pandemic Study Supports Social Distancing|work=National Institutes of Health|url=https://www.nih.gov/news-events/nih-research-matters/flu-pandemic-study-supports-social-distancing|access-date=30 March 2021|archive-date=23 April 2017 |archive-url=https://web.archive.org/web/20170423064820/https://www.nih.gov/news-events/nih-research-matters/flu-pandemic-study-supports-social-distancing|url-status=live}} A study from 2011 found the mandatory nationwide school closure and other forms of social distancing in Mexico were effective at reducing influenza transmission rates.

During the swine flu outbreak in 2009 in the UK, in an article titled "Closure of schools during an influenza pandemic" published in The Lancet Infectious Diseases, a group of epidemiologists endorsed the closure of schools to interrupt the course of the infection, slow the further spread and buy time to research and produce a vaccine.{{Cite news |author-last=Wardrop |author-first=Murray |url=https://www.telegraph.co.uk/news/health/swine-flu/5874683/Swine-flu-schools-should-close-to-halt-spread-of-virus-ministers-told.html |title=Swine flu: schools should close to halt spread of virus, ministers told |date=21 July 2009 |work=The Telegraph |access-date=17 March 2020 |url-status=live |issn=0307-1235 |url-access=subscription |archive-url=https://web.archive.org/web/20200216122920/https://www.telegraph.co.uk/news/health/swine-flu/5874683/Swine-flu-schools-should-close-to-halt-spread-of-virus-ministers-told.html |archive-date=16 February 2020 }} Having studied previous influenza pandemics including the 1918 flu pandemic, the influenza pandemic of 1957 and the 1968 flu pandemic, they reported on the economic and workforce effect school closure would have, particularly with a large percentage of doctors and nurses being women, of whom half had children under the age of 16. They also looked at the dynamics of the spread of influenza in France during French school holidays and noted that cases of flu dropped when schools closed and re-emerged when they re-opened. They noted that when teachers in Israel went on strike during the flu season of 1999–2000, visits to doctors and the number of respiratory infections dropped by more than a fifth and more than two fifths respectively.{{Cite news |url=https://www.reuters.com/article/us-flu-schools-idUSTRE56J4OO20090720 |title=Closing schools won't stop pandemics: study |date=20 July 2009 |publisher=Reuters |access-date=17 March 2020 |url-status=live |editor-last=Walsh |editor-first=Eric |archive-url=https://web.archive.org/web/20200404010410/https://www.reuters.com/article/us-flu-schools-idUSTRE56J4OO20090720 |archive-date=4 April 2020 }}

During the SARS outbreak of 2003, social distancing measures were implemented, such as banning large gatherings, closing schools and theaters, and other public places, supplemented public health measures such as finding and isolating affected people, quarantining their close contacts, and infection control procedures. This was combined with the wearing of masks for certain people.{{Cite journal |author-last=Bell |author-first=David M. |date=November 2004 |title=Public Health Interventions and SARS Spread, 2003 |journal=Emerging Infectious Diseases |volume=10 |issue=11 |pages=1900–1906 |doi=10.3201/eid1011.040729 |issn=1080-6040 |pmc=3329045 |pmid=15550198}} During this time in Canada, "community quarantine" was used to reduce transmission of the disease with moderate success.{{cite journal |title=Quantifying the impact of community quarantine on SARS transmission in Ontario: estimation of secondary case count difference and number needed to quarantine |author-last1=Bondy |author-first1=Susan J. |author-last2=Russell |author-first2=Margaret L. |author-last3=Laflèche |author-first3=Julie M. L. |author-last4=Rea |author-first4=Elizabeth |date=24 December 2009 |pmid=20034405 |doi=10.1186/1471-2458-9-488 |pmc=2808319 |volume=9 |journal=BMC Public Health |page=488 |issue=1 |doi-access=free }}

Social distancing was noted advice during the 2009 swine flu pandemic, especially as people started wearing N95 respirators.

{{excerpt|N95 respirator|H1N1 swine flu pandemic|only=paragraph|paragraph=2|hat=0}}

{{See also|COVID-19 pandemic|flattening the curve|Social distancing measures related to the COVID-19 pandemic}}{{Update section|date=March 2021}}File:Katapult importance social distancing.gif |url=https://www.washingtonpost.com/graphics/2020/world/corona-simulator/ |access-date=29 March 2020 |url-status=live |archive-url=https://web.archive.org/web/20200330062958/https://www.washingtonpost.com/graphics/2020/world/corona-simulator/ |archive-date=30 March 2020}}]]

During the COVID-19 pandemic, social distancing and related measures are emphasized by several governments as alternatives to an enforced quarantine of heavily affected areas. According to UNESCO monitoring, more than a hundred countries have implemented nationwide school closures in response to COVID-19, impacting over half the world's student population.{{Cite web |title=COVID-19 Educational Disruption and Response |date=4 March 2020 |website=UNESCO |url=https://en.unesco.org/themes/education-emergencies/coronavirus-school-closures |access-date=23 March 2020 |url-status=live |archive-url=https://web.archive.org/web/20200329110914/https://en.unesco.org/themes/education-emergencies/coronavirus-school-closures |archive-date=29 March 2020}} In the United Kingdom, the government advised the public to avoid public spaces, and cinemas and theaters voluntarily closed to encourage the government's message.{{Cite news |title=Most UK cinemas shut after virus advice |date=17 March 2020 |work=BBC News |url=https://www.bbc.com/news/entertainment-arts-51925490 |access-date=21 March 2020 |url-status=live |archive-url=https://web.archive.org/web/20200323161040/https://www.bbc.com/news/entertainment-arts-51925490 |archive-date=23 March 2020}}

With many people disbelieving that COVID-19 is any worse than the seasonal flu,[https://www.marketwatch.com/story/coronavirus-vs-the-flu-its-just-like-other-viruses-and-we-should-go-about-our-normal-business-right-wrong-heres-why-2020-03-09 'We're going to have more deaths': Influenza kills more people than the coronavirus so everyone is overreacting, right? Wrong—and here's why] {{Webarchive|url=https://web.archive.org/web/20200408184533/https://www.marketwatch.com/story/coronavirus-vs-the-flu-its-just-like-other-viruses-and-we-should-go-about-our-normal-business-right-wrong-heres-why-2020-03-09 |date=8 April 2020 }}, MarketWatch, Quentin Fottrell, 9 March 2020 it has been difficult to convince the public—particularly youth, and the anti vaxx community to voluntarily adopt social distancing practices.{{cite news |url=https://www.nytimes.com/2020/04/17/us/politics/trump-coronavirus-governors.html |title=Trump Encourages Protest Against Governors Who Have Imposed Virus Restrictions |first1=Michael D. |last1=Shear |first2=Sarah |last2=Mervosh |work=The New York Times |date=17 April 2020 |access-date=24 October 2020 |archive-date=23 April 2020 |archive-url=https://web.archive.org/web/20200423000143/https://www.nytimes.com/2020/04/17/us/politics/trump-coronavirus-governors.html |url-status=live }} Updated 29 April 2020{{cite web |url=https://undark.org/2020/04/16/anti-vaccine-covid-19/ |access-date=24 October 2020 |title=How the Anti-Vaccine Community Is Responding to Covid-19 |first=Katharine |last=Gammon |date=16 April 2020 |work=Undark |archive-date=5 March 2024 |archive-url=https://web.archive.org/web/20240305113328/https://undark.org/2020/04/16/anti-vaccine-covid-19/ |url-status=live }} In Belgium, media reported a rave was attended by at least {{val|300}} before it was broken up by local authorities. In France, teens making nonessential trips are fined up to {{currency|amount=150|code=$|linked=yes}}. Beaches were closed in Florida and Alabama to disperse partygoers during spring break.{{cite news |url=https://www.wthr.com/article/parents-police-struggle-social-distance-young-coronavirus-outbreak |title=Parents, police struggle to social distance the young in coronavirus outbreak |date=20 March 2020 |access-date=23 March 2020 |archive-url=https://web.archive.org/web/20200323063717/https://www.wthr.com/article/parents-police-struggle-social-distance-young-coronavirus-outbreak |archive-date=23 March 2020 |url-status=live }} Weddings were broken up in New Jersey and an 8{{nbsp}}p.m. curfew was imposed in Newark. New York, New Jersey, Connecticut and Pennsylvania were the first states to adopt coordinated social distancing policies which closed down non-essential businesses and restricted large gatherings. Shelter in place orders in California were extended to the entire state on 19 March. On the same day Texas declared a public disaster and imposed statewide restrictions.{{cite news |title=Uh-Oh Moment Finally Hits States Slow to Adopt Social Distancing |date=20 March 2020 |author-first1=Elise |author-last1=Young |author-first2=David R. |author-last2=Baker |work=Bloomberg News |publisher=Bloomberg L.P. |url=https://www.bloomberg.com/news/articles/2020-03-20/uh-oh-moment-finally-hits-states-slow-to-adopt-social-distancing |access-date=29 March 2020 |url-status=live |archive-url=https://web.archive.org/web/20200323063706/https://www.bloomberg.com/news/articles/2020-03-20/uh-oh-moment-finally-hits-states-slow-to-adopt-social-distancing |archive-date=23 March 2020}}

These preventive measures such as social-distancing and self-isolation prompted the widespread closure of primary, secondary, and post-secondary schools in more than 120 countries. As of 23 March 2020, more than 1.2 billion learners were out of school due to school closures in response to COVID-19. Given low rates of COVID-19 symptoms among children, the effectiveness of school closures has been called into question.{{Cite web |title=Lessons from Ebola: The secret of successful epidemic response |author-last=Frieden |author-first=Tom |author-link=Tom Frieden |work=CNN |date=11 March 2020 |url=https://www.cnn.com/2020/03/11/health/coronavirus-lessons-from-ebola/index.html |access-date=23 March 2020 |url-status=live |archive-url=https://web.archive.org/web/20200323214843/https://edition.cnn.com/2020/03/11/health/coronavirus-lessons-from-ebola/index.html |archive-date=23 March 2020}} Even when school closures are temporary, it carries high social and economic costs.{{Cite web |title=Coronavirus deprives nearly 300 million students of their schooling: UNESCO |newspaper=The Telegram |via=Reuters |url=http://www.thetelegram.com/news/world/coronavirus-deprives-nearly-300-million-students-of-their-schooling-unesco-419714/ |access-date=23 March 2020 |url-status=live |archive-url=https://web.archive.org/web/20200328210511/https://www.thetelegram.com/news/world/coronavirus-deprives-nearly-300-million-students-of-their-schooling-unesco-419714/ |archive-date=28 March 2020}} However, the significance of children in spreading COVID-19 is unclear.{{Cite journal |author-last1=Lipsitch |author-first1=Marc |author-last2=Swerdlow |author-first2=David L. |author-last3=Finelli |author-first3=Lyn |date=26 March 2020 |orig-date=2020-02-19 |title=Defining the Epidemiology of Covid-19 – Studies Needed |journal=New England Journal of Medicine |volume=382 |issue=13 |pages=1194–1196 |doi=10.1056/NEJMp2002125 |pmid=32074416 |issn=0028-4793|doi-access=free }}{{Cite journal |author-last1=Zimmermann |author-first1=Petra |author-last2=Curtis |author-first2=Nigel |date=18 March 2020 |title=Coronavirus Infections in Children Including COVID-19: An Overview of the Epidemiology, Clinical Features, Diagnosis, Treatment and Prevention Options in Children |journal=The Pediatric Infectious Disease Journal |volume=39 |issue=5 |pages= 355–368|doi=10.1097/INF.0000000000002660 |pmid=32310621 |pmc=7158880 |issn=0891-3668 |doi-access=free }} While the full impact of school closures during the coronavirus pandemic are not yet known, UNESCO advises that school closures have negative impacts on local economies and on learning outcomes for students.{{Cite web |title=Adverse consequences of school closures |date=10 March 2020 |website=UNESCO |url=https://en.unesco.org/themes/education-emergencies/coronavirus-school-closures/consequences |access-date=23 March 2020 |url-status=live |archive-url=https://web.archive.org/web/20200325181733/https://en.unesco.org/themes/education-emergencies/coronavirus-school-closures/consequences |archive-date=25 March 2020}}

In early March 2020, the sentiment "Stay Home" was coined by Florian Reifschneider, a German engineer and was quickly echoed by notable celebrities such as Taylor Swift, Ariana Grande{{Cite magazine |title=Taylor Swift Urges Fans to Stay Home Amid COVID-19 Outbreak: "I love you so much and I need to express my concern that things aren't being taken seriously enough right now," superstar writes |author-first=Brenna |author-last=Ehrlich |date=15 March 2020 |magazine=Rolling Stone |url=https://www.rollingstone.com/music/music-news/taylor-swift-urges-fans-to-stay-home-amid-covid-19-outbreak-967629/ |access-date=28 March 2020 |url-status=live |archive-url=https://web.archive.org/web/20200319124912/https://www.rollingstone.com/music/music-news/taylor-swift-urges-fans-to-stay-home-amid-covid-19-outbreak-967629/ |archive-date=19 March 2020}}{{Cite web |author-first=Florian |author-last=Reifschneider |date=2020 |title=A Movement to Stop the COVID-19 Pandemic |website=#StayTheFuckHome |url=https://staythefuckhome.com/ |access-date=29 March 2020 |url-status=live |archive-url=https://web.archive.org/web/20200329165848/https://staythefuckhome.com/ |archive-date=29 March 2020}} and Busy Philipps{{Cite web |title=Busy Philipps Joins Cameo to Record "Stay the Fuck Home" Messages for Coronavirus |author-first=Alex |author-last=Hudson |date=17 March 2020 |website=exclaim.ca |url=http://exclaim.ca/film/article/busy_philipps_joins_cameo_to_record_stay_the_fuck_home_messages_for_coronavirus |access-date=29 March 2020 |url-status=live |archive-url=https://web.archive.org/web/20200327135529/http://exclaim.ca/film/article/busy_philipps_joins_cameo_to_record_stay_the_fuck_home_messages_for_coronavirus |archive-date=27 March 2020}} in hopes of reducing and delaying the peak of the outbreak. Facebook, Twitter and Instagram also joined the campaign with similar hashtags, stickers and filters under #staythefhome, #stayhome, #staythefuckhome and began trending across social media.{{Cite web |title=AMA, AHA, ANA: #StayHome to confront COVID-19 |date=24 March 2020 |publisher=American Medical Association |location=Chicago, USA |url=https://www.ama-assn.org/press-center/press-releases/ama-aha-ana-stayhome-confront-covid-19 |access-date=30 March 2020 |url-status=live |archive-url=https://web.archive.org/web/20200328063402/https://www.ama-assn.org/press-center/press-releases/ama-aha-ana-stayhome-confront-covid-19 |archive-date=28 March 2020}}{{Cite web |title=No, Netflix Is Not Spoiling Its Own Shows To Fight Coronavirus |author-first=Madeline |author-last=Berg |work=Forbes |url=https://www.forbes.com/sites/maddieberg/2020/03/26/no-netflix-is-not-spoiling-its-own-shows-to-fight-coronavirus-but-these-ad-guys-are/ |access-date=30 March 2020 |url-status=live |archive-url=https://web.archive.org/web/20200327154558/https://www.forbes.com/sites/maddieberg/2020/03/26/no-netflix-is-not-spoiling-its-own-shows-to-fight-coronavirus-but-these-ad-guys-are/ |archive-date=27 March 2020}}{{Cite news |title='It feels like wartime': how street artists are responding to coronavirus. The pandemic may have closed museums and galleries down but artists have found other ways to comment on the crisis |author-first=Nadja |author-last=Sayej |date=25 March 2020 |newspaper=The Guardian |series=Street art |url=https://www.theguardian.com/artanddesign/2020/mar/25/street-artists-coronavirus-us-it-feels-like-wartime |access-date=30 March 2020 |url-status=live |archive-url=https://web.archive.org/web/20200329005102/https://www.theguardian.com/artanddesign/2020/mar/25/street-artists-coronavirus-us-it-feels-like-wartime |archive-date=29 March 2020}} The website claims to have reached about two million people online and says the text has been translated into 17 languages.{{Cite magazine |title=The #StayTheF***kHome movement just wants you to, well, you know |author-first=Jorge |author-last=Solis |date=16 March 2020 |magazine=Newsweek |series=Culture |url=https://www.newsweek.com/staythefkhome-movement-just-wants-you-well-you-know-1492581 |access-date=30 March 2020 |url-status=live |archive-url=https://web.archive.org/web/20200327145436/https://www.newsweek.com/staythefkhome-movement-just-wants-you-well-you-know-1492581 |archive-date=27 March 2020}}

{{see also|Mental health during the COVID-19 pandemic}}

There are concerns that social distancing can have adverse affects on participants' mental health.{{Cite news |title=Social distancing can strain mental health. Here's how you can protect yourself. |author-last=Ao |author-first=Bethany |newspaper=The Philadelphia Inquirer |date=19 March 2020 |url=https://www.inquirer.com/health/coronavirus/coronavirus-mental-health-social-distancing-20200319.html |access-date=24 March 2020 |url-status=live |archive-url=https://web.archive.org/web/20200326073833/https://www.inquirer.com/health/coronavirus/coronavirus-mental-health-social-distancing-20200319.html |archive-date=26 March 2020}} It may lead to stress, anxiety, depression or panic, especially for individuals with preexisting conditions such as anxiety disorders, obsessive compulsive disorders, and paranoia.{{Cite web |title=Stress and Coping |series=Coronavirus Disease 2019 (COVID-19) |date=23 March 2020 |orig-date=2020-02-11 |publisher=Centers for Disease Control and Prevention |url=https://www.cdc.gov/coronavirus/2019-ncov/prepare/managing-stress-anxiety.html |access-date=24 March 2020 |url-status=live |archive-url=https://web.archive.org/web/20200329113040/https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/managing-stress-anxiety.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fprepare%2Fmanaging-stress-anxiety.html |archive-date=29 March 2020}} Widespread media coverage about a pandemic, its impact on economy, and resulting hardships may create anxiety. Change in daily circumstances and uncertainty about the future may add onto the mental stress of being away from other people.{{Cite web |title=Coronavirus: Social distancing and isolation can take a toll on your mental health, here's how some people are coping. Managing mental health in the time of coronavirus |author-last=Willis |author-first=Olivia |date=22 March 2020 |work=ABC News |url=https://www.abc.net.au/news/health/2020-03-22/mental-health-coronavirus-quarantine-self-isolation/12078550 |access-date=24 March 2020 |url-status=live |archive-url=https://web.archive.org/web/20200328041752/https://www.abc.net.au/news/health/2020-03-22/mental-health-coronavirus-quarantine-self-isolation/12078550 |archive-date=28 March 2020}}

Psychologist Lennis Echterling noted that, in such social distancing situations, using technology for "connection with loved ones...is imperative" to combat isolation, for the sake of one's well-being.{{cite web |url=https://www.jmu.edu/news/counselingctr/2020/03-combatting_loneliness_during_social_isolation.shtml |title=Combatting Loneliness During Social Isolation |author=Genevieve Askin & Janice Lewis |publisher=James Madison University |access-date=16 August 2024 |archive-date=16 August 2024 |archive-url=https://web.archive.org/web/20240816053629/https://www.jmu.edu/news/counselingctr/2020/03-combatting_loneliness_during_social_isolation.shtml |url-status=live }} Social worker Mindy Altschul noted that the concept of "social distancing" ought to be reframed as "physical distancing", so as to emphasize the fact that being physically isolated need not, and should not, result in being socially isolated.{{cite web |url=https://www.hackensackmeridianhealth.org/en/healthu/2021/11/11/staying-connected-while-social-distancing-is-important-heres-why |title=Staying Connected While Social Distancing Is Important, Here's Why |author=Kylie Stanger |publisher=Hackensack Meridian Health |access-date=16 August 2024 |archive-date=18 May 2024 |archive-url=https://web.archive.org/web/20240518111000/https://www.hackensackmeridianhealth.org/en/healthu/2021/11/11/staying-connected-while-social-distancing-is-important-heres-why |url-status=live }}

People with autism also suffer impact from social distancing. Adjusting to a new routine can be stressful for everyone within the spectrum but especially for children who have trouble with change.{{cite news |last1=Treadwell-Deering |first1=Diane E. |title=Coronavirus (COVID-19): Helping Kids With Autism Cope |url=https://kidshealth.org/en/parents/coronavirus-autism.html |access-date=26 July 2020 |work=KidsHealth.org |date=July 2020 |archive-date=26 July 2020 |archive-url=https://web.archive.org/web/20200726201129/https://kidshealth.org/en/parents/coronavirus-autism.html |url-status=dead }} Children with autism may not know what is going on or might not be able to express their fears and frustrations. They also may need extra support to understand what's expected of them in some situations. The adjustment to a new situation can lead to challenging behavior uncharacteristic of the autistic individual's true character.{{cite news |last1=Farmer |first1=Sam |title=Coronavirus and social distancing through an autistic lens |url=https://thehill.com/changing-america/opinion/496836-social-isolation-through-my-autistic-lens |access-date=26 July 2020 |work=The Hill |date=8 May 2020 |archive-date=30 September 2023 |archive-url=https://web.archive.org/web/20230930221309/https://thehill.com/changing-america/opinion/496836-social-isolation-through-my-autistic-lens/ |url-status=live }} In some countries and demographics, teenagers and young adults within the autistic spectrum disorder (ASD) receive support services including special education, behavioral therapy, occupational therapy, speech services, and individual aides through school, but this can be a major challenge, particularly since many teenagers with ASD already have social and communication difficulties.{{cite news |last1=Thom |first1=Robyn |last2=McDougle |first2=Chris |title=Strategies to support teens and young adults with autism spectrum disorder during COVID-19 |url=https://www.health.harvard.edu/blog/strategies-to-support-teens-and-young-adults-with-autism-spectrum-disorder-during-covid-19-2020042419619 |access-date=26 July 2020 |work=Harvard University |date=24 April 2020 |archive-date=24 February 2024 |archive-url=https://web.archive.org/web/20240224070859/https://www.health.harvard.edu/blog/strategies-to-support-teens-and-young-adults-with-autism-spectrum-disorder-during-covid-19-2020042419619 |url-status=live }} Aggressive and self-injurious behaviors may increase during this time of fear and uncertainty.

In his 1957 science fiction novel The Naked Sun, Isaac Asimov portrays a planet where people live with social distancing. They are spread out, miles from each other, across a sparsely-populated world. Communication is primarily through technology. A male and a female still need to engage in sex to make a baby, but it is seen as a dangerous, nasty chore. In contrast, when communication is through technology the situation is the reverse: there is no modesty, and casual nudity is frequent. The novel's point of departure is a murder: this seemingly idyllic world, in fact, has serious social problems.

From the perspective of epidemiology, the basic goal behind social distancing is to decrease the effective reproduction number, $R\_e$ or $R$, which in the absence of social distancing would equate to the basic reproduction number, i.e. the average number of secondary infected individuals generated from one primary infected individual in a population where all individuals are equally susceptible to a disease. In a basic model of social distancing,{{cite book |author-last=Becker |author-first=Niels |title=Modeling to Inform Infectious Disease Control |date=2015 |publisher=CRC Press |isbn=978-1-49873107-2 |page=104}} where a proportion $f$ of the population engages in social distancing to decrease their interpersonal contacts to a fraction $a$ of their normal contacts, the new effective reproduction number $R$ is given by:

$$R\; =\; [1-(1-a^2)f]R\_0$$

Where the value of $R$ can be brought below{{nbsp}}1 for sufficiently long, containment is achieved, and the number infected should decrease.{{cite web

|language = en

|url = https://www.science.org/content/article/ending-coronavirus-lockdowns-will-be-dangerous-process-trial-and-error

|title = Ending coronavirus lockdowns will be a dangerous process of trial and error

|publisher = Science

|date = 14 April 2020

|access-date = 20 April 2020

|archive-date = 30 September 2023

|archive-url = https://web.archive.org/web/20230930221308/https://www.science.org/content/article/ending-coronavirus-lockdowns-will-be-dangerous-process-trial-and-error

|url-status = live

}}

For any given period of time, the growth in the number of infections can be modeled as:{{Cite web|url=https://www.visualcapitalist.com/the-math-behind-social-distancing/|title=The Math Behind Social Distancing|last1=Lu|first1=Marcus|date=28 March 2020|website=Visual Capitalist|access-date=16 April 2020|archive-date=30 September 2023 |archive-url=https://web.archive.org/web/20230930221317/https://www.visualcapitalist.com/the-math-behind-social-distancing/|url-status=live}}

$$y\_n\; =\; \backslash sum\_\{i=0\}^n\; R^i$$

where:

• $y\_n$ is the number of infected individuals after $n$ incubation periods (5 days, in the case of COVID-19)

Using COVID-19 as an example, the following table shows the infection spread given:

• A: No social distance mitigation
• B: 50% reduction in social interaction
• C: 75% reduction in social interaction

An empirical study published in July 2020 in The BMJ (British Medical Journal) analyzed data from 149 countries, and reported an average of 13% reduction in COVID-19 incidence after the implementation of social distancing policies. Another study found that four social distancing interventions combined resulted in a reduction of the infection rate from 66% to less than 1%.https://www.researchgate.net/publication/340108203_The_Effectiveness_of_Social_Distancing_in_Mitigating_COVID-19_Spread_a_modelling_analysis page 6

• COVID-19 party
• Civil inattention
• Herd immunity
• Lockdown
• Pest house
• Stay-at-home order

{{clear}}

{{Reflist}}

{{commons category|Social distancing}}

{{wikiquote}}

• [https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/social-distancing.html CDC Social Distancing]
• [https://www.redcross.org/about-us/news-and-events/news/2020/coronavirus-what-social-distancing-means.html American Red Cross: How to Social Distance]
• [https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/coronavirus-social-distancing-and-self-quarantine Johns Hopkins: Social and Physical Distancing]

{{Public health}}

{{COVID-19 pandemic}}

Category:Infectious diseases

Category:Quarantine

Category:Epidemics

Category:Epidemiology

Category:Medical hygiene