AS IRELAND LOOKS forward to living beyond – or alongside – Covid-19, a major fault line has emerged over one aspect of the public health advice – the two-metre physical distancing rule.
Ministers, opposition politicians, business owners and health officials have all been taking to the airwaves to make points and counterpoints about whether the two-metre distance – a tenet of health advice since the crisis emerged – is sustainable into the future.
Yesterday morning, Minister for Education Joe McHugh said that with the two-metre rule in place “it’s going to look very very difficult to see all students back in September”.
“Even with a one-metre rule,” he added, “it’s very difficult to see all students back in September. So we have to look at the evidence now that the health officials are gathering.”
Fianna Fáil’s justice spokesperson Jim O’Callaghan yesterday morning called on the government to back a decrease to a one-metre physical distancing rule.
“I think we need to recognize that we are being exceptionally cautious in the advice that we’re following here,” he said. “Government must take other factors into account.”
Health officials, however, have stressed that for now the two-metre distance is staying. On Wednesday, Chief Medical Officer Tony Holohan told Cabinet ministers that he doesn’t intend to advise that the two-metre guidance be reduced.
Holohan said that he believes the current advice “represents a reasonable interpretation of the evidence and a precautionary approach to its application”.
The decision on whether to reduce the physical distancing requirement is essentially political and can only be made by the government. But it will also mean balancing risk – a decision made harder by how little we actually know about coronavirus.
Differences
The two-metre guidance, displayed prominently on public signs and in government messaging across Ireland, is not universally applied. Both Singapore and Hong Kong advise one metre, while in Australia the guidance is 1.5m.
In the US, 1.8m is the golden rule, but the UK and New Zealand have also both opted for two metres.
Yesterday evening, France announced that bars and restaurants could begin opening from 2 June – with a distance of one metre required between tables.
As one academic paper has noted:
All governments state that their advice is based on the scientific evidence underpinning the control of pandemics. So how do different countries come up with different recommendations and do the public know what these distances actually look like?
Global health organisations have also produced differing interpretations of physical distancing guidelines.
The World Health Organization, for one, defines physical distancing as keeping a distance of “at least 1m from each other”.
In contrast, the European Centre for Disease Control and Prevention (ECDC), however, still advises two metres.
The WHO’s special envoy on Covid-19, David Nabarro, has said that risk can still be reduced if the physical distance is reduced to one metre, but stressed that two metres was preferable to largely eliminate transmission.
Two or one?
This is where the debate becomes more complex. Dr Kim Roberts, leader of the Virology research group in Trinity College Dublin, says that it would be wrong to portray either one-metre or two-metre distances as competing public health choices.
“In terms of the one metre-two metre rule, it’s all about the activities you’re doing,” she stresses. “It’s about thinking about the situation they’re in at the moment.”
Keeping a two-metre distance from other people outside your household is more likely to reduce transmission than keeping one-metre away. But, Roberts says, having a quick chat with someone standing one-metre away is relatively safe.
That changes if someone is shouting, sneezing or coughing – in that case, coronavirus-carrying droplets travel further, beyond any one-metre limit.
That means looking exactly at the risks involved – and navigating difficult decisions. Sitting inside a restaurant for a few hours is likely to be rendered much riskier if the physical distance is only one metre, while the same could be said of working in an office setting.
“Rules that are very direct and narrow are not helpful. Because the risk changes from one activity to another,” she said.
Another problem is simply that we don’t fully understand the virus we’re trying to suppress. Roberts stresses that we don’t fully know how influenza is transmitted in droplets and aerosols, let alone Covid-19.
Studies are still being carried out to determine how exactly the virus is spread – how far droplets travel, how long it stays on surfaces and how easy it is to pick up. But, as things stand, all that is limited – hence the stress on caution from health officials.
“We don’t have the data yet,” Roberts says.
Schools
As Minister for Education Joe McHugh suggested, physical distancing makes returning to schools particularly difficult.
In Denmark, a return of students to school was accompanied by two-metre social distancing, before being reduced to one metre. It also saw classes split up, more lessons outdoors and a strict system of hand-washing.
And while one-metre has been described as safe in many circumstances, Danish officials have not mandated it as safe in all scenarios – at least two metres of physical distance is still needed in some scenarios where respiratory droplets are more likely to spread.
This includes lecturing – a teacher in a school, speaking loudly across a classroom to a roomful of a pupils would likely need to be more than two metres away from children.
It may take a long time before the full impact of these decisions are fully understood. In the meantime, Ireland and other countries around the world will continue trying to put together a system of public health guidance that can sustain both daily life and prevent dangerous spikes in hospitalisations.
The contingent nature of staying safe from a highly transmissible virus makes it difficult to put down absolute, rigid rules – no one piece of guidance is able to guarantee what’s safe in every scenario.
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