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Social Distancing & History of avoiding infections in community-Prof (Dr.) Sundeep Mishra(AIIMS)

Prof (Dr.) Sundeep Mishra Department of Cardiology, AIIMS, New Delhi

Since beginning communities have gone to extraordinary lengths to avoid infections, however, before COVID pandemic nobody thought that a virus, 100 times smaller than even bacteria, would make human closeness a big problem. Even centuries before we knew about microorganisms, antibodies or vaccination, people had a pretty good idea that being infected was something to avoid at all costs. Looking at humanity’s long history of desperate, even nauseating strategies for avoiding infection involved staying home, keeping distance, toad vomit-flavored lozenges or the prospect of tooth pulling.

In Ayurveda, Pandemic is explained in Charaka Samhita Viman Sthana under Janpadodhwansniya Adhyaya. Regarding prevention of infections Ayurveda has discussed conduct under “Sadvritta” (Code of good conduct). It can be classified as

  • Personal – regime of bathing, cleaning of eyes, nose, ears, teeth, oral cavity, nails etc
  • Social – not using unwashed clothes, dirty or uncomfortable clothes, clothes worn by others, not appropriate to the season, occasion or clothes made from unnatural fiber.

Social Distancing – Time: 5th century BC – Scene: Bible, the Book of Leviticus 13:46: “And the leper in whom the plague is… he shall dwell alone; [outside] the camp shall his habitation be.”

 Quarantine – Time: 541 – 542 CE – Scene: Plague of Justinian, Emperor Justinian enforced an ineffective quarantine on the Byzantine Empire, including dumping bodies into the sea; he predominantly blamed the widespread outbreak on “Jews, Samaritans, pagans, heretics, Arians, Montanists and homosexuals”.

Four Thieves Vinegar – Today we achieve disinfection by hand washing or using alcohol based disinfectants. Legend says that in the Middle Ages “four thieves vinegar” – a concoction of herbs brewed in cider vinegar was invented by a group of grave robbers to keep them safe from decomposing infected material. However, when they were arrested they agreed to share their secret recipe in exchange for freedom. Since then, it was common to douse oneself in– before leaving the house, as a way of staving off the plague.

Cane Six Spans Long – Fast forward 16th-Century Sardinia; Scene – outbreak in the city of Alghero, the good doctor Quinto Tiberio Angelerio devised an ingenious method of social distancing, in which “any person going out from home must carry a cane six spans long [the distance measured by a human hand], and as long as the cane is, one must not approach other people”. Furthermore, he also recommended only one person per household venture out to do the shopping, and urged his readers to be careful when shaking hands.

Toad Vomit Lozenges – Time: 17th century – Scene:  Black Death, Sir Isaac Newton, the celebrated physicist developed toad-vomit lozenges to combat the epidemic.

1793, yellow fever outbreak, the US government simply evacuated entire sections of Philadelphia, then-capital of the USA. At that time nearly ½ the population of Philadelphia (estimated 20,000 people) was evacuated.

Lazarettos – Time: 18th Century, Scene: Italy, Leper colonies and lazarettos were established as a means of preventing the spread of leprosy and other contagious diseases through social distancing.

Closure of Parks and Public Places – Time:1916 – Scene – New York City polio epidemic, 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. New York City parks and playgrounds were closed, 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.

1918 flu pandemic – Scene: St. Louis, USA, after the first cases of influenza were detected in the city, authorities implemented school closures, bans on public gatherings and other social-distancing interventions. Later, the influenza fatality rates in St. Louis were much less than in Philadelphia, which had fewer cases of influenza but allowed a mass parade to continue and did not introduce social distancing until more than two weeks after its first cases.

Dental Job – Time: 1940s, as a part of dental practice, women would routinely have all their teeth removed, as a way to prevent sepsis (during pregnancy). As a matter of fact this strategy was so popular that it was often paid for as part of a wedding gift, or for their 18th birthday.

School closures – Time: 1957-58 – Scene:  Asian flu in US, enforcing school closures were shown to reduce morbidity from the Asian flu by 90% and up to 50% in controlling influenza in the U.S.

1963, Edward Hall, a cultural anthropologist, coined the term proxemics to define studies about social distancing in everyday life.

Hall proposed four main zones of space between individuals:

  • Intimate distance (less than half a metre), such as in giving or receiving a hug.
  • Personal distance (about 1 metre), usually reserved for family or good friends.
  • Social distance (2 to 3 metres), when meeting strangers.
  • Public distance (more than 5 metres), such as in public presentations.


Evolution of the term – Social Distancing

It started with a memoir by a friend of Napoleon, who talked about how he experienced social distance (space) in his friendship with Napoleon, as Napoleon began to conquer more places. Then it’s used a lot as a euphemism for class in 19th-century British newspapers and as a euphemism for race in 19th century U.S. newspapers. In the 1920s, the Social Distance Scale [which measures prejudice by asking participants to describe how comfortable they feel interacting with people of another race] becomes a social science tool, a reductive attempt to slice the world into ethnic groups, and it’s still in use.


Definition of Social Distancing (Modern)

In public health, social distancing, aka physical distancing, is a set of non-pharmaceutical interventions / measures intended to prevent the spread of a contagious disease by maintaining a physical distance between people and reducing the number of times people come into close contact with each other.

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