The 6-Foot Myth

The complex and contradictory science of social distancing

Social distancing is supposedly critical to reduce COVID-19 infections, but the actual science on how the virus is spread suggests otherwise. (Halfpoint/Shutterstock)

I travel a lot, for business as well as pleasure. It’s amazing how each area of the United States handles the pandemic (actually, now an endemic) so differently.

Los Angeles International Airport (LAX) is a zoo even in the best of times, but it is going through a major renovation for the 2028 Summer Olympics. Crowded is an understatement.

My wife and I were in line for an elevator to take us up to one of the Delta lounges. A couple (younger than us) were a few people in front. When the elevator arrived, they went into the empty elevator, and the husband (I am assuming) whips around, holds his hand up, and says “NO more.” Another couple in front of us politely notes that there is plenty of room for a few more. The husband then blurts out, “She has cancer, you [expletive]!”

I suppose cancer allows some forgiveness for someone being nasty and angry, but I’m not so sure. He kept everyone else from boarding the elevator, and the door closed. When we finally did get to the lounge, we noticed this couple sitting in the very crowded lounge. This got me wondering where this six-foot social distancing comes from?

Dr. Carl Flügge, a German scientist, proposed the idea that people who are well should keep their distance from people who are sick. This was back in the 1840s.

In the 1940s, some scientists were able to film, frame by frame, a person sneezing and yelling and found that we humans spray “spittle” about three to six feet. This is now dogma, and dogma is hard to break.

A recent study by MIT published in the journal Proceedings of the National Academy of Sciences of the United States of America came to a startling result: When indoors, the risk for COVID contagion is nearly the same at six feet or 60 feet because the aerosolized particles mix throughout the air.

I think I may have to find a larger elevator!

The Journal of Infectious Diseases published a study done mainly by researchers in Australia who made an interesting finding when researching aerosol spray of COVID-19. They found that “of ten studies on horizontal droplet distance, eight showed droplets travel more than 2 meters (≈6 ft), in some cases more than 8 meters (≈26 ft)”.

“We found that the evidence base for current guidelines is sparse, and the available data do not support the 1 - 2 m (≈3 - 6 ft) rule of spatial separation.”

I have been asked on several occasions not to enter an elevator in the hospital by someone already in the elevator because of an overwhelming fear of “catching” COVID.

Next time, I’ll hand out a copy of that article.

The World Health Organization (WHO) recommends 1 meter (roughly 3 feet) of social distancing. This is followed in England, France, and China; Australia, Italy, and Germany use 1.5 meters. The WHO based its findings on a study published in the Lancet in June 2020.

“Transmission of viruses was lower with physical distancing of 1 m or more, compared with a distance of less than 1 m,” it read.

A few months ago, I had a patient complain that our waiting room wasn’t socially distanced enough for her. She also complained that we didn’t have an elevator monitor to limit it to one person per ride (I admit, it’s a small elevator). I politely asked her how she would suggest we knock out the walls to accommodate her concerns, as well as where we should build that new elevator? I thought I was sarcastic, but she thought I was serious and sent me a two-page response.

Protection is good, but there are extremes.

Actual physical distancing may make sense for those who are truly vulnerable. I personally wouldn’t take an elderly person with chronic health issues such as emphysema, leukemia, and COPD (chronic obstructive pulmonary disease) to a crowded arena. I wouldn’t have taken them before COVID either.

The problem with social distancing rules is it varies depending on where you live and if there is another agenda that the political powers feel outweighs the need for social distancing. Life is full of risks, and each day, we weigh those risks and live our lives.

There are 36,000 deaths each year from motor vehicle accidents, yet we drive almost every day. We make decisions based on our needs and desires.

We were recently in Nashville, Tennessee, and enjoyed an amazing time. Great city, great food, music, and good friends. People respected one another, and not a mask was in sight on these crowded streets. Nashville, like Los Angeles, has COVID, yet those cities handle the situation very differently.

“One of the bottom lines is that we don’t know how long social distancing measures and lockdowns can be maintained without major consequences to the economy, society, and mental health.” Dr. John Ioannidis, a Stanford professor and an author of numerous studies on evidence-based medicine and statistics, wrote in STAT on March 17, 2020.

(Ioannidis achieved wide fame for his 2005 paper published in PLOS, “Why Most Published Research Findings Are False.”)

Last week, I flew on an airline and the flight attendant was adamant, you must wear your mask at all times, and can only take it off while “actively eating” and must replace the mask in between bites. The person next to me leaned over and said maybe we should all sit six feet apart while we eat!

Sadly, real life has nothing to do with the rules of social distancing.