You Should Be Socially Distancing, but Don’t Ignore the Risks

The things we don’t think about are the things that get us.

Originally published on Medium.com 18 March 2020

The risk of Covid-19 is real, and many parts of the United States are finally adopting the correct policy response: social distancing. But the — entirely correct — policy of social distancing has its own terrible consequences. They will come as a surprise, but they are entirely predictable. Somewhere in America (and in other places), terrible things are about to happen as the weeks of at-home voluntary isolation begin to drag on.

A child playing at home, rather than school, will be killed by an improperly stored gun.

A person stuck at home with an abusive partner will be killed.

Anxiety and isolation will drive someone struggling with mental health challenges to suffer a sharp downward spiral and commit suicide.

An elderly person will suffer a fall or mishap and suffer for hours, or days, before being found.

A person struggling with opiate addiction will suffer a fatal overdose and not be found for days.

All of these things happen regularly; they are completely predictable causes of mortality. But all of these examples represent risks that rise precipitously in a period of social distancing. Consider the case of a child killed by an improperly stored gun. Children die regularly from finding and playing with guns in the household. Sometimes they shoot themselves. Sometimes they shoot another child. But the useful way to think about accidental child shootings is as a random event that you can describe with a math equation. There are X number of children living in homes where a gun is accessible. They spend Y number of hours playing in the home. For each hour spent in the home, there is Z percentage chance that the child will find the gun and shoot someone. Z is a very low number, but X is (in the United States) a very high number.

Under social distancing requirements, with daycares and schools closed, Y just became a much, much higher number.

The family whose child gets shot is going to experience this event as a terrible, shocking tragedy that happened because a child was at home, rather than at school or daycare. But it is actually an utterly predictable and preventable event, at the macro level. Next week, children will spend additional hours at home. Each of those hours is the equivalent of an additional pull on the world’s most evil slot machine.

So why am I writing this?

Two core ideas of public health are meaningful here. First, we can save lives by predicting risks and taking action. Do you have a child? Do you have a gun? Go buy a gun safe, and use it. Do you have an elderly friend or family member living alone? Set up a system to check on that person and maintain contact despite the requirements of social distancing. Are you prone to depression and stuck alone? Create a daily routine for yourself that includes walks outside and scheduled calls with friends and family. Most “surprise” risks are actually quite predictable, and most of them can be addressed with relatively straightforward actions. The key is to look around at your own life and environment and to think seriously about what you can do. In a lot of cases you will not be able to eliminate danger in your life — kids are kids, and taking a walk every day is not going to magically solve mental health challenges.

So think, instead, about the risk equation. Covid-19 and social distancing will move some of those Xs, Ys, and Zs marginally up in unexpected ways, so we all need to look for ways to move them marginally back down. (And hey, silver linings: the current crisis is also moving a few of those sliders down. Traffic fatalities are probably going to radically fall in the next few weeks.)

The second public health idea is about collective action. Someone stuck in an abusive situation is going to find it difficult to mitigate that risk, for all kinds of reasons. Someone struggling with addiction is not going to bootstrap out of opiate dependence. So part of what we all need to do is to make a conscious choice to recognize and push back on the ways in which social distancing can collapse the systems that keep people safe. Humans are social animals; a lot of us mitigate risk in our lives by the simple choice to be amongst other people — to escape an abuser for nine hours a day by going to work, or to grapple with cravings by going to an AA meeting. Those are often deeply-flawed strategies, but they are relatively easy to execute and thus better than no strategy. And for a lot of people, herding is all they have.

So try to think about the people in your life whose principle risk mitigation strategy just got taken away. And if you are a healthy person or a person with resources, now is the time push back against the tendency for “social distancing” to turn into “close the gates and pull up the ladder.” We’re trying to protect ourselves from the spread of a disease — not from other humans. If you are reading this article, you possess tools of communication. Reach out. You have a mind capable of understanding and thinking about risk. Talk to friends and family who might not have thought about it.

Despite the name, social distancing is exclusively about physical separation. It is an important strategy for mitigating this pandemic. But to really make it work, we have to deal with the fact that humans aren’t really designed for distance, and that implementing it will expose or increase all sorts of unnoticed risks in our lives. The good news is that we also have the mental ability to predict those problems and address them. So get going. We’re trying to build a society here.