Two medical educators take a broader look at what it means to ‘distance’

We have entered an age of social distancing. As we know, living as we do now slows the rise of the Covid-19 pandemic by reducing the number of interactions people have in a day, limiting the virus’ capacity to spread.

The phrases “social distancing” and “physical distancing” were practically unknown to the general public prior to this outbreak, yet the concept has been essentially ubiquitous in the past month. Since March 1, 2020, the popularity of the word “distancing” in Google searches has risen exponentially. This time of distancing presents an opportune moment to consider what we mean by distance in relation to disease.

We normally distance ourselves from disease

While social and physical distancing may be relatively new phrases, the act of distancing ourselves from those who are sick, ill, or suffering is not new. Often this distance is clinical: We put people who are sick in hospitals or other facilities, keeping illness away from us. We have also improved our ability to prevent and treat disease, therefore providing a clinical buffer. Sometimes this distance is geographical: Disease may be happening in places far from us and among groups we do not belong to. Sometimes this distance is social: We do not think of the people who are sick or suffering as being like us. The sick are often labeled with terms that signify an “other” status.

Americans have been gifted the ability to forget, in a way, about how severe disease can be and that it often leads to death.

Clinical distance

When people develop an illness or a disease, they often seek care in a hospital or clinical setting. This means that disease is often contained and kept in clinical settings, far from places of leisure and work.

Thanks to effective and safe vaccines, we no longer regularly experience clinically severe infectious diseases like measles, mumps, rubella, or even chicken pox. Our medical technology and expertise have become more and more sophisticated at diagnosis — as has our treatment of noncommunicable diseases. We are able to detect diseases sooner and treat them before they become severe. This means that the majority of Americans have been gifted the ability to forget, in a way, about how severe disease can be and that it often leads to death. Because of these improvements, we have clinically distanced ourselves from the reality of disease and disease severity.

Geographic distance

In the United States, and many other high-income countries, we often view disease as something occurring elsewhere. We may feel bad that other countries or demographics experience disease and think it is regrettable, but ultimately it does not occupy the forefront of our minds. For example, while Ebola threatened multiple countries in Africa and was responsible for thousands of deaths between 2014 and 2019, it only became a concern to Americans when there was the possibility that it might be brought to the United States. It was only when Ebola touched close to home that we began to think about it. And after the threat to Americans was over, the subsequent outbreaks were not covered by mainstream media.

At the start of the novel coronavirus outbreaks in China, Americans did not see the virus as a threat to U.S. soil. Because the majority of Americans have been geographically distanced from major epidemics previously, this has helped us ignore the realities of poverty and inequity that can contribute to dire public health threats in our world.

Social distance

The clinical and geographic distance from disease have been compounded by othering, stigma, and a climate of mistrust and xenophobia in the United States. This has created a pervasive social distance from disease. Epidemics that have raged in the United States, like HIV/AIDS in the late 1980s and early 1990s, never felt particularly threatening to the average American, because it affected gay men—a small, stigmatized group in the population. Even now, the HIV/AIDS epidemic rages in Black communities in the South but garners little attention in White America.

Even at the beginning of the Covid-19 pandemic, the coronavirus was happening to “them” (China) and not to “us” (the West). The language federal officials used to describe the novel coronavirus emphasized that distance (the “Chinese” virus), and the rise in violence toward Asian Americans indicates the potential negative consequences of distancing ourselves socially from disease.

It is incumbent upon us to physically distance to mitigate the spread of the virus, yes, but not to widen the distance between us and disease clinically, geographically, or socially.

Distancing in a time of Covid-19

It is perhaps not surprising, and has extra metaphorical valence, that at a time when the threat of disease and doom feels incredibly close, we are now so far from one another. This is likely the closest most Americans have felt to disease, and we are dealing with that, in part, by adding distance between ourselves and those with disease.

This distance has an important role to play in containing disease, as we know, but it also comes at a cost. When we distance ourselves as we have historically, and as we are doing now, we lose the capacity to empathize with those who have disease. It is incumbent upon us to physically distance to mitigate the spread of the virus, yes, but not to widen the distance between us and disease clinically, geographically, or socially. Perhaps now, in the midst of a pandemic, we can be reminded that health is close to each of us and that our health is inextricably tied to one another.

A compassionate approach to health can help us bridge the distance that colors our approach to disease. Compassion requires us to see and expose the reasons behind our distancing from disease. It asks us to alter and interrupt the distance in order to change our relationship with disease entirely. We must be willing to change our structural relationship with disease in order to ensure equal and fair access, testing, and treatment for all. A compassionate response to distance is similar to a compassionate response to disease: It asks us to actively engage with our biases and preconceived notions.

While there will be important disparities in experiences and outcomes, no one group will be left untouched by this outbreak. Perhaps this will also allow us, in the future, to remember that we live in a highly connected and globalized world. A world that has more similarities than differences. A world where we can no longer ignore the inequities that are present that have led to this distance in the past. Perhaps we can use this period of distancing to remind ourselves that we are actually not that distant from each other or from disease after all.