Dr Jonathan Smith
Editor’s note: Dr Jonathan Smith originally wrote the piece below as a letter to his local neighbourhood of about 50 families. It struck a chord, and his neighbours began sharing it widely within their own networks. Shortly after, and many tens of thousands of email forwards later, it went viral. Smith, a lecturer in epidemiology at Yale University who is currently completing his PhD in epidemiology at Emory University, graciously granted permission to repost the piece. This piece was written in 2020 at the beginning of the pandemic and published on WBUR: Boston University
As an infectious disease epidemiologist, I feel morally obligated to provide information on what we are seeing from a transmission dynamic perspective and how it applies to the social distancing measures. Like any good scientist, I have noticed two things that are either not well articulated or not present in the “literature” of online media. (I have also relied on other infectious disease epidemiologists for peer review of this piece.)
Specifically, I want to make two aspects of these distancing measures very clear and unambiguous.
First, we are in the very infancy of this epidemic’s trajectory. That means that even with these measures in place, we will see cases and deaths continue to rise globally, nationally, and in our own communities. This may lead some to think that the social distancing measures are not working. They are. They may feel futile. They aren’t. You will feel discouraged. You should. This is normal in chaos. This is the normal epidemic trajectory. Stay calm.
The enemy we are facing is very good at what it does; we are not failing. We need everyone to hold the line as the epidemic inevitably gets worse. This is not an opinion. This is the unforgiving math of epidemics for which I and my colleagues have dedicated our lives to understanding with great nuance, and this disease is no exception. Stay strong and in solidarity knowing that what you are doing is saving lives, even as people continue getting sick and dying. You may feel like giving in. Don’t.
We need everyone to hold the line as the pandemic inevitably gets worse. This is not an opinion. This is the unforgiving math...
Second, although social distancing measures have been (at least temporarily) well-received, there is an obvious-but-overlooked phenomenon when considering groups (that is, households) in transmission dynamics. While social distancing decreases contact with members of society, it, of course, increases contact within a group (that is, family). This small and obvious fact has surprisingly profound implications on disease transmission dynamics.
The basic mechanics of this mathematical principle dictate that even if there is only a little bit of additional connection between groups (that is, social dinners, playdates, unnecessary trips to the store, etcetera), the pandemic likely won’t be much different than if there was no measure in place. The same underlying fundamentals of disease transmission apply, and the result is that the community is left with all of the social and economic disruption but very little public health benefit.
You should perceive your entire family to function as a single individual unit: If one person puts themselves at risk, everyone in the unit is at risk. Seemingly small social chains get large and complex with alarming speed. If your son visits his girlfriend, and you later sneak over for coffee with a neighbour, your neighbour is now connected to the infected office worker that your son’s girlfriend’s mother shook hands with. This sounds silly, it’s not. This is not a joke or hypothetical. We as epidemiologists see it borne out in the data time and time again. Conversely, any break in that chain breaks disease transmission along that chain.
This outbreak will not be overcome in one grand, sweeping gesture, but rather by the collection of individual choices we make in the coming months.
In contrast to hand-washing and other personal measures, social distancing measures are not about individuals, they are about societies working in unison. These measures also require sustained action before results are evident. It is hard (even for me) to conceptualize how on a population level “one quick little get together” can undermine the entire framework of a public health intervention, but it can. I promise you it can. I promise. I promise. I promise. You can’t cheat it. People are already itching to cheat on the social distancing precautions just a “little” — a short playdate, a quick haircut, or picking up a needless item from the store. From a transmission dynamics standpoint, this very quickly recreates a highly connected social network that undermines much of the good work our communities have done thus far.
This virus is unforgiving to unwise choices. As this epidemic continues, it will be easy to be drawn to the idea that what we are doing isn’t working and we may feel compelled to “cheat” with unnecessary breaches of social distancing measures. By knowing what to expect, and knowing the critical importance of maintaining these measures, my hope is to encourage continued community spirit and strategizing to persevere in this time of uncertainty.
Jonathan Smith, a lecturer in epidemiology at Yale University, is completing his PhD in epidemiology at Emory University. His research focuses specifically on differential transmissibility of infectious diseases under various population-level and individual-level control measures.