Guidance on Community Social Distancing During COVID-19 Outbreak (1)

by Africa Centre for Disease Control and Prevention (Africa CDC)

Background

In Africa, the number of COVID-19 cases and impacted countries has been increasing steadily. As of 12 March 2020, 129 cases have been diagnosed in 12 countries, with one death recorded. The experience in countries outside Africa is that, after initial cases are diagnosed, community transmission occurs rapidly. Member States need to immediately implement individual social distancing and plan to implement community social distancing.

Social distancing is an accepted strategy to delay and reduce the magnitude of outbreaks of pandemic influenza. At the individual level, social distancing involves the use of non-contact greetings, maintaining at least one metre distance between yourself and other people, and staying home when ill. At the community level, social distancing involves closure of any events or settings in which people gather together, including schools, workplaces, houses of worship, and cultural, social and sports events. For COVID-19, social distancing is necessary at the individual and community levels, because transmission occurs frequently from person-to-person and infection causes severe illness in up to 20 percent of people. No population immunity exists, and no vaccine or cure exists yet. Reducing contact between people reduces the cumulative number of opportunities for transmission and it’s the only way to help protect people who are at high risk for severe COVID-19 disease.

Little is known about the efectiveness of community social distancing for COVID-19. As of March 2020, what we know is:

  1. For influenza virus, which is the most similar comparable infection, individual and community social distancing, combined with rigorous isolation of people with symptoms (confirmed or suspected cases), delays and reduces the magnitude of outbreaks.
  2. Transmission is facilitated by proximity, duration, and number of contacts. The aim of community social distancing is to reduce the number, closeness and length of contacts between people as much as possible. Full lockdown may not be feasible, but all effort should be made to prevent as many unnecessary opportunities for contact as possible.
  3. Community social distancing should be instituted,  at a minimum, as soon as there is any evidence of community transmission and then maintained for weeks or months depending on the stage of the outbreak or presence of cases within the community.
  4. The primary outcome of community social distancing is to slow transmission and reduce daily case numbers, to permit:
    • Health facilities to attend to a manageable volume of patients without compromising quality of care;
    • Public health oficials to apply new knowledge to target interventions more precisely;
    • Researchers to develop vaccines and medications.
  5. Specific transmission characteristics of COVID-19 suggest that community social distancing is necessary to delay and reduce the magnitude of outbreaks:
    • Transmission occurs frequently among close contacts.
    • Transmission may occur from people who are infected and do not yet have symptoms.
    • Transmission may occur from people who are infected and never develop symptom
  6. Rigorous application of community social distancing in China has slowed transmission.
  7. Community social distancing is disruptive, difficult and potentially dangerous. It is severely and inequitably impacting economic, social, and cultural activity. However, careful community engagement can mitigate these effects.

Many questions exist about community social distancing for COVID-19, including:

  1. How effective is individual social distancing in delaying and reducing the magnitude of outbreaks without or when combined with community social distancing?
  2. For community social distancing, how effective is school closure, particularly for different levels of schools (e.g. primary, secondary, tertiary)?
  3. How effective is community social distancing if other contact activities such as work and public transport continue? What measures can workplaces take to reduce transmission?
  4. How severe are the harms from community social distancing on individuals and communities, including physical health, mental health, social cohesion, and economic life?
  5. How feasible and acceptable is community social distancing in different communities and cultures, particularly if people cannot earn income, cannot purchase goods at markets, and cannot attend religious services?

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