Issue 21: A harm reduction approach to physical distancing

If we're in for months or even years of keeping away from one another, "stay at home" is not an option. We need to rethink how we make use of time and space

My apologies, but the promised second part of yesterday’s briefing will come in Wednesday’s newsletter. Today’s briefing is by Daniel Weinstock (DW), who is James McGill Professor in the Faculty of Law and the Director of the McGill Institute for Health and Social Policy — AP

The Physical Distancing Dilemma

If, like me, you spend an inordinate amount of time poring over the research that is being generated in record time in the context of the COVID-19 pandemic by researchers in a wide array of disciplines, you will know that uncertainties abound. What’s more, they abound across a wide range of dimensions. Models predicting rates of infection are propounded and quickly discarded, estimations of the likelihood of a vaccine range from the optimistic to the cautionary.

In such a context, we need to make plans that cover a wide range of fact patterns.  I want to begin thinking about one such pattern. What if it turns out that we need to engage in physical distancing for the next couple of years, or maybe even indefinitely? Unless there are significant advances in the treatment of COVID-19, distancing is likely to be required until a vaccine is discovered, manufactured at a planetary scale, and administered at a sufficient scale to ensure some degree of collective immunity. And if we don’t discover a vaccine, we’ll probably have to engage in distancing for longer. Keeping the curve flat enough so as not to overwhelm our health systems until we achieve herd immunity could take years. And if having gone through COVID-19 does not confer immunity, then….

If physical distancing requires that the kind of confinement we have been undergoing for the past few weeks extends into the indefinite future, it is going to be a tough sell. As warm weather returns to Canada, the risk is that Canadians will “vote with their feet”, and observe stay at home orders in an increasingly lax way. As they do, the ability of law enforcement to effectively enforce a stay at home policy will quickly be overtaxed. Should we then just give up on physical distancing? Do we end up defaulting to the reviled model according to which we just throw up our hands and let the virus make its way through our communities, resulting in staggering numbers of deaths?

A Harm Reduction Approach

Not necessarily. The kind of scenario that I have just mooted is structurally familiar to those of us who are interested in “harm reduction” models. The circumstances of harm reduction are ones in which we come to realize that it is impossible to enforce the prohibition of some mode of behaviour that is either controversial or outright condemnable, or at least not possible at acceptable cost. Partisans of harm reduction approaches claim that the continued attempt to enforce prohibitions lead to the worst of all possible worlds, a kind of unregulated non-compliance, if you will. 

Sufficient compliance with stay-at-home policies will be very difficult to maintain and to enforce, and it will get increasingly difficult as lockdowns extend, from weeks, to months, to possibly years. If physical distancing is equated with staying at home unless it is absolutely necessary to leave, then we are in trouble.

Moreover, the concerns that physical isolation policies raise are not just about the growing gulf between our willingness to comply and the ability to enforce. There are moral costs as well. “Stay at home” is a massively inegalitarian response to the pandemic, because it distributes the burdens of combatting the virus so unequally. Some people get to stay home while still being paid, in nice houses with family members and partners with whom they get along. Others live in cramped spaces, or cohabit with abusive partners, and/or end up losing their livelihoods and so have to make do in increasingly straitened economic circumstances. It’s one thing to accept this inegalitarian policy as a short, sharp shock, to get us over the first wave of the pandemic. It is quite another to require it over the long haul. It involves putting the mental and physical health of some of our most vulnerable citizens at risk.

So we seem to have hit an impasse. In the absence of a pharmaceutical or technological fix, the most plausible policy response we have is both impracticable and unacceptably inegalitarian over the long haul. 

Stretching Space

But there may be a way out. One possibility whose full potential has perhaps not yet been fully explored is that physical distancing does not require confinement, or at least not as much confinement as has been required thus far. This possibility would involve making a much more efficient use of time and of space in our organization of work and leisure, so that we can, as it were, spread people out as they go about their activities in a way that respects social distancing requirements.

Think, first, of space. A reaction of many municipal governments in the face of COVID-19 has been to close off green spaces, or to render them inaccessible. For example, in Montreal, the parking lots of Mount-Royal park have been closed, which makes the park for all intents and purposes inaccessible to a vast proportion of Montrealers. Similar policies have been enacted in other jurisdictions, where vast expanses such as parking lots and schoolyards have been closed off. 

Presumably, the thinking is that if you close these spaces off, you make going out less attractive to people, and they will then be more inclined to comply with “stay at home” restrictions. But the other possibility, one that risks becoming more likely as time goes by is that people will go out, but that they will do so in spaces such as narrow sidewalks in which they are far less likely to be able to comply with physical distancing requirements than they would be in wide, open spaces. 

In Montreal, this risk has already been tacitly recognized by city officials, who have widened the area in which people are able to walk by eliminating at least one side of streets’ parking spaces. There’s a tension here: on the one hand, officials want to make attractive spaces inaccessible to disincentivize people going out, but on the other they recognize that they will go out, and so they make the spaces that are left to them more compatible with distancing requirements. 

The harm reduction thinking that is implicit in the latter set of measures should in my view be fully embraced. We should make spaces more widely available, rather than less, so that people can spread themselves out in ways that make physical distancing possible.

We should consider doing this not just with outdoor, but with indoor spaces as well. Those of our fellow citizens who do not have access to safe, adequate housing should be able to access currently unused spaces (theatres, cinemas, hotels) where distancing requirements could be enforced, in order to work, to study, or simply to take a break from unsafe home conditions.

The basic idea is: if you need to space people out, use as much of the space that there is!

Rethinking Time

Researchers in Australia have argued in a recent piece that we should think about time in the same way, and I agree. Our society has evolved so that almost everyone has largely convergent work and leisure schedules. Everyone works, roughly, from 9 to 5. Every child goes to school, roughly, from 8 to 3 or thereabouts. As anyone who has ever driven a car or taken public transport to work, or tried to get lunch in a downtown food court knows, this creates temporal jams. There are times in the day where temporal convergence forces us into densely packed crowds. In recent decades we have started experimenting with flexible work schedules, but this is still a marginal phenomenon.

Just as we don’t use space as efficiently as we might in order to achieve physical distancing, so we don’t use the 24-hour clock or the 7-day week as efficiently as we might to achieve the same end. We are already toying with the thought that deconfinement will require creative uses of time. For example, it has been suggested here in Quebec that when schools reopen, the school day will be organized in such a way that children will never all be at school at the same time. There will be a morning and an afternoon shift. The plausible thought is that if you spread out the day and distribute kids across it, rather than lumping them all in the same 6 - 7 hour slot, you make distancing more possible.

At the same time, jurisdictions have had the opposite temporal reflex. Curfews have been imposed, and in Quebec, Sunday has been re-imposed as a day of rest even for certain essential services, such as grocery stores. While the impetus behind this is intelligible, it makes little sense if our goal is to maximize opportunities for physical distancing. Spread the same number of people out over longer periods of time, and the chance that they will be able to distance without having to confine grows. Rather than restricting the times during which people can access the spaces that they need to be in, why not extend them? For the length of the pandemic, keep stores, workplaces, and yes, perhaps even schools open 24/7, and distribute people in sparser, and more distancing-enabling ways.

Get out of the box

Unimaginable? Perhaps. But the present set of circumstances, and the responses that we have enacted to them, would have seemed unimaginable just a few short weeks ago. The predicament we find ourselves in requires out-of-the box thinking, especially under the moderately pessimistic conditions that I have identified as premises for this intervention.

Obviously, we will need planners and architects to help us figure out the details of how to re-organize our institutions, our spaces and our communities. But the basic point stands. If we want to achieve long-term physical distancing, “stay at home” cannot be the solution. It exacerbates inequality, and in any case is probably only achievable given a massive uptake in surveillance and coercion by the state, and snitching on the part of ordinary citizens, which would leave an unattractive stain on our post-pandemic lives. (DW)

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Policy for Pandemics is produced and edited by Andrew Potter and co-edited by Charlotte Reboul and Paisley Sim (bios here) If you have any feedback or would like to contribute to this newsletter, please send an email to andrew2.potter@mcgill.ca