Why should we voluntarily engage in social distancing, effectively isolating ourselves—whether this means not shaking hands or hugging friends, working from home, or not going out to a bar or restaurant?
Let’s first start by understanding the science. In the absence of a vaccine or effective treatment, the best way to stop an infectious agent is to not spread it. By limiting the transmission of the virus, you essentially let it run its course in those individuals already infected. A couple of features of COVID-19 deserve consideration here.
First, there is a period of time between when an individual is exposed to this novel coronavirus and when he or she shows symptoms, the so-called asymptomatic phase. With some infectious diseases, the exposed person cannot pass the virus on to others during this interval. That does not seem to be the case with COVID-19. An individual can be exposed and be infectious before he or she feels ill, has a fever, or exhibits other symptoms. Although this is likely not the main route of transmission, this asymptomatic, transmissible period is an important aspect of COVID-19 to understand.
Second, COVID-19 seems to be very contagious, even through indirect exposure. The virus will only attach itself to respiratory tissue, so it has to be introduced through one’s eyes (tear ducts drain into the nose) nose or mouth. Having an infectious person sneeze or cough directly into your eyes, nose or mouth would have a high risk of transmitting the virus to you. So would touching your eyes, nose, or mouth after contacting someone who has sneezed or coughed. These are direct modes of transmission. With COVID-19, it seems that the virus can also be transmitted indirectly. For instance, you could also acquire the virus if you touch your nose, eye or mouth after contacting a surface such as a table or door handle onto which an infectious person has transmitted the virus, mostly by sneezing or coughing. Although this indirect route is likely not the highest risk mode of transmission, it is an important consideration.
These two facts—that the virus can be transmitted before one is symptomatic and that it can be transmitted indirectly—underscore the need to socially distance to prevent ongoing transmission. While for some people this is not feasible, for many it is. By reducing the potential number of people that can both infect and be infected, the virus can be more effectively managed.
What moral obligation is at the heart of this? It comes down to a recognition of our vast social interdependence, something which we have in many cases lost sight of or failed to recognize. In the context of COVID-19, we must observe a reciprocal responsibility for one another. I choose not to go out in a large group not only because I don’t want to become infected myself, but also because I do not want to unknowingly infect someone else. This is a moral decision. We have a reciprocal duty to protect our neighbors and in turn to expect our neighbors to protect us. Especially with COVID-19 and its transmissible asymptomatic phase and indirect means of contagion, it is not enough to socially isolate once we have a fever or feel sick. These measures may help reduce transmission, but in many instances by the time a person develops symptoms, she or he will have potentially infected dozens, if not hundreds of other people.
The same is true for hand washing and sanitizing. While these are effective tools, they function on the presumption that you have already been exposed to the virus. You wash or sanitize your already inoculated hands to prevent introducing the virus into your respiratory tract where it has the high potential of attaching to your tissue and infecting you.
Given what we know, social distancing will work. However, if we allow our “me first” approach to flourish during the pandemic, we will all be harmed. There is no place for rugged individualism on any level. We have to take it upon ourselves to make difficult decisions and trust in our neighbors to do likewise, not only for their own good, but for that of their neighbor and their community. We must practice reciprocity. “I make these sacrifices not only for me, but for you and for all of us.”
One may object to the call for social distancing by arguing that given the relatively low mortality rate and often mild symptoms associated with COVID-19, contracting the virus is not the end of the world. “It’s not Ebola after all.” COVID-19 has been compared to influenza and the common cold. Some will argue that social distancing is an overreaction. One of the key moral differences here is that people already vulnerable because of poor health or advanced age seem to have the most severe cases and the greatest risk of suffering and or dying from COVID-19. We have only to look at the number of deaths reported in Washington State nursing homes. Our social reciprocity takes into account that some of us are more vulnerable than others, regardless of how you define vulnerability. By socially distancing, you are utilizing the most effective tool available to protect those most vulnerable to this infection. You are protecting yourself and your neighbor.
I also think our moral obligation to reciprocity goes even further. Many of us have relationships with people who are likely to suffer economic losses because of social distancing. If your favorite restaurants, shops, and small businesses are forced to close for weeks, or potentially months, in order to protect themselves, their employees, and you, they will almost certainly face an economic loss. These places served us during times of prosperity; it is important, in whatever way we can, to reciprocally support them now and especially after they safely reopen. This could mean buying gift cards now for use at the restaurant later or paying your dog walker at least a portion of her or his fee even if you are walking your dog yourself during this time.
The same is true for electively utilizing limited resources. Many of us have come to see easy and convenient access to healthcare as something we deserve as a result of having health insurance. Medical groups and hospitals have promoted this idea to attract patients, guaranteeing same-day appointments for minor issues and allowing unlimited access to providers. Right now, there are others in our community who will truly have an urgent need to see their provider or utilize emergency services. Reciprocity, for now, means that we seek care only if there is an urgent need. It means that we think about other people as well as ourselves. Social reciprocity means that we consider the impact of our decisions on others. It is a moral obligation.
Finally, for those who cannot socially distance themselves, the people who work at your grocery store, your pharmacy and your hospital, reciprocally protect them while they are serving you. If possible, avoid touching. If you are sick, wear a mask. Wash your hands, and use sanitizer frequently. These measures are not as effective as social distancing, but they will go a long way in protecting from infection those who are unable to distance.
Because many of our structures allow us to function without being aware of our social interdependence, we probably don’t usually think much about our reciprocal relationships. If any good can come of this pandemic, I hope it is a recognition of how tightly all of our lives are bound together and a recognition of the need for reciprocity in all of our relationships. Our lives and our world depends on it.