Opinion | The Checkup With Dr. Wen: In defense of the 6-foot social distancing rule – The Washington Post

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Pandemic-era social distancing guidelines have taken a beating this week. Critics have argued passionately that the Centers for Disease Control and Preventions recommendation to remain six feet apart was arbitrary, wrong and should never have been implemented.

I disagree. The guidance, like other public health recommendations, wasnt perfect. But it did help to reduce transmission and was an important point of reference at a time when people needed simple, easy-to-follow guidelines.

Anthony S. Fauci, who during the pandemic was the nations top infectious-diseases expert, endured the brunt of the criticism during a bruising congressional hearing on Monday. Questions zeroed in on testimony he gave during a closed-door session in January that the six-foot rule sort of just appeared and wasnt based on data. At times, the exchange devolved into personal attacks, with Rep. Marjorie Taylor Greene (R-Ga.) repeatedly refusing to address Fauci as Dr. Fauci, saying his medical license should be revoked and that he belongs in prison.

Recall that, at the start of the pandemic, SARS-CoV-2 was a novel coronavirus. Health officials knew little about it and assumed it behaved like other common respiratory viruses. Influenza and respiratory syncytial virus (RSV) are among the viruses that are transmitted predominantly via small droplets expelled when someone coughs, sneezes and breathes. These particles can land on someones nose, mouth or eyes, or they can be inhaled by those in proximity. They can also land on surfaces and infect people who touch them.

Over time, scientists learned that the covid-19 virus and especially new variants of the pathogen was highly contagious. Studies demonstrated that it not only spread via droplets, but also by much smaller aerosol particles. Whereas droplets are heavier and quickly fall to the ground, aerosols can linger and be carried over longer distances.

Public health guidance eventually pivoted toward improving ventilation as an infection control measure, as aerosol experts had long advocated. Today, the science is pretty well settled that covid-19 can be transmitted via both droplets and aerosols.

Critics of the six-foot rule are right in some ways. With aerosol transmission, someone could become infected even if they are further than six feet away. And, as Fauci suggested in his testimony, there have been no randomized-controlled trials looking at six feet of distancing vs., for instance, the World Health Organizations more lenient recommendation of one meter, which is just over three feet.

But heres what the six-foot rule got right: Droplet transmission remains one of two dominant routes of spread. A rule that reduces droplet transmission wont curb all spread, but it can help protect people from the virus.

Moreover, I think Americans understood there wasnt something magical about the exact distance. Did anyone really believe that being five feet away from others was dangerous while seven feet was safe? Rather, this guidance was based on a common-sense understanding that being in close contact with an infected person is risky.

This understanding is still correct. A large contact-tracing study published last year in Nature found that household contacts accounted for 6 percent of exposures to the covid-19, but 40 percent of transmissions. Most positive cases occurred after at least an hour of exposure, suggesting that prolonged close contact is of highest risk.

Another interesting study examined a cluster of covid cases on a 10-hour commercial flight with 217 passengers and crew. Of the 16 people who ended up testing positive, 12 were seated near the infected person. Seating proximity increased infection risk more than sevenfold.

As readers of the Checkup newsletter know, I often discussed the six-foot rule alongside two other ways to reduce transmission: being outdoors and masking. If the goal is to avoid covid, someone in an indoor crowded area should wear a high-quality mask, but its not necessary if they are outdoors or well-spaced from others. The six-foot rule provided a helpful starting point to help people decide what precautions they needed to take.

Dont get me wrong: I think its crucial for lawmakers to discuss whether workplaces and schools needed to impose six-foot separation rules And I would love to have more research on how much mitigation measures such as social distancing and masking reduced transmission. We also need data on their very real harms. Such information is necessary to guide policy decisions moving forward.

But none of this means people were misguided in keeping their distance from potentially infected people. It also does not mean that we should disregard social distancing as a mitigation measure against other contagious diseases. If, for example, the avian flu outbreak progresses to human-to-human transmission, we might need to bring back distancing to reduce droplet exposure.

And it definitely does not mean that Fauci somehow misled the public. Those viewing Mondays congressional testimony should ignore the partisan noise and focus on the calm responses from the physician-scientist who guided the country through a once-in-a-generation health crisis and continues to serve as the very model of a dedicated public servant.

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Opinion | The Checkup With Dr. Wen: In defense of the 6-foot social distancing rule - The Washington Post