Social Distancing: What It Isn’t Good For
Let's talk about the health benefits of physical touch and it's implications for social distancing during the COVID-19 pandemic.
In a recent Washington Post article in which she cites numerous psychological researchers, Sarah Kaplan writes, “All of the researchers expressed concern about the effect of a period of prolonged isolation on people around the globe.” She quotes Bert N. Uchino from the University of Utah as saying, “We’re living [in a] very different and worrisome time— not just at the biomedical level but at the psychosocial level as well.”
In this article, Ms. Kaplan concludes, in short, that loneliness is bad for your health, and social support is good for your health. That’s a simple, fair summation of decades of extensive research into the neuro-psycho-endo-immune system — what we call the “NEI SuperSystem” in integrative medicine. This is a complicated, continuously adapting web of feedback and feed-forward interactions between the brain, the immune system, and the body’s hormones (the endocrine system). Given the immense complexity of this system, which we still don’t fully understand, it's impossible to predict what our current social isolation will have on society in the long run. Ms. Kaplan surmises that, based on the knowledge we do have, the implications are troubling. I agree.
One of the challenges with our current knowledge base is that it's quite difficult to study preventive or protective factors. It is much easier, for example, to study what the effects of a stress like a car accident might have on a particular disease outcome, eg, the rate of heart attacks in a particular population over a given period of time. It is much harder, however, to ascertain what positive factors may prevent heart attacks in a particular population over a given period of time. By definition, if you prevent the measurable outcome, there isn’t anything to measure. There are ways around this, of course, but it's a much more laborious picture to paint.
Kangaroo Care for the Rest of Us
Considering this, it may be helpful to look one step beyond Ms. Kaplan’s article. She cites research stating that even non-physical social contact can mitigate the effects of stress, and, while that may be true, if we leave it there we might be cutting off our collective nose to spite our face. Why? Because this overlooks the huge positive impact that physical contact can have. More than simply reducing the negative impact of stress, physical contact can turn stressful experiences into positive, enriching, bonding experiences which actually protect us from, among other things, infection.
When we are born, physical touch is absolutely necessary for life. Through the work of researchers such as Harry Harlow, Rene Spitz, John Bowlby, and others in the early and mid-1900s we learned the hard way that babies who have not been touched or cuddled — even when all their other physical needs are met — literally die. Dr. Harry Bawkin, a pediatrician, wrote in JAMA in January 1942, “It seems hard to believe that only a quarter of a century ago the death rate for infants under 1 year of age in various foundling institutions throughout the country was nearly 100 per cent.”
Prodita Sabarani underlines this in an article in The Conversation entitled, “Can a Lack of Love Be Deadly?”.
In the case of hospitals, in Europe and the US in the first half of the 20th century, nurses were required to cover their faces with surgical masks and not interact with babies. Parents and other family members were prevented from visiting freely as it was believed this would prevent infections from spreading and help keep babies healthy. However, instead of getting better the babies got worse.
Today, even with exceptionally vulnerable preemies in our Neonatal ICUs, it's recognized across the world that skin-to-skin contact, called “kangaroo care,” is absolutely necessary for the baby’s survival. Furthermore, recent research indicates that physical contact is essential for brain and neurological development. In fact, the effects of kangaroo care can be seen ten years later, with better stress response and cognitive development relative to preemies who did not receive similar care.
Even beyond infancy, the importance of physical contact is part of our cultural consciousness:
when we experience a deep sentiment, we say we are “touched”
children’s games like tag center around being touched
we seal a wedding with a kiss
the touch of Christ conferred healing
in India, the most undesired members of society are labelled “untouchable.”
Across the world and in language, art, custom, and religion, the power of touch is universally acknowledged.
It’s About You... Sort of
In medical school, we used to sardonically joke to each other that the first step of running a life-saving code is to Check your own pulse! in simpler terms, get yourself under control first. In still simpler words, DON’T PANIC! I have found this to be a helpful strategy in most of life’s major crises.
During this COVID-19 crisis, therefore, let’s remember that the goals of social distancing are not about you, they’re about those around you. In current practice, social distancing is to prevent you from infecting others; it's not intended to keep you from getting sick.
Sure, you could outfit your kids in custom-made ziplock bubbles and think, “What could it hurt?” The problem with this type of knee-jerk extremist thinking is that it actually can hurt. It assumes that the only important issue in life is reducing potential contact with this one particular virus.
It would be like training the full attention of the entire U.S. Department of Defense on Easter Island around the clock. I supposed there could be a potential South Pacific menace headed our way (and be honest: who isn’t a little creeped out by those giant stone heads, anyway?), but in context, what sense would it make to flatly ignore the entire rest of the world?
Anxiety — or, rather, adrenaline, the neurotransmitter that causes anxiety — forces the brain to hyper-focus and to see only black and white. This is quite adaptive when the threat is immediate, like being attacked by a lion. In that case, it's best to limit your thinking — eg, “lion bad, living good” — and not get distracted by the finer esthetics of savannah living as you run for your life.
Our current situation, however, requires far more consideration and discernment. Furthermore, it's an ongoing threat, which means we need to plan sustainably for the future and not just react instinctively for the moment.
Risky Business (and Messy, too)
Life is inherently messy, and full of germs. And so are we.
In fact, geneticists estimate that approximately 8% of the human genome is made up of viral DNA, so we wouldn’t even be us without viruses. Virus does not equal evil. Much like the rest of life, touching other humans is equally messy and germy — and just as equally necessary!
A life of perpetual personal protective equipment and social distancing is not sustainable. Whatever the health benefits may be — which is unknown; this is the first social experiment of its kind in known history — there is surely also a cost to our mental and physical health. And before we forfeit the benefits of physical, skin-to-skin contact with others, let’s make sure that this sacrifice is actually warranted. To wit, social distancing would not have stopped Bubonic Plague.
What does the risk/benefit equation look like for each of us and our loved ones? Good question. What we can say is that there are potential risks and benefits to whatever path we choose. And what we can definitely say is: There is no “playing it safe” — not in the COVID-19 era and not in the rest of life.
A lot of us are afraid, and that can be good ("lion bad…” right?). But we have to be careful with this instinctively reactionary fear. What if each of us instead accepted the inevitability of risk and had the audacity to chose which risks we're willing to take? What if we didn’t so readily relinquish our autonomy to promises of safety when such promises are often unsubstantiated?
Maybe we make a deal with ourselves and our loved ones: During this pandemic of paranoia, when alarm bells assail us on all fronts, we do our best to keep our heads about us and remember who of those closest to us needs what the most.
