Develop frameworks to reimagine physically distanced lifestyles

Adapt and Thrive in the “New Normal”

Russell Furr, Michael Halaas and Jason Wang on reimagining physically distanced lifestyles

Once unheard of, social distancing has become ingrained in our daily routines. Russell Furr, associate vice provost for environmental health and safety; Michael Halaas, deputy chief information officer; and Jason Wang, MD, PhD, associate professor of pediatrics and medicine, are among those who have spent much time reflecting on what it’s meant to adjust to such a different way of life; how social distancing influences children, students and the workforce; and what individuals can do to restore some sense of normalcy while keeping distance.

Furr, Halaas and Wang emphasize that risk is on a spectrum, and that some activities should be more concerning than others, particularly those confined to indoor spaces. They likewise emphasize that physical distancing doesn’t have to mean social isolation, and there are ways to stay in touch while staying safe.

Even as scientists and doctors devise treatments and vaccines for COVID-19, prevention through physical distancing will remain key to stopping the spread of the virus. For this reason, it’s critical that researchers, public health officials and individuals in the community provide feedback to one another in an effort to communicate how new scientific evidence informs social distancing guidelines more broadly.

What was it like when it first became clear that social distancing was necessary, and how did you bring that to the broader community?

Furr: In the beginning of the outbreak, we had no model or framework for understanding what “social distancing” meant. The debate around masks early on highlighted that. There was this concept that we had never asked people to do anything like this before and, therefore, we couldn’t ask them to do it now. As we learned more about transmission, it became very apparent that this was a necessary measure. Public health officials and the community began to rethink what was feasible. It took some time to internalize practicing social distancing, and even now there’s still room for improvement.

Halaas: Thinking back to those early days, it’s clear that we were all experiencing a bit of shock. There was a lot of confusion about mask wearing, how long the virus lives on surfaces, how one gets infected and so on, and all of that added a sort of chaos to our deliberations about what to do. We were trying to figure out how we can continue to execute on our missions and educate students, all while trying to empty out the campus and get students on planes. It was a really interesting — and challenging — conjunction of events that we’d never had to deal with before.

Wang: I go to Asia quite often, and the difference in how people view social distancing seems rooted in culture, mostly to do with the environment and context. When I go to Taiwan, people already use masks as a way to socially distance since often there isn’t room for people to have 6 feet of space between them. For Americans, it took people having to do more drastic social distancing — sheltering in place — for the idea of physical distancing to be taken more seriously.

Fast-forward to today: Has that initial shock worn off? How are things functioning now in terms of adapting to a physically distant lifestyle?

Furr: I think people are becoming more comfortable doing what needs to be done while physically apart. Whether or not we like it is different story. In my family, for instance, my kids were dreading any kind of online school, but slowly, over the summer, they came to terms with the fact that they were going to do their classes online and that it can be done successfully. That doesn’t mean that it’s easy — there is a lot of anxiety and concern caused by this absence of human interaction. COVID-19 has also really shifted the way we do research in labs as well. Facilities that were bustling and very busy each day have more of a scheduled cadence now, with different individuals coming in at certain times. This of course changes some of the dynamic of interaction and collaboration, but ultimately keeps everyone safe. Overall, though, it’s amazing how much people can get done, even if they’re not always thrilled with how it happens.

Halaas: It’s tough. I’ve heard things like, “I can take a vacation, but what am I going to do?” Social distancing eliminates many of the things that brought joy to life and made it dynamic. We have to now focus on how we achieve what’s practically necessary until we can get to the other side. Part of that is simply adjusting. And while we’re all getting more comfortable, there will be bumps in the road. For me, for instance, if someone is not wearing a mask, I feel pretty awkward — I won’t even really make eye contact.

Wang: From a clinical perspective, about 80% of my clinic has been moved to telemedicine. When I have an appointment with a patient, my visual field is restricted: It goes only as far as Zoom allows; sometimes I’m speaking with a mother and child, and I can see only half of their faces. On the flip side, I’m able to see inside the patient’s home if they allow it, so there’s an extra layer of patient connection. You have to take the good with the bad, and I think as we adapt to seeing patients in these new ways, there will be new interactive technologies that can help make the transition smoother.

Where do we go from here? How can social distancing be improved?

Furr: As we’re navigating what it means to socially distance and better understanding what prompts transmission, people are beginning to test the waters of small gatherings and travel. I think there’s a balance in understanding the relative risk of different activities. Going to the beach and staying more than 6 feet from a neighbor is much less risky than going to a restaurant and eating indoors. It’s about understanding that this is not black and white, and there is a spectrum of risk to consider when making decisions. The good news is as we learn more, we can adjust our approach. For example, we can increase the number of researchers in a lab or allow small indoor classes as we establish confidence in our controls.

Halaas: I think a lot of it is dependent on small social networks, and how key people around you feel about it. If you live with somebody who’s high risk, or who has anxiety issues about it, it substantially affects your own behavior. But even if you’re like me and you’re very cautious, it doesn’t mean you have to restrict yourself to one place. I was in Tahoe last week, and down by the lake it was jam-packed on the beaches and in the restaurants, so I stayed up in the mountains and avoided the lake scene. There has to be a balance in how we decide where to go and what to do.

Additionally, I’m not a researcher, but if we got clarity on what masks work the best for a broad population, that would be game changing.

Wang: There are strategies that people develop to stay socially connected while physically distant, and one of these is having a close cohort of individuals that you see, and when you’re together, you still keep social distance. For example, I see my neighbor outside putting the chairs 6 feet apart in their driveway, and they have friends over to chat.

There are also two research questions that I’m particularly interested in that are essential to understanding COVID-19 and how we should be thinking about social distancing. Kids generally don’t have as severe symptoms if infected with SARS-CoV-2. But recent data shows that children have higher viral loads, 10 to 100 times higher, and we don’t know why that is. The second question pertains to asymptomatic individuals, who account for about 40% of cases. Do asymptomatic individuals transmit the disease similarly to symptomatic individuals? We don’t know that, or the duration for which they’re infectious.

Do you think the current compliance with social distancing is adequate?

Halaas: It’s hard to say it’s adequate when you look at the case count and the number of people dying. But if you look at it in reverse, when we don’t do social distancing and masking, the numbers clearly go up. When we started to see a surge here in San Francisco, mask wearing went to almost 100%. Now we see really good adherence to mask wearing, and the case count is starting to go down. So, we at least know that it’s impactful; whether it’s adequate is more difficult to definitively decide, and I think part of that is defining what exactly “adequate” means. We’ve seen that you can’t look at COVID in isolation from the economy, joblessness or other impacts on health system. “Adequate” is a complicated set of parameters, but we do know it doesn’t just pertain to case count; we have to think about containing this virus in the context of not completely destroying the economy and causing other kinds of secondary effects.

Understanding the real impact of policy decisions, whether they’re financial or personal, is not something we can do without the contributions of community stakeholders

What does stakeholder involvement look like?

Wang: When you make new policies you have to involve stakeholders. You have to tell them about the science behind the policy and they, in turn, have to communicate with the policy makers about what is feasible to carry out in their community. Stakeholder groups should be a diverse representation of the voices of a community. That way, you get buy-in on the strategies you’re putting forth. Often in a community, you have budget constraints as well, so there are practical issues in how and what to implement; prioritizing stakeholder feedback allows us to better understand what those issues are and how to solve them or adjust.

Furr: I agree. Understanding the real impact of policy decisions, whether they’re financial or personal, is not something we can do without the contributions of community stakeholders. We’ve been adapting, innovating and iterating on so many different aspects of work and life, but the only way to know if you’re getting better is to get feedback from people who are involved at different points in the process. That can include the development of new drugs, new tools for our workplaces or the implementation of new guidelines to come to campus; otherwise, you’re flying blind. The feedback we get from people, which candidly is not always enjoyable, continues to be the most valuable thing to gauge how we’re doing as we plan our next steps. We welcome feedback when something isn’t working, but it’s also helpful to know if someone feels like a change, or policy, is helping to improve things.