Do you know the difference between social distancing and physical distancing?
I thought I did, but found out this week that what I've been talking about in the design of the built environment is actually physical distancing.
According to Lisa Maragakis, M.D., M.P.H. , Senior Director of Infection Prevention at Johns Hopkins in Baltimore, Md., social distancing "means staying home and away from others as much as possible to help prevent spread of COVID-19. The practice of social distancing encourages the use of things such as online video and phone communication instead of in-person contact."
Physical Distancing is About Boundaries
Physical distancing on the other hand is the term used to reinforce the need to stay at least six feet away from others and wear a face mask. Unlike social distancing, it relies on design strategies such as visual cues and furniture placement to denote boundaries and circulation patterns.
So when patients go to the clinic or doctor's office and sit in chairs the waiting area placed six feet apart, it's physical distancing. When they sit in their car and wait for a text confirmation that they can come in, it's social distancing.
What's the Right Distance?
The other thing I found out this week is that countries have different recommendations for physical distancing. China, Denmark, and France recommend three feet; Australia, Germany, and Italy recommend five feet; and the U.S. recommends six feet.
Why is this?
Well, for one, there are a lot of ways that the virus that causes Covid-19 can be transmitted through the air. According to the experts, this is the size of the droplets, viral load in the droplets, infectious dose needed to cause Covid-19 in person's body, and the environment (airflow, ventilation, temperature, humidity).
Not Enough Evidence
We also haven't had enough time to gather credible evidence to support a universal recommendation.
In a study funded by the World Health Organization published in the Lancet in June, researchers concluded that the risk of transmission becomes significantly lower with a distance of three feet or more from an infected person. Another study of infected patients in a Covid-19 unit found the virus in the air as far as 13 feet away from an infected person.
Again, I'm sure these results depend on the other variables I mentioned above, but six feet seems to be a good compromise.
Listen to the Experts
And even though the science on this is evolving, we need to listen to the experts and make decisions about physical distancing based on the best credible evidence. As Kirk Hamilton points out in his thoughtful editorial in the HERD Journal, we can't be fooled by "easily accessible but unreliable Internet content."
Fortunately, the healthcare design community has pretty much embraced the science behind the evidence-based design process. The pandemic has created an opportunity to further reinforce design's impact on outcomes.
I can't wait to see more studies on which design strategies are most effective at promoting physical distancing.
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