A Note from Jonathan P. Smith, Epidemiologist, Yale University School of Public Health

Hey everybody!

As an infectious disease epidemiologist, at this point I feel morally obligated to provide some information on what we are seeing from a transmissiodynamic perspective and how they apply to the social distancing measures.

Like any good scientist I have noticed two things that are either not articulated or not present in the “literature” of social media. I am also tagging my much smarter infectious disease epidemiologist friends for peer review of this post. Please correct me if I am wrong (seriously).

Specifically, I want to make two aspects of these measures very clear and unambiguous. First, we are in the very infancy of this epidemic’s trajectory. That means even with these measures we will see cases and deaths continue to rise globally, nationally, and in our own communities in the coming weeks.

Our hospitals will be overwhelmed, and people will die that didn’t have to. This may lead some people 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. But this is also normal epidemic trajectory. Stay calm. This enemy that 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 my 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. We know what will happen; I want to help the community brace for this impact.

Stay strong and with solidarity knowing with absolute certainty that what you are doing is saving lives, even as people begin getting sick and dying. You may feel like giving in. Don’t.

Second, although social distancing measures have been (at least temporarily) well-received, there is an obvious-but-overlooked phenomenon when considering groups (i.e. families) in transmission dynamics. While social distancing decreases contact with members of society, it of course increases your contacts with group (i.e. family) members. This small and obvious fact has surprisingly profound implications on disease transmission dynamics. Study after study demonstrates that even if there is only a little bit of connection between groups (i.e. social dinners, play dates/playgrounds, etc.), the epidemic trajectory isn’t 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 neighbor, your neighbor 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 a hypothetical. We as epidemiologists see it borne out in the data time and time again and no one listens. Conversely, any break in that chain breaks disease transmission along that chain. 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 take a long time to see the results. It is hard (even for me) to conceptualize how ‘one quick little get together’ can undermine the entire framework of a public health intervention, but it does. I promise you it does. 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 play date, a haircut, or picking up a needless item at the store, etc. From a transmission dynamics standpoint, this very quickly recreates a highly connected social network that undermines all of the work the community has done so far.

Until we get a viable vaccine this unprecedented outbreak will not be overcome in grand, sweeping gesture, rather only by the collection of individual choices our community makes in the coming months. This virus is unforgiving to unwise choices. My goal in writing this is to prevent communities from getting ‘sucker-punched’ by what the epidemiological community knows will happen in the coming weeks.

It will be easy to be drawn to the idea that what we are doing isn’t working and become paralyzed by fear, or to ‘cheat’ a little bit in the coming weeks. By knowing what to expect, and knowing the importance of maintaining these measures, my hope is to encourage continued community spirit, strategizing, and action to persevere in this time of uncertainty.

Jonathan P. Smith Lecturer in Epidemiology, Yale University School of Public Health

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3 Responses to A Note from Jonathan P. Smith, Epidemiologist, Yale University School of Public Health

  1. Bonni Canary says:

    OMG Claire—how dreadful. I have read that after your first week of self quarantine you are less likely every day to test positive. Our son is staying in our detached studio because he flew in from Brooklyn NY (epicenter or the epicenter) on Mar 17. We are being advised that he should self quarantine 21 days to be safe. Hopefully you will stay healthy and the rest of your family will recover and maybe even be able to be super donors!


  2. Jack gilman says:

    Very good


  3. Claire Silk says:

    It is so unfortunate that people are not listening to these folks who know what’s coming. They have devoted their lives to the study of epidemiology. This is the tip of the iceberg. Go home, stay home. If you go to the store, wear 2 masks if necessary, gloves, and clothes that can be stored in a bag until you can wash them in at least warm water, if not hot. Unfortunately, my sister passed away at the very inception of this epidemic. The wake and funeral were closed to family only, and now many in the family have COVID 19. Thus far, our cases are all fairly mild, thank God. I am fortunate to be in isolation at my nephew’s guest house in AZ. Besides not being able to play with my beautiful great niece Lily, I am weathering the storm. I have 6 more days to go!!!!! Thank you Kris for these wonderful, science based articles. There is so much information out there, it can be difficult discern fact from fiction. I, for one am hoping for the the huge silver lining that will surely come from all of this. Believe it! I miss you all and our beautiful EDM. We will return sooner than expected as all surgeries have been cancelled for now.


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