6 Pandemic Planning—Social Distancing

Pandemic Planning—Social Distancing
This fact sheet provides information on how to utilize social distancing as a means to help control or minimize the spread of a possible pandemic virus among individuals and in the community.

Background
A severe pandemic (defined as a worldwide epidemic) in a vulnerable population, such as the 1918 flu pandemic, represents a worst-case scenario for pandemic planning and preparedness. Communities, individuals, employers, schools, and other organizations are being asked to plan for the use of interventions that will help limit the spread of disease. At this time, there is concern because of continued spread of a highly pathogenic avian influenza (H5N1) virus among animals in Asia, Africa, the Middle East, and Europe that has the potential to significantly threaten human health. If a virus such as H5N1 mutates and spreads easily from one person to another, an avian influenza may break out globally. While there are no reports of sustained human-to-human transmission of avian influenza, governments and international health agencies are preparing for a possible pandemic. A pandemic can originate from any unknown source, such as the H5N1 virus.

What Is Social Distancing?
Social distancing (SD), self-shielding, voluntary isolation, and reverse quarantine are all methods that attempt to limit close physical proximity between infected and healthy individuals. They provide individuals with some measure of personal control over their own exposure to a potential pandemic. SD can be instituted voluntarily by individuals or through actions taken by local, state, or government officials such as closure of schools, discontinuance of public transportation, and restrictions on large gatherings or public venues. During the 1918 pandemic, leaders of the Church were supportive of SD efforts to curtail public meetings and other social functions sponsored by the Church. Some examples of their efforts included the following:
• Postponing the April 1919 sessions of general conference until June
• Holding a nonpublic funeral for President Joseph F. Smith
• Suspending local Church meetings in areas affected by the pandemic
• Holding special fasts to help ease the pandemic
• Publishing articles in Saturday’s edition of the Deseret Evening News to help fill the spiritual void left when Church meetings were suspended

Why Social Distancing?
Influenza is thought to be primarily spread through large respiratory droplets (droplet transmission) that directly contact the nose, mouth, or eyes. These droplets are produced when infected people cough, sneeze, or talk, sending the infectious droplets and very small sprays (aerosols) into the air and into contact with other people. Large droplets can only travel a limited distance; therefore, people should limit close contact (within 6 feet) with others when possible. To a lesser degree, human influenza is spread by touching objects contaminated with influenza viruses and then transferring the infected material from the hands to the nose, mouth, or eyes.

What Are the Benefits of Social Distancing?
Adults may decrease their risk of infection by practicing SD and minimizing their nonessential social contacts and exposure to highly populated environments. Low-cost and sustainable SD practices can be adopted by individuals within their community (for example, going to the grocery store once a week rather than every other day, avoiding large public gatherings) and at their workplace (for example, spacing people farther apart in the workplace, telecommuting when feasible, substituting teleconferences for meetings) for the duration of a community outbreak.
Children are a significant factor in the transmission of influenza for many reasons. Compared with adults, children usually shed more influenza virus and for a longer period. They also are less skilled in handling their secretions and are in close proximity with many other children for most of the day at school. Schools, in particular, clearly serve as a means to transmit seasonal community influenza epidemics. Infected children and parents are also thought to play a major role in introducing and transmitting influenza virus within their households. Therefore, given the disproportionate contribution of children in spreading disease and viruses, targeting their social networks both within and outside of schools would be expected to help disrupt influenza spread. Given that children and teens are together at school for a significant portion of the day, dismissal of students from school could effectively disrupt a significant portion of influenza transmission within these age groups. Mathematical modeling also suggests a reduction of overall disease especially when schools are closed early in the outbreak. Parents may determine to keep their children at home, therefore providing a form of voluntary SD. During this period, parents would be encouraged to consider child care arrangements that do not result in large gatherings of children outside the school setting.

What Are the Basics of Social Distancing
Social distancing may be a viable alternative for the general public to avoid the pandemic influenza infection until a vaccine becomes available. Below, in order of potential effectiveness, are various aspects of SD suggestions:
1. Limit exposure to other people within 6 feet.
2. Minimize exposure to enclosed spaces containing crowds, such as movie theatres, grocery stores, gas stations, schools, malls, and so forth.
3. Use personal protective equipment, such as N95 masks (see Pandemic Planning—
Personal Protective Equipment fact sheet), if you must get within 6 feet of anyone outside your immediate family (or other individuals where you have intimate knowledge of their health conditions) or if you must go into an enclosed space containing crowds. It should be noted that there is limited information on the use of surgical masks for the control of a pandemic in settings where there is no identified source of infection.
4. Wash hands after touching any item that may have been touched by others or use disposable gloves (see Pandemic Planning—Personal Hygiene fact sheet for more details). Contaminated surfaces can transmit influenza for 24 hours.

Potential Impacts of Social Distancing
Closure of office buildings, stores, schools, and public transportation systems may be feasible community containment measures during a pandemic and are considered forms of forced SD. All of these have significant impact on the community and workforce. Careful consideration should be focused on their potential effectiveness and how to maintain critical supplies and infrastructure while limiting community interaction. For example, when public transportation is cancelled, other modes of transportation must be provided for emergency medical services and medical evaluation. The mandatory closure of public venues will have a direct and significant effect on worship services, as well as proselytizing efforts by missionaries.
References
www.osha.gov/Publications/influenza_pandemic.html
www.pandemicflu.gov/plan/community/commitigation.html