Proper Social Distancing. Image Credit - Valerie

Lack of Evidence and Unintended Consequences: Social Distancing and Social Isolation

While everyone is stuck in their homes, many of them are wondering where the evidence is for this economic shutdown we are in the midst of. Is there actually any evidence for it at all?

Proper Social Distancing. Image Credit - Valerie

Proper Social Distancing. Image Credit – Valerie Licensed by CC 2.0

Protests around the country have erupted, as people are unable to pay their bills, which are in most cases much more than rent. Food, phone service, and debts are among the personal bills, along with business bills such as rent, phones, internet, supplies, vehicle insurance, financing loans, etc., etc.

As far as evidence, the vast majority of studies that have been conducted on social distancing were conducted during the Covid-19 pandemic. Since we know so little about the disease, most of these studies are, by their nature, based on conjecture and assumptions.

There are too many unknowns to make accurate statements of fact. On PubMed, the entire first two pages of results about social distancing are during this Covid-19 pandemic.

When it comes to actual studies in the literature, there was only one systematic review that was published before March of 2020 that includes epidemiological evidence. (This particular review discussed a total of 15 studies, only three of which were epidemiological or population-based studies.)

The other 12 were computer modeling studies. If the computer models that gave us the estimates of 245,000 people dying from this disease are any indication, computer modeling studies are nearly useless. That same computer model was revised to show a much lower estimate based on new data, that 60,000 people would die.  This is a four-fold decrease.

A computer model is only as good as the data that you put into it. If the statisticians put garbage in, they will get garbage out. These types of studies are unreliable.  According to Insight Medical Publishing, “Models are typically used when it is either impossible or impractical to create experimental conditions in which scientists can directly measure outcomes. Direct measurement of outcomes under controlled conditions will always be more reliable than modelled estimates of outcomes.”

Another summary of evidence for social distancing appeared in the Lancet, however, this summary relied exclusively on computer modeling during the ongoing pandemic, so the results are not very reliable. The studies stated that there was over a 90% reduction in transmission, but was not verified in real-life, and had no control. It was merely an estimate, and may or may not be accurate.

The three studies in the review above that were epidemiological in nature were analyzed for risk of bias, and two of the studies were defined as having serious risk of bias, where the third was defined as having critical risk of bias. So these three studies, which were the only studies conducted on actual populations, were highly biased and may be yielding unreliable information.

All in all, however, the conclusion of the systematic review was that social distancing measures, which did not include complete workplace closure, as this was not a recommended outcome for reasons that have become all-too-obvious, yielded a 23% reduction in case transmission.

While the studies did not include complete closure, they did include having people who could work from home do so, and everyone else practicing social distancing (keeping six feet apart). Since the current lockdowns have allowed some businesses to remain open, notably grocery stores and pharmacies, there has similarly in this pandemic not been a complete and total closure of every business.  Social distancing has also been practiced in these businesses.

So it can be concluded that, similarly to this study, the measures taken likely only contributed to a 23% reduction in transmission.

All of this is not to suggest that social distancing is ineffective; simply that there is a lack of evidence that is pre-Covid-19. In addition, Covid-19 is novel, new, and unknown, so all studies that are done about this disease are, as a result, speculative, and such studies would by definition make many assumptions.

The other notable problem with the social distancing measures is that there is no control. There is no first-world country where no measures have been taken. While it may be possible to later look at Sweden as something of a control, it is not a complete control because the people there took the social distancing measures to heart.

So, while they were allowed to go to school and to work as normal, most of them chose not to. There was an estimated 2/3 reduction in business related activity among the Swedes, and a 90% reduction in those visiting vacation destinations during the Easter holiday.

There is one other problem with using Sweden’s data, and that is that they are over-counting the death rate. Every single person who died in that country who had Covid-19 within the prior 30 days was considered to have died from Covid-19, even if their actual cause of death was a heart attack, stroke, bacterial pneumonia, or something else.

This has the effect of inflating the numbers, and is in contradistinction to their neighbors, such as the Netherlands, where the death rate is counted much more conservatively (an individual must have died from Covid-19 in order to be counted as having died from it).

Perhaps we could look to Nigeria. However, as it has been noted by New York City’s Mayor, this disease is much more likely to cause death in those suffering from poverty, such as those in low-income areas in New York.  Unfortunately, many Nigerians are living in poverty, and their country is considered a developing country. We would need to look to a first-world nation.

Martindale Nursing Home. Image Credit -  Gawler History

Martindale Nursing Home. Image Credit – Gawler History Licensed by CC 2.0

As the title suggests, there is one other point to make, and that is the unintended consequences of social isolation on those most vulnerable. There have been some studies in recent years that have found that one predictor of long life and health is social interaction with others. One was published in the American Journal of Public Health in 1992.

The book Touch by Tiffany Field speaks a great deal about the effects of touch on the elderly, and how many elderly people, especially those in nursing homes, deal with loneliness, depression, and other ill health effects that are caused therefrom.

One study in a nursing home in Turkey found that giving elderly residents hand massages or other touch interventions, versus a control, helped reduce their anxiety and increase their comfort levels.

Other studies such as one published in the journal Brain, Behavior, and Immunity, showed that loneliness and depression had negative effects on the immunity in university students.

In other words, there was a measurable effect on the immunity of people suffering from loneliness, depression, and anxiety. To the point where it could be detected in salivary levels of Immunoglobulin A of several different subsets, and their transporter module, Secretory Component.

This study concluded that perceived stress (of which depression was a part) decreased these people’s actual real-time immunity.

During these lockdowns, patients in nursing homes are being protected from the public, in that they cannot have visitors of their own. No family, no friends, no outside visitors.

However, their nurses and other staff members can leave and return every day, thus increasing the possibility of infecting them. While they have this exposure, their immunity is likely lowered in a measurable way from the loneliness and depression that they are experiencing.

It is well-known that elderly people who have no family suffer from higher levels of depression and loneliness in general, and in the protection of them, it is a possibility that they are being made more susceptible to the very disease from which they are being protected. Germs aren’t everything; there are many other factors in immune response.

A recent study in Neuroscience and Behavioral Reviews, published in 2020, determined that there was a correlation between loneliness and inflammatory processes that cause chronic health conditions.

The study found that loneliness appeared to cause an excess of inflammation, which then became chronic, and was the basis for many diseases.  According to a report about this study at cybermedlife, “While inflammation repairs and heals, chronic inflammation can damage healthy cells, tissues and organs, eventually leading to heart problems, arthritis, diabetes and some cancers.”

It is thus also possible that the loneliness and depression are leading to the worsened outcomes among nursing home residents. As we have already seen, in New York alone, one fifth of the deaths are among nursing home residents.

 

Wheldon Care Center Nursing Home. Image Credit - Brian-Bullock

Wheldon Care Center. Image Credit – Brian-Bullock Licensed by CC 2.0

However, the nursing homes in Sweden remained open to visitors, who very likely did not visit in order to protect the residents, and the death rates there have been higher as well.  About 42 percent of Sweden’s total death count has been in nursing homes. This has led to additional controversy around the world.

This is a topic for which further research is needed, and it is unfortunate that there will be no control group against which the other first-world countries can be compared.

Perhaps, however, in Sweden, the overall death rate will be lower, which would indicate that the severe lockdown measures were not as helpful as could have been assumed if every single country had implemented them. Thus far, the per capita death rate is not extremely high there, and is comparable to that of New York State, which is at a similar virus transmission stage to Sweden.

Again, time will tell, and the world will be looking for evidence.

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