Social distancing

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People maintaining social distance while waiting to enter a store. To allow shoppers to maintain distance within the store, only a limited number are allowed inside at one time.

Social distancing, or physical distancing,[1][2][3][4][5] is a set of infection control actions intended to stop or slow down the spread of a contagious disease. The objective of social distancing is to reduce the probability of contact between persons carrying an infection, and others who are not infected, so as to minimize disease transmission, morbidity and ultimately mortality.[6]

Social distancing is most effective when an infection can be transmitted via droplet contact (coughing or sneezing); direct physical contact, including sexual contact; indirect physical contact (e.g., by touching a contaminated surface); or airborne transmission (if the microorganism can survive in the air for long periods).[7]

Social distancing may be less effective in cases where an infection is transmitted primarily via contaminated water or food or by vectors such as mosquitoes or other insects and less frequently from person to person.[8] Drawbacks of social distancing can include loneliness, reduced productivity and the loss of other benefits associated with human interaction.

Historically, leper colonies and lazarettos were established as a means of preventing the spread of leprosy and other contagious diseases through social distancing,[9] until transmission was understood and effective treatments invented.


In this computer lab, every other workstation has been closed off to increase the distance between people working.
Taiwanese president Tsai Ing-wen giving a traditional Taiwanese greeting instead of shaking hands

Social distancing measures used to control the spread of contagious illnesses include:[10][7]

  • school closure (proactive or reactive)[11]
  • workplace closure,[12] including closure of "non-essential" businesses and social services ("Non-essential" means those facilities that do not maintain primary functions in the community, as opposed to essential services[13])
  • isolation
  • quarantine
  • cordon sanitaire
  • protective sequestration
  • cancellation of mass gatherings such as sports events, films or musical shows[14]
  • shutting down or limiting mass transit[15]
  • closure of recreational facilities (community swimming pools, youth clubs, gymnasiums)[16]
  • "self-shielding" measures for individuals include limiting face-to-face contacts, conducting business by phone or online, avoiding public places and reducing unnecessary travel[17][18]


Social distancing practices, including gestures that avoid physical contact, reduce the risk of becoming infected during flu pandemics.[19]

The gesture of namaste, placing one's palms together, fingers pointing upwards, drawing the hands to the heart, is one non-touch alternative. During the 2020 coronavirus pandemic in the United Kingdom, this gesture was used by Prince Charles upon greeting reception guests, and has been recommended by the Director-General of the World Health Organization, Tedros Adhanom Ghebreyesus, and Israeli Prime Minister Benjamin Netanyahu.[20] Other alternatives include the wave, the shaka (or "hang loose") sign, and placing a palm on your heart, as practiced in parts of Iran.[20]


1916 New York City polio epidemic[edit]

Floor markings can help people maintain distance in public places
New York City parks and playgrounds were closed during a 1916 polio epidemic.[21]

During the 1916 New York City polio epidemic, when there were over 27000 cases and more than 6000 deaths due to polio in the United States, with over 2000 deaths in New York City alone, movie theatres 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.[22][23]

Influenza pandemic of 1918[edit]

Passenger without mask being refused boarding of a streetcar (Seattle, Washington, 1918)

During the influenza pandemic of 1918, Philadelphia saw its first cases of influenza on 17 September.[24] The city continued with its planned parade and gathering of more than 200000 people and over the subsequent three days, the city's 31 hospitals became fully occupied. Over one week, 4500 people died.[25][26] Social distancing measures were introduced on 3 October, more than two weeks after the first case.[24] Unlike Philadelphia, St. Louis experienced its first cases of influenza on 5 October and the city took two days to implement several social distancing measures,[24] including closing schools, theatres, and other places where people get together. It banned public gatherings, including funerals. The actions slowed the spread of influenza in St. Louis and a spike in cases and deaths, as had happened in Philadelphia, did not occur.[27] The final death rate in St. Louis increased following a second wave of cases, but remained overall less than in other cities.[28]

SARS 2003[edit]

During the SARS outbreak of 2003, social distancing measures such as banning large gatherings, closing schools and theaters, and other public places, supplemented public health measures such as finding and isolating affected people, quarantining their close contacts, and infection control procedures. This was combined with wearing masks for certain people.[29]

2019–2020 coronavirus pandemic[edit]

During the 2019–2020 coronavirus pandemic, social distancing and related measures were emphasised by several governments as alternatives to an enforced quarantine of heavily affected areas. According to UNESCO monitoring, over 100 countries have implemented nationwide school closures in response to COVID-19, impacting over half the world’s student population.[30] In the United Kingdom, the government advised the public to avoid public spaces, and cinemas and theatres voluntarily closed to encourage the government's message.[31]

Some teens and young adults refused to voluntarily adopt social distancing practices. In Belgium, media reported a rave was attended by at least 300 before it was broken up by local authorities. In France teens making nonessential trips are fined up to US$150. Beaches were closed in Florida and Alabama to disperse partygoers during spring break.[32] Weddings were broken up in New Jersey and an 8 p.m. curfew was imposed in Newark. New York, New Jersey, Connecticut and Pennsylvania were the first states to adopt coordinated social distancing policies that closed down non-essential businesses and restricted large gatherings. Shelter in place orders in California were extended to the entire state on 19 March. On the same day Texas declared a public disaster and imposed statewide restrictions.[33]

Social media campaigns[edit]

In early March 2020, the sentiment "Stay The Fuck Home" was coined by Florian Reifschneider, a German engineer and was quickly echoed by notable celebrities such as Taylor Swift, Ariana Grande[34][35] and Busy Philipps[36] in hopes of flattening the curve. Facebook, Twitter and Instagram also joined the campaign with similar hashtags, stickers and filters under #staythefhome, #stayhome, #staythefuckhome and began trending across social media.[37][38][39][40][41][42][43][44][45][46][47][48]


Social distancing helps prevent a sharp peak of infections ("flattens the epidemic curve") to keep healthcare services from being overwhelmed.[49][50]

Knowing that a disease is circulating may trigger a change in behaviour by people choosing to stay away from public places and other people. When implemented to control epidemics, such social distancing can result in benefits but with an economic cost. Research indicates that measures must be applied rigorously and immediately in order to be effective.[51] During the 1918 flu pandemic, authorities in the US implemented school closures, bans on public gatherings, and other social distancing interventions in Philadelphia and in St. Louis, but in Philadelphia the delay of five days in initiating these measures allowed transmission rates to double three to five times, whereas a more immediate response in St. Louis was significant in reducing transmission there.[52]

Bootsma and Ferguson analyzed social distancing interventions in 16 US cities during the 1918 epidemic and found that time-limited interventions reduced total mortality only moderately (perhaps 10–30%), and that the impact was often very limited because the interventions were introduced too late and lifted too early. It was observed that several cities experienced a second epidemic peak after social distancing controls were lifted, because susceptible individuals who had been protected were now exposed.[53]

School closures[edit]

Swine flu cases per week in the United Kingdom in 2009; schools typically close for summer in mid-July and re-open in early September.[54]

Mathematical modeling has shown that transmission of an outbreak may be delayed by closing schools. However, effectiveness depends on the contacts children maintain outside of school. Often, one parent has to take time off work, and prolonged closures may be required. These factors could result in social and economic disruption.[55][11]

School closures were shown to reduce morbidity from the Asian flu by 90% during the 1957–1958 outbreak,[56] and up to 50% in controlling influenza in the US, 2004–2008.[57] Similarly, mandatory school closures and other social distancing measures were associated with a 29% to 37% reduction in influenza transmission rates during the 2009 flu epidemic in Mexico.[58]

During the swine flu outbreak in 2009 in the UK, in an article titled "Closure of schools during an influenza pandemic" published in the The Lancet Infectious Diseases, a group of epidemiologists endorsed the closure of schools in order to interrupt the course of the infection, slow further spread and buy time to research and produce a vaccine.[59] Having studied previous influenza pandemics including the 1918 flu pandemic, the influenza pandemic of 1957 and the 1968 flu pandemic, they reported on the economic and workforce effect school closure would have, particularly with a large percentage of doctors and nurses being women, of whom half had children under the age of 16. They also looked at the dynamics of the spread of influenza in France during French school holidays and noted that cases of flu dropped when schools closed and re-emerged when they re-opened. They noted that when teachers in Israel went on strike during the flu season of 1999–2000, visits to doctors and the number of respiratory infections dropped by more than a fifth and more than two fifths respectively.[60]

During the 2019–2020 coronavirus pandemic, preventive measures such as social-distancing and self-isolation prompted the widespread closure of primary, secondary, and post-secondary schools in over 120 countries. As of 23 March 2020, over 1.2 billion learners were out of school due to school closures in response to COVID-19.[30] Given low rates of COVID-19 infection among children, the effectiveness of school closures has been called into question.[61] Even when school closures are temporary, it carries high social and economic costs.[62] However, the significance of children in spreading COVID-19 is unclear.[63][64] While the full impact of school closures during the coronavirus pandemic are not yet known, initial evidence suggests school closures have had negative impacts on local economies and learning outcomes for students.[65][66]

Workplace closures[edit]

Modeling and simulation studies based on US data suggest that if 10% of affected workplaces are closed, the overall infection transmission rate is around 11.9% and the epidemic peak time is slightly delayed. In contrast, if 33% of affected workplaces are closed, the attack rate decreases to 4.9%, and the peak time is delayed by one week.[67]

Quarantine of possible cases[edit]

During the 2003 SARS outbreak in Singapore, approximately 8000 people were subjected to mandatory home quarantine and an additional 4300 were required to self-monitor for symptoms and make daily telephone contact with health authorities as a means of controlling the epidemic. Although only 58 of these individuals were eventually diagnosed with SARS, public health officials were satisfied that this measure assisted in preventing further spread of the infection.[68] Voluntary self-isolation may have helped reduce transmission of influenza in Texas in 2009.[69] Short and longterm negative psychological effects have been reported.[70]

Cordon sanitaire[edit]

The Lazzaretto of Ancona was constructed in the 18th century on an artificial island to serve as a quarantine station and leprosarium for the port town of Ancona, Italy.

In 1995, a cordon sanitaire was used to control an outbreak of Ebola virus disease in Kikwit, Zaire.[71][72][73] President Mobutu Sese Seko surrounded the town with troops and suspended all flights into the community. Inside Kikwit, the World Health Organization and Zaire medical teams erected further cordons sanitaires, isolating burial and treatment zones from the general population and successfully containing the infection.[74] During the 2003 SARS outbreak in Canada, "community quarantine" was used to reduce transmission of the disease with moderate success.[75]

Protective sequestration[edit]

Two lepers denied entrance to town. Woodcut by Vincent of Beauvais, 14th century.

During the 1918 influenza epidemic, the town of Gunnison, Colorado, isolated itself for two months to prevent an introduction of the infection. Highways were barricaded and arriving train passengers were quarantined for five days. As a result of the isolation, no one died of influenza in Gunnison during the epidemic.[76] Several other communities adopted similar measures.[77]

Canceling mass gatherings[edit]

Evidence suggesting that mass gatherings increase the potential for infectious disease transmission is inconclusive.[78] Anecdotal evidence suggests that certain types of mass gatherings may be associated with increased risk of influenza transmission, and may also "seed" new strains into an area, instigating community transmission in a pandemic. During the 1918 influenza pandemic, military parades in Philadelphia[25] and Boston[79] may have been responsible for spreading the disease by mixing infected sailors with crowds of civilians. Restricting mass gatherings, in combination with other social distancing interventions, may help reduce transmission.[80]

Travel restrictions[edit]

Border restrictions or internal travel restrictions are unlikely to delay an epidemic by more than 2–3 weeks unless implemented with over 99% coverage.[81] Airport screening was found to be ineffective in preventing viral transmission during the 2003 SARS outbreak in Canada[82] and the US.[83] Strict border controls between Austria and the Ottoman Empire, imposed from 1770 until 1871 to prevent persons infected with the bubonic plague from entering Austria, were reportedly effective, as there were no major outbreaks of plague in Austrian territory after they were established, whereas the Ottoman Empire continued to suffer frequent epidemics of plague until the mid-nineteenth century.[84]

A Northeastern University study published in March 2020 found that "travel restrictions to and from China only slow down the international spread of COVID-19 [when] combined with efforts to reduce transmission on a community and an individual level. […] Travel restrictions aren't enough unless we couple it with social distancing."[85] The study found that the travel ban in Wuhan only delayed the spread of the disease to other parts of mainland China by three to five days, although it did reduce the spread of international cases by as much as 80 percent. A primary reason that travel restrictions were less effective is that many people with COVID-19 do not show symptoms during the early stages of infection.[86]


Simulations comparing rate of spread of infection, and number of deaths due to overrun of hospital capacity, when social interactions are "normal" (left, 200 people moving freely) and "distanced" (right, 25 people moving freely).
Green = Healthy, uninfected individuals
Red = Infected individuals
Blue = Recovered individual
Black = Dead individuals

There are concerns that social distancing can have adverse affects on participants' mental health.[87] It may lead to stress, anxiety, depression or panic, especially for individuals with preexisting conditions such as anxiety disorders, obsessive compulsive disorders, and paranoia.[88] Widespread media coverage about a pandemic, its impact on economy, and resulting hardships may create anxiety. Change in daily circumstances and uncertainty about the future may add onto the mental stress of being away from other people.[89]

Theoretical basis[edit]

From the perspective of epidemiology, the basic goal behind social distancing is to decrease the basic reproduction number, , which is the average number of secondary infected individuals generated from one primary infected individual in a population where all individuals are equally susceptible to a disease. In a basic model of social distancing,[90] where a proportion of the population engages in social distancing to decrease their interpersonal contacts to a fraction of their normal contacts, the new effective reproduction number is given by:[90]

For example, 25% of the population reducing their social contacts to 50% of their normal level gives an effective reproduction number about 81% of the basic reproduction number. A seemingly small reduction has a profound effect in delaying the exponential growth and spread of a disease.

See also[edit]


  1. ^ Harris, Margaret; Adhanom Ghebreyesus, Tedros; Tu; Ryan, Michael "Mike" J.; Vadia; Van Kerkhove, Maria D.; Diego; Imogen; Charles; Corinne; Costas (2020-03-20). "COVID-19" (PDF). World Health Organization. Archived (PDF) from the original on 2020-03-25. Retrieved 2020-03-25.
  2. ^ Venske, Regula (2020-03-26). Schwyzer, Andrea (ed.). "Die Wirkung von Sprache in Krisenzeiten" [The effect of language in times of crisis] (Interview). NDR Kultur (in German). Norddeutscher Rundfunk. Archived from the original on 2020-03-27. Retrieved 2020-03-27. (NB. Regula Venske is president of the PEN Centre Germany.)
  3. ^ Hensley, Laura (2020-03-23). "Social distancing is out, physical distancing is in — here's how to do it". Global News. Corus Entertainment Inc. Archived from the original on 2020-03-27. Retrieved 2020-03-27.
  4. ^ Tangermann, Victor (2020-03-24) [2020-03-20]. "It's Officially Time to Stop Using The Phrase 'Social Distancing'". science alert (Futurism / The Byte). Archived from the original on 2020-03-27. Retrieved 2020-03-27. [1]
  5. ^ "New Study Estimates Effects of Physical Distancing on Progression of COVID-19 Epidemic". sci-news. 2020-03-26. Archived from the original on 2020-03-26. Retrieved 2020-03-27.
  6. ^ Johnson, Carolyn Y.; Sun, Lena; Freedman, Andrew (2020-03-10). "Social distancing could buy U.S. valuable time against coronavirus: It's a make-or-break moment with coronavirus to test one of the most basic — but disruptive — public health tools". The Washington Post. Archived from the original on 2020-03-27. Retrieved 2020-03-11.
  7. ^ a b "Information About Social Distancing" (PDF). Public Health Department: Santa Clara Valley Health & Hospital System. 2017. Archived (PDF) from the original on 2020-03-27. Retrieved 2020-03-17.
  8. ^ "Interim Pre-Pandemic Planning Guidance: Community Strategy for Pandemic Influenza Mitigation in the United States—Early, Targeted, Layered Use of Nonpharmaceutical Interventions" (PDF). Centers for Disease Control and Prevention. February 2007. Retrieved 2020-03-23.
  9. ^ Souvay, Charles Léon (1913). "Leprosy". Catholic Encyclopedia. 9.
  10. ^ Kinlaw, Kathy; Levine, Robert (2007-02-15). "Ethical guidelines in Pandemic Influenza – Recommendations of the Ethics Subcommittee of the Advisory Committee to the Director, Centers for Disease Control and Prevention" (PDF). Centers for Disease Control and Prevention. Archived (PDF) from the original on 2020-02-05. Retrieved 2020-03-23. (12 pages)
  11. ^ a b Cauchemez, Simon; Ferguson, Neil Morris; Wachtel, Claude; Tegnell, Anders; Saour, Guillaume; Duncan, Ben; Nicoll, Angus (2009). "Closure of schools during an influenza pandemic". The Lancet Infectious Diseases. 9 (8): 473–481. doi:10.1016/S1473-3099(09)70176-8. ISSN 1473-3099. PMID 19628172.
  12. ^ Kumar, Supriya; Crouse Quinn, Sandra; Kim, Kevin H.; Daniel, Laura H.; Freimuth, Vicki S. (January 2012). "The Impact of Workplace Policies and Other Social Factors on Self-Reported Influenza-Like Illness Incidence During the 2009 H1N1 Pandemic". American Journal of Public Health. 102 (1): 134–140. doi:10.2105/AJPH.2011.300307. PMC 3490553. PMID 22095353.
  13. ^ "Social Distancing Support Guidelines For Pandemic Readiness" (PDF). Colorado Department of Public Health and Environment. March 2008. Archived from the original (PDF) on 2017-02-13. Retrieved 2017-02-13.
  14. ^ Booy, Robert; Ward, James (2015). "Evidence compendium and advice on social distancing and other related measures for response to an influenza pandemic" (PDF). Paediatric Respiratory Reviews. National Centre for Immunisation Research and Surveillance. 16 (2): 119–126. doi:10.1016/j.prrv.2014.01.003. PMID 24630149. Archived from the original (PDF) on 2015-05-15. Retrieved 2015-05-15. (13 pages)
  15. ^ Taylor, Kate (2020-03-20) [2020-03-17]. "No Bus Service. Crowded Trains. Transit Systems Struggle With the Virus. - U.S. cities with public transit systems are being forced to adapt to the risks posed by the coronavirus, implementing new sanitation protocols while contending with fewer riders and workers". The New York Times. ISSN 0362-4331. Archived from the original on 2020-03-25. Retrieved 2020-03-25.
  16. ^ "Flu Pandemic Mitigation - Social Distancing". Archived from the original on 2020-03-22. Retrieved 2020-03-23.
  17. ^ Glass, Robert J.; Glass, Laura M.; Beyeler, Walter E.; Min, H. Jason (November 2006). "Targeted Social Distancing Designs for Pandemic Influenza". Emerging Infectious Diseases. Centers for Disease Control and Prevention. 12 (11): 1671–1681. doi:10.3201/eid1211.060255. PMC 3372334. PMID 17283616. Archived from the original on 2020-03-23. Retrieved 2020-03-28.
  18. ^ "Social Distancing Guidelines (for workplace communicable disease outbreaks)". Society for Human Resource Management. 2017. Archived from the original on 2017-04-23. Retrieved 2017-04-23.
  19. ^ "Guidance on Preparing Workplaces for an Influenza Pandemic". Occupational Safety and Health Act of 1970. United States Department of Labor. OSHA 3327-02N 2007. Archived from the original on 2020-03-25. Retrieved 2020-03-18. [2]
  20. ^ a b Barajas, Julia; Etehad, Melissa (2020-03-13). "Joined palms, hands on hearts, Vulcan salutes: Saying hello in a no-handshake era". Los Angeles Times. Archived from the original on 2020-03-27. Retrieved 2020-03-18.
  21. ^ Popular science monthly. New York, USA: D. Appleton. 1916. p. 400.
  22. ^ Battin, M. Pabst; Francis, Leslie P.; Jacobson, Jay A.; Smith, Charles B. (2009). The Patient as Victim and Vector: Ethics and Infectious Disease. Oxford University Press. p. 87. ISBN 978-0-19-533583-5.
  23. ^ Melnick, J. (1996-07-01). "Current status of poliovirus infections". Clinical Microbiology Reviews. 9 (3): 293–300. doi:10.1128/CMR.9.3.293. PMC 172894. PMID 8809461.
  24. ^ a b c Ryan, Jeffrey R. (2008). Pandemic Influenza: Emergency Planning and Community Preparedness. CRC Press. p. 133. ISBN 978-1-4200-6088-1.
  25. ^ a b Davis, Kenneth C. (2018-09-21). "Philadelphia Threw a WWI Parade That Gave Thousands of Onlookers the Flu". Smithsonian Magazine. Archived from the original on 2020-03-27. Retrieved 2020-03-27.
  26. ^ Starr, I. (October 1976). "Influenza in 1918: Recollections of the Epidemic in Philadelphia". Annals of Internal Medicine. 85 (4): 516–518. doi:10.7326/0003-4819-85-4-516. PMID 788585.
  27. ^ Smith, Richard (2007-06-30). "Social measures may control pandemic flu better than drugs and vaccines" (PDF). British Medical Journal. 334 (7608): 1341. doi:10.1136/bmj.39255.606713.DB. ISSN 0959-8138. PMC 1906625. PMID 17599996. Archived (PDF) from the original on 2020-03-27. Retrieved 2020-03-27.
  28. ^ Kalnins, Irene (September 2006). "The Spanish influenza of 1918 in St. Louis, Missouri". Public Health Nursing. Boston, Mass., USA. 23 (5): 479–483. doi:10.1111/j.1525-1446.2006.00586.x. ISSN 0737-1209. PMID 16961567.
  29. ^ Bell, David M. (November 2004). "Public Health Interventions and SARS Spread, 2003". Emerging Infectious Diseases. 10 (11): 1900–1906. doi:10.3201/eid1011.040729. ISSN 1080-6040. PMC 3329045. PMID 15550198.
  30. ^ a b "COVID-19 Educational Disruption and Response". UNESCO. 2020-03-04. Retrieved 2020-03-23.
  31. ^ "Most UK cinemas shut after virus advice". BBC News. 2020-03-17. Archived from the original on 2020-03-23. Retrieved 2020-03-21.
  32. ^ "Parents, police struggle to social distance the young in coronavirus outbreak". 2020-03-20.
  33. ^ "Uh-Oh Moment Finally Hits States Slow to Adopt Social Distancing". 2020-03-20.
  34. ^ Ehrlich, Brenna; Ehrlich, Brenna (2020-03-15). "Taylor Swift Urges Fans to Stay Home Amid COVID-19 Outbreak".
  35. ^ "A Movement to Stop the COVID-19 Pandemic". #StayTheFuckHome.
  36. ^ "Busy Philipps Joins Cameo to Record "Stay the Fuck Home" Messages for Coronavirus".
  37. ^ Handler, Rachel (2020-03-16). "Ariana Grande Invented Staying Home". Vulture.
  38. ^ "Please Just #StayTheFuckHome". PAPER. 2020-03-16.
  39. ^ Nedd, Alexis. "#StayTheFHome urges people to stop the spread of the coronavirus". Mashable.
  40. ^ "AMA, AHA, ANA: #StayHome to confront COVID-19". American Medical Association.
  41. ^ Erizanu, Paula. "#Staythefuckhome: visit the online bar that just opened in St Petersburg". The Calvert Journal.
  42. ^ "HuffPost is now a part of Verizon Media".
  43. ^ Berg, Madeline. "No, Netflix Is Not Spoiling Its Own Shows To Fight Coronavirus". Forbes.
  44. ^ Solis, Jorge (2020-03-16). "The #StayTheF***kHome movement just wants you to, well, you know". Newsweek.
  45. ^ Sayej, Nadja (2020-03-25). "'It feels like wartime': how street artists are responding to coronavirus". The Guardian.
  46. ^ Moss, Marissa R. (2020-03-16). "Indie Artists Turn to Livestreaming as Coronavirus Crisis Unfolds: How artists and venues are coming up with innovative ways to keep the lights on and the music playing — without leaving the house". Rolling Stone.
  47. ^ "When The People You Love Can't Accept That They Need To Stay Home". BuzzFeed News.
  48. ^ "The TV Shows & Movies You Should Watch in Self-Isolation". Highsnobiety. 2020-03-25.
  49. ^ Wiles, Siouxsie (2020-03-14). "After 'Flatten the Curve', we must now 'Stop the Spread'. Here's what that means". The Spinoff. Morningside, Auckland, New Zealand. Archived from the original on 2020-03-26. Retrieved 2020-03-13.
  50. ^ Anderson, Roy Malcom; Heesterbeek, Hans J. A. P.; Klinkenberg, Don; Hollingsworth, T. Déirdre (2020-03-09). "How will country-based mitigation measures influence the course of the COVID-19 epidemic?". The Lancet. 395 (10228): 931–934. doi:10.1016/S0140-6736(20)30567-5. ISSN 0140-6736. PMID 32164834. Archived from the original on 2020-03-27. Retrieved 2020-03-28. A key issue for epidemiologists is helping policy makers decide the main objectives of mitigation—e.g., minimising morbidity and associated mortality, avoiding an epidemic peak that overwhelms health-care services, keeping the effects on the economy within manageable levels, and flattening the epidemic curve to wait for vaccine development and manufacture on scale and antiviral drug therapies.
  51. ^ Maharaj, S.; Kleczkowski, A. (2012). "Controlling epidemic spread by social distancing: Do it well or not at all". BMC Public Health. 12 (1): 679. doi:10.1186/1471-2458-12-679. PMC 3563464. PMID 22905965.
  52. ^ Hatchett, R. J.; Mecher, C. E.; Lipsitch, Marc (2007). "Public health interventions and epidemic intensity during the 1918 influenza pandemic". Proceedings of the National Academy of Sciences of the United States of America. 104 (18): 7582–7587. doi:10.1073/pnas.0610941104. PMC 1849867. PMID 17416679.
  53. ^ Bootsma, Martin C. J.; Ferguson, Neil Morris (2007-05-01) [2007-03-13, 2006-12-13]. Singer, Burton H. (ed.). "The effect of public health measures on the 1918 influenza pandemic in U.S. cities". Proceedings of the National Academy of Sciences of the United States of America. 104 (18): 7588–7593. doi:10.1073/pnas.0611071104. PMC 1849868. PMID 17416677. Archived from the original on 2020-03-22. Retrieved 2020-03-28. [3] (6 pages)
  54. ^ "2009 Press Releases". Health Protection Agency. 2009-12-24. Archived from the original on 2009-12-24. Retrieved 2009-12-24.
  55. ^ Zumla, Alimuddin; Yew, Wing-Wai; Hui, David S. C. (2010). Emerging Respiratory Infections in the 21st Century, An Issue of Infectious Disease Clinics. 24. Elsevier Health Sciences. p. 614. ISBN 978-1-4557-0038-7.
  56. ^ Chin, T. D.; Foley, J. F.; Doto, I. L.; Gravelle, C. R.; Weston, J. (1960). "Morbidity and mortality characteristics of Asian strain influenza". Public Health Reports. 75 (2): 148–158. doi:10.2307/4590751. JSTOR 4590751. PMC 1929395. PMID 19316351.
  57. ^ Wheeler, C. C.; Erhart, L. M.; Jehn, M. L. (2010). "Effect of school closure on the incidence of influenza among school -age children in Arizona". Public Health Reports. 125 (6): 851–859. doi:10.1177/003335491012500612. PMC 2966666. PMID 21121230.
  58. ^ "Flu Pandemic Study Supports Social Distancing". NIH Research Matters. National Institutes of Health. 2011-06-06.
  59. ^ Wardrop, Murray (2009-07-21). "Swine flu: schools should close to halt spread of virus, ministers told". The Telegraph. ISSN 0307-1235. Retrieved 2020-03-17.
  60. ^ Walsh, Eric, ed. (2009-07-20). "Closing schools won't stop pandemics: study". Reuters. Retrieved 2020-03-17.
  61. ^ Frieden, Tom. "Lessons from Ebola: The secret of successful epidemic response". CNN. Retrieved 2020-03-23.
  62. ^ "Coronavirus deprives nearly 300 million students of their schooling: UNESCO". The Telegram. Retrieved 2020-03-23 – via Reuters.
  63. ^ Lipsitch, Marc; Swerdlow, David L.; Finelli, Lyn (2020-03-26) [19 February 2020]. "Defining the Epidemiology of Covid-19 — Studies Needed". New England Journal of Medicine. 382 (13): 1194–1196. doi:10.1056/NEJMp2002125. ISSN 0028-4793. PMID 32074416.
  64. ^ Zimmermann, Petra; Curtis, Nigel (2020-03-18). "Coronavirus Infections in Children Including COVID-19: An Overview of the Epidemiology, Clinical Features, Diagnosis, Treatment and Prevention Options in Children". The Pediatric Infectious Disease Journal. Online First. doi:10.1097/INF.0000000000002660. ISSN 0891-3668.
  65. ^ Lindzon, Jared (2020-03-12). "School closures are starting, and they'll have far-reaching economic impacts". Fast Company. Retrieved 2020-03-23.
  66. ^ "Adverse consequences of school closures". UNESCO. 2020-03-10. Retrieved 2020-03-23.
  67. ^ Rousculp, M. D.; Johnston, S. S.; Palmer, L. A.; Chu, B. C.; Mahadevia, P. J.; Nichol, K. L. (2010). "Attending work while sick: implication of flexible sick leave policies". Journal of Occupational and Environmental Medicine. 52 (10): 1009–1013. doi:10.1097/jom.0b013e3181f43844. PMID 20881626.
  68. ^ Tan, Chorh-Chuan (May 2006). "SARS in Singapore – Key Lessons from an Epidemic" (PDF). Annals Academy of Medicine. 35 (5): 345–349. PMID 16830002.
  69. ^ Teh, B.; Olsen, K.; Black, J.; Cheng, A. C.; Aboltins, C.; Bull, K.; et al. (2012). "Impact of swine influenza and quarantine measures on patients and households during the H1N1/09 pandemic". Scandinavian Journal of Infectious Diseases. 44 (4): 289–296. doi:10.3109/00365548.2011.631572. PMID 22106922.
  70. ^ Brooks, Samantha K.; Webster, Rebecca K.; Smith, Louise E.; Woodland, Lisa; Wessely, Simon; Greenberg, Neil; Rubin, Gideon James (2020-03-14). "The psychological impact of quarantine and how to reduce it: rapid review of the evidence". The Lancet. 395 (10227): 912–920. doi:10.1016/S0140-6736(20)30460-8. ISSN 0140-6736. PMID 32112714.
  71. ^ Garrett, Laurie (2014-08-14). "Heartless but Effective: I've Seen 'Cordon Sanitaire' Work Against Ebola". The New Republic.
  72. ^ "Outbreak of Ebola Viral Hemorrhagic Fever -- Zaire, 1995". Morbidity and Mortality Weekly Report. 1995-05-19. pp. 381–382.
  73. ^ Hoffmann, Rachel Kaplan; Hoffmann, Keith (2015-02-19). "Ethical Considerations in the Use of Cordons Sanitaires". Clinical Correlations.
  74. ^ Garrett, Laurie (2011). Betrayal of Trust: The Collapse of Global Public Health. Hachette Books. ISBN 1-40130386-2.
  75. ^ Bondy, S. J.; Russell, M. L.; Laflèche, J. M.; Rea, E. (2009). "Quantifying the impact of community quarantine on SARS transmission in Ontario: estimation of secondary case count difference and number needed to quarantine". BMC Public Health. 9 (1): 488. doi:10.1186/1471-2458-9-488. PMC 2808319. PMID 20034405.
  76. ^ "Gunnison: Case Study". Center for the History of Medicine. University of Michigan Medical School.
  77. ^ Markel, Howard; Stern, Alexandra; Navarro, J.; Michalsen, Joseph; Monto, Arnold; Digiovanni, Cleto (2006). "Nonpharmaceutical Influenza Mitigation Strategies, US Communities, 1918–1920 Pandemic" (PDF). Emerging Infectious Diseases. 12 (12): 1961–1964. doi:10.3201/eid1212.060506. PMC 3291356. PMID 17326953.
  78. ^ Inglesby, Thomas V.; Nuzzo, Jennifer B.; O'Toole, Tara; Henderson, Donald A. (2006). "Disease Mitigation Measures in the Control of Pandemic Influenza". Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science. 4 (4): 366–375. CiteSeerX doi:10.1089/bsp.2006.4.366. PMID 17238820.
  79. ^ "The Flu in Boston". American Experience. WGBH – via
  80. ^ Ishola, David A.; Phin, Nick (December 2011). "Could Influenza Transmission Be Reduced by Restricting Mass Gatherings? Towards an Evidence-Based Policy Framework". Journal of Epidemiology and Global Health. 1 (1): 33–60. doi:10.1016/j.jegh.2011.06.004. PMID 23856374.
  81. ^ Ferguson, Neil Morris; Cummings, Derek A. T.; Fraser, Christophe; Cajka, James C.; Cooley, Philip C.; Burke, Donald S. (2006). "Strategies for mitigating an influenza pandemic". Nature. 442 (7101): 448–452. Bibcode:2006Natur.442..448F. doi:10.1038/nature04795. PMC 7095311. PMID 16642006.
  82. ^ Bell, David M. (2004). "Public health interventions and SARS spread, 2003". Emerging Infectious Diseases. 10 (11): 1900–1906. doi:10.3201/eid1011.040729. PMC 3329045. PMID 15550198.
  83. ^ Cetron, Martin (2004). "Isolation and Quarantine: Containment Strategies for SARS, 2003". Learning from SARS: Preparing for the Next Disease Outbreak. National Academy of Sciences. ISBN 0-30959433-2.
  84. ^ Kohn, George C. (2007). Encyclopedia of Plague and Pestilence: From Ancient Times to the Present (PDF). Infobase Publishing. p. 30. ISBN 978-1-43812923-5.
  85. ^ Arntsen, Emily (2020-03-06). "Closing borders can delay, but can't stop the spread of COVID-19, new report says". News@Northeastern. Northeastern University. Archived from the original on 2020-03-23. Retrieved 2020-03-28.
  86. ^ Chinazzi, Matteo; Davis, Jessica T.; Ajelli, Marco; Gioannini, Corrado; Litvinova, Maria; Merler, Stefano; Pastore y Piontti, Ana; Mu, Kunpeng; Rossi, Luca; Sun, Kaiyuan; Viboud, Cécile; Xiong, Xinyue; Yu, Hongjie; Halloran, M. Elizabeth; Longini, Ira M.; Vespignani, Alessandro (2020-03-06). "The effect of travel restrictions on the spread of the 2019 novel coronavirus (COVID-19) outbreak". Science: eaba9757. doi:10.1126/science.aba9757. PMID 32144116.
  87. ^ Ao, Bethany. "Social distancing can strain mental health. Here's how you can protect yourself". Retrieved 2020-03-24.
  88. ^ "Coronavirus Disease 2019 (COVID-19)". Centers for Disease Control and Prevention. 2020-02-11. Retrieved 2020-03-24.
  89. ^ Willis, Olivia (2020-03-22). "Managing mental health in the time of coronavirus". ABC News. Retrieved 2020-03-24.
  90. ^ a b Becker, Niels (2015). Modeling to Inform Infectious Disease Control. CRC Press. p. 104. ISBN 978-1-49873107-2.

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