Eric Paul Justin, MD, MPH, MBA

We all remember those dreaded words don’t we? Whether it was a truly long trip and even on shorter trips. Our young ones uttered that simple question many times. And we did the same thing when we were young. Distances were hard for us to understand. Time was also a tough concept especially when seated for what seemed forever. At least we knew where we were going then, didn’t we?

Several months back we all started on a journey together. The actual start date doesn’t matter much now. The fact is we have been ‘in our seats’ for a long time. First the COVID-19 cases seemed incidental and much of the early information was about people and countries thousands of miles away. And then COVID-19 got closer and landed on our shores.

At first we didn’t know it. By the time it became crystal clear that there is indeed a problem, there were already several US cities significantly impacted. And it has only gotten worse. In addition to our problems of ‘distance’ and ‘destination’ we have also had to deal with the greatest level of uncertainty for our future than at almost any time in modern history.

Three hundred and thirty million or more of us are in the back seat for this upsetting but epic journey. As a nation we have been challenged to go on a journey we didn’t ask for, nor were we prepared to start. Nature doesn’t usually give us a choice. So as individuals we must try to do the right things. Instead of packing a bag for our journey we must in fact ‘repackage’ our lives and for the foreseeable future do things differently. For starters:

Best ways to prevent infection from COVID-19 begin with SOCIAL DISTANCING.You can also take everyday actions that help prevent the spread of respiratory illnesses:

  • Wash your hands regularly with soap and water for at least 20 seconds. No need to scald your hands. If soap and water are not available, use hand sanitizer that is at least 60% alcohol.
  • Avoid touching your eyes, nose, and mouth with unwashed hands.
  • Do not come in close contact with people who are sick.
  • Clean and disinfect frequently touched objects and surfaces.
  • Cover your nose and mouth with a tissue when you sneeze or cough. Throw the tissue in the trash and wash your hands afterward.
  • Stay home when you are sick.

Social distancing alone has made this journey hard for most people. Whether one has given up church services or simply a day on the job with co-workers as well as a myriad of other routine activities, we must subtract those from our schedules for now. Yet it is important to maintain some kind of schedule on a daily basis.

The goal should be to try to maintain your life’s flow in as intact a fashion as is possible. You will likely have to add more of some activities like more FaceTime with family and friends. You may also have to add entirely new things to do. This could be doing that 5,000 piece jigsaw puzzle you never opened from last Christmas or exploring and taking an online course or taking an online museum tour. And one more recommendation…watch less ‘news’ and schedule that as well, rather than ‘catching up with the news’ which all to often may end up with a constant stream of television/couch time.

Given the extreme lengths that social distancing requires for it to work well, it is fair to ask: does it works? My emphatic answer is YES! I like a bit of proof as much as anyone else. So here is a great example that Social Distancing does work from a medical journal article about the “Spanish Influenza Pandemic of 1918/19.” That pandemic killed tens of millions of people around the world at the end of and shortly after World War One. Here is a graph from that article (www.pnas.org︎cgi︎doi︎10.1073︎pnas.0610941104) to view:

Excess P&I mortality over 1913–1917 baseline in Philadelphia and St. Louis, September 8–December 28, 1918. Data are derived from ref. 10.

The solid black line represents deaths in the city of Philadelphia between September 8 and December 28, 1918. As you can see it is a tall large ‘spike.’ The dashed line represents deaths in the city of St Louis during the same time period. These are adjusted for the ‘usual number of deaths’ experienced in both cities between 1913 and 1917. Thus the graph shows only deaths due to influenza in both cities. What is the difference?

Early and extensive use of social distancing in St Louis. They had another term for it (nonpharmacologic interventions) but it is essentially the same concept. It involves closing schools, churches, theaters, other events and spaces in which large numbers of people gather. Also allowing only essential business activities for a period of time was critical. Cities that used only one or a few of these categories of closures did not do well.

It is fairly easy to see that far fewer people died in St Louis (dashed line). They started social distancing almost immediately after it became clear that they had documented cases of influenza.

Philadelphia delayed social distancing for several weeks after knowing of their first cases and city officials also allowed a large annual parade to take place despite foreknowledge that it would likely make the spread of influenza worse.

The consequence is clear. Social distancing works if done promptly, pervasively and not piecemeal. Lives are saved. By how much? As many as 50% fewer lives were lost in cities that performed like St Louis. And remember that in 1918 St. Louis was still a pretty big city for its day.

I believe the answer as to our destination is clear. We are trying to go where St. Louis went in 1918! And I believe leadership, both political and medical, in the Kansas City area are doing an outstanding job to get us there. We should listen to their advice and directives as if our lives and the lives of our loved ones depends on it.

As to ‘are we there yet?’…clearly not. But we have the beginnings of a road map that is quickly being enhanced by numerous people all over the United States and around the globe. And we have so many, many dedicated, helpful people whether first responders, health care professionals, or delivery drivers and the people who make sure we have groceries and other goods on the shelves at HyVee and Price Chopper.

God Bless you, your family, our church and our community. And please, stay healthy and well.

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