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Social Distancing: An Anthropological History
Hanson Park
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Social Distancing: An Anthropological History

Hanson Park
Department of Anthropology, College of Social Science, Seoul National University
1 Gwanak-Ro, Gwanak-Gu, Seoul 08826, Republic of Korea

COVID-19 (referred to as "Corona-19" in Korea) is spreading with little sign of stopping and is making a severe impact not only on the world's medical establishments and public health, but across a broad spectrum of life, including the economy, society, culture, politics, and diplomacy. No one knows when the COVID-19 pandemic will come to an end. According to a simulation published by the John Hopkins Center for Health Security, the virus will continue to spread until at least 80 percent of the world's population has become infected. The simulation estimates that least 65 million people will have died in a period of 18 months. The US Centers for Disease Control and Prevention recently suggested that at least 200 million people will become infected in the US alone. A research team at the Harvard T. H. Chan School of Public Health predicted that 1.4 billion to 4.2 billion people will become infected with COVID-19. While these kinds of predictive models tend to be inaccurate, the pandemic still shows no end in sight.

The World Health Organization (WHO) has already announced that COVID-19 is a pandemic, the third such announcement in history. The announcement itself is not what is important here, however: even before the WHO came into existence, there have been worldwide pandemics. The first pandemic announced by the WHO was in 1968, the Hong Kong flu. Around one million people died. The second pandemic announced by the WHO was a novel influenza strain in 2009, which led to around 600 million infections and at least 150,000 deaths.

The COVID-19 pandemic is much more devastating than these. There is no treatment or vaccine available, and the virus is spreading very fast. There are few tools we possess that can combat the disease. Even the most distinguished doctors can do nothing without medical treatments. Testing kits are being developed and supplied as quickly as possible, but cases are rising fast because there is no way to treat them. Desperate to avoid being infected by COVID-19, people are turning to face masks for protection. There has even been panic buying of toilet paper and foodstuffs. This, however, is no way to tackle the disease.

All of this is not new to humanity. Humankind did not have medications to fight such diseases as recently as 200 years ago. Edward Jenner announced the discovery of vaccination in 1798, while Alexander Fleming announced the world's first antibiotic, penicillin, in 1929. One of the world's oldest professions is being a doctor, but doctors have only recently been given powerful weapons to fight against disease. Doctors have now brought back an old way to fight against infectious disease: social distancing. While the phrase sounds a bit awkward, social distancing has in fact been around for a long time. Traditional social distancing can be divided into two different strategies.

The first strategy is to isolate patients in a designated area. The Old Testament's Leviticus describes ways in which to diagnose, treat, and make atonement for leprosy, scabies, and sexually-transmitted diseases, a summary of which is as follows: "If the shiny spot on the skin is white but does not appear to be more than skin deep and the hair in it has not turned white, the priest is to isolate the affected person for seven days. On the seventh day the priest is to examine them, and if he sees that the sore is unchanged and has not spread in the skin, he is to isolate them for another seven days" (Leviticus 13:4-5, New International Version). This has essentially become the basis of quarantining people at hospitals or at home.

The second strategy takes an opposite approach: the sick patient is "driven away" to isolate them from uninfected persons. Chapter 5 of the book of Numbers states that "Command the Israelites to send away from the camp anyone who has a defiling skin disease or a discharge of any kind, or who is ceremonially unclean because of a dead body" (Numbers 5:2, New International Version). The measure is essentially aimed at preventing sick people from entering a country or locking down a specific area.

Leprosy, or Hansen's Disease, has spread among humankind since the Paleolithic Era. During the 13th century, a hospital to treat lepers that could accommodate 19,000 people existed in Europe. Korea established the Jahye Hospital on Sorokdo Island in 1909, effectively creating a leper colony. The lepers' lives were tragic. In fact, their lives were little better than those of an ordinary person living in the Middle Ages. In any case, the primitive social distancing strategy created terrible stigmas and discrimination. It was, however, the only measure that worked when humankind lacked antibiotics or vaccines.

Of course, these distancing measures were nothing like forcing the sick into a hell filled with zombies—as is commonly portrayed in movies or novels. Many members of the clergy ignored the dangers and lived together with the lepers. And many of those clergy who helped the sick became lepers themselves. There is a similarity between the doctors in Korea rushing to Daegu and Gyeongsangbuk-do to help contain the COVID-19 outbreak and the ascetics who chose to live in leper colonies. Even lepers, who suffered from prejudice, were careful. When they had to leave their quarantine areas, lepers would clap or hit a leper bell to warn others of the danger they posed. This was a way for people with symptoms of the virus to leave the colony and quarantine themselves at home. When they no longer were sick, they could "cleanse" themselves by conducting certain rites of atonement. The New Testament is full of stories about how Jesus "announced" that people had been cured of disease. But, was the disease actually treated? Or did Jesus simply cure them of the discrimination and stigma they faced?

At this point, you may be confused whether this article is focused on science or religion. The theoretical background to social distancing is the basic reproduction number, or R0 for short. Let us call the proportion of people who actually conduct social distancing within a certain population "f." This new R0 would look like this:

New R1 = [1 - (1 - (a2)f] R0

Efforts to delay the start of all schools, conduct classes online, and have more people work from home are aimed at raising the "f" value. Avoiding handshakes and sitting apart from others is aimed at lowering the "a" value. If people voluntarily take part in social distancing, the R0 can be reduced drastically. If the value can be reduced to a figure below 1, then the rate of infection will, naturally, fall.

The spread of COVID-19 has, however, led to all sorts of ways to counter it. Promoting kimchi as a cure-all is so common that it has hardly been mentioned now, but we have seen the rise of salt being treated as a "cure-all" again—particularly when salt water is used to wash your lips and nose. Garlic is also promoted to combat the disease. We have also heard that dozens of people died after drinking industrial-strength alcohol in the belief that it would disinfect their stomachs. There have even been people who rubbed sesame oil into their noses. King Sejong the Great (r. 1418-1450) of the Joseon Dynasty, revered through the ages for his enduring wisdom, told his people to rub sesame oil into their noses when an infectious disease broke out, but this is not something we should ever do—even if it was King Sejong who ordered it.

Interestingly, when the infectious disease started spreading, King Sejong told his officials to investigate how many people were infected, how fast the disease was spreading, and changes in the disease infection rate year-on-year. He also ordered them to find an effective treatment for the disease. The Annals of the Joseon Dynasty states: "[King Sejong] ordered [officials] to see whether infectious diseases were prevalent in the residential areas of villages this year, requesting a report including descriptions of the infectious disease deaths and the infection numbers in comparison to the previous year. Based on the Six Codes of Government, [officials] were ordered to eradicate the conditions and spread of the disease, preventing the tragedy of infectious disease deaths by prescribing medicine for symptoms."" This passage is from the 19th year of King Sejong's reign. He understood the importance of conducting scientific epidemiological investigations and communicating with the public. The problem was, however, there was no prescription of medicine that would be effective against the disease.

There have also been strange claims made about combatting COVID-19. Some even argue that the disease can be beaten through "herd immunity" by allowing all members of a certain population to become infected. However, if we were to manage infectious disease through herd immunity each time, the Earth would soon be emptied of its people. There is another problem: We do not know anything about how immunity can be created against SARS-CoV-2, the virus that causes COVID-19, and immunity against regular coronaviruses only lasts for a period of months. You will not necessarily avoid a cold next year just because you got one this year.

The primitive distancing strategy is based mainly on preventing infections from spreading and isolating sick people. It is an extreme strategy that creates serious prejudices against the sick. It considers those infected, those who had contact with the infected, and those receiving treatment as one and the same. If the strategy worked all the time, it would be acceptable, but it is not always effective. Sick people hide their symptoms, and medical professionals hesitate to treat the sick. The strategy is impossible to use in highly urbanized and densely populated modern society, where there is a prodigious movement of goods and people.

There is a better strategy we can take: continue to delay the start of school, restrict meetings of people, shut down facilities used by lots of people, and promote personal hygiene, including handwashing. This strategy is for lowering the "a" and raising the "f" values. It is impossible to make the "f" value "1" because we just cannot isolate every single person into their own rooms. There are also people who have no choice but to increase their contact with others, such as medical personnel, the police, firefighters, and disease control officials. Soldiers cannot just drop their weapons and head home. Any ordinary person reading this article must engage in social distancing for it to be effective.

"If these throngs catch the infectious disease while away from home, they will certainly face death. Perhaps the naval soldiers currently on their way to participate in the construction next month can be notified to return [home]." Lauding the king's gracious favor, the top official Kim Jong-seo had the soldiers retreat and return home to rest. Perhaps this was the basis of what we now call "working from home"? This passage was from the records of the 14th year of King Sejong.

 

Hanson Park is psychiatrist and neuroanthropologist. He lectures on evolution and human society at Seoul National University's Department of Anthropology and is currently researching the process of evolution of the mind. He has translated the books Artificial Happiness: The Dark Side of the New Happy Class, Ancient Bodies, Modern Lives: How Evolution Has Shaped Women's Health, and Evolution and Human Behaviour: Darwinian Perspectives on the Human Condition. He is the author of Disaster and Mental Health, The Psychiatry: A User's Manual, I have been depressed since I was an Australopithecus, and Evolutionary contemplation: Seven steps away from the mind.

 
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