I published the following article in Kevin MD on April 13th, 2020.
As chief resident of my rural Hawaii Island Family Medicine Residency program, I look back with our nation upon the past four months that turned our whole world topsy-turvey. At the start of this year, I remember when leaders of organizations, businesses, and churches started sharing their new “2020 visions” for a year of great hope and optimism. Yet none of us could have fully prepared for what was brewing in Wuhan in early January. As prior Secretary of Defense Donald Rumsfeld stated, “there are known knowns … known unknowns … but there are also unknown unknowns — the ones we don’t know we don’t know. And if one looks throughout the history of our country and other free countries, it is the latter category that tend to be the difficult ones.”
I remember closely watching the high mortality rates of the novel coronavirus coming out of China in late January being 10 to 30 times greater than the seasonal influenza virus. I was surprised at the dismissals of the virus being “nothing more than the flu” and confused why the World Health Organization (WHO) declined to declare the Novel coronavirus an international emergency. With our first confirmed COVID-19 case in the United States on January 15th and in Hawaii on March 6th, suddenly, the virus felt far too close for comfort as our country was caught in a flurry of confusion, panic, and fear. On March 11th, the WHO finally declared the virus a global pandemic. Since then, we have spent four weeks suffering unbearable losses while playing catch up with testing delays due to an initial round of defective COVID-19 tests and personal protective equipment and ventilator shortages.
Not only does the novel coronavirus present a completely new biological problem for the human species, it also undermines even the most basic of assumptions that underlie every aspect of human society. Jerusalem’s Holy Sepulchre church had closed its doors for the first time since 1349 when it closed for the Black Plague. We even willingly forfeited our first amendment constitutional right to assembly in our attempt to flatten the curve. After weeks of stay-at-home and social distancing orders to maintain a six-foot distance have been implemented, we are starting to realize the mental health consequences of these prolonged isolation measures without a clear end in sight. Medically, the unintended physical problems that can result from prolonged social isolation and loneliness include diabetes, heart disease, and even early death. In order to address this social distance that has disrupted our way of life, communities have rallied together to find new ways to use social media and video conferencing to maintain any sense of normalcy in a world that has flipped upside down.
I have been ruminating on the idea that the psychological distance between persons using online platforms is roughly equivalent to having an in-person conversation with ten feet of physical distance. Why? Comparatively, online communication feels less intimate than a conversation with a friend sitting across a three-foot coffee table. It is more akin to talking with a friend from across the hall or awkwardly sitting across a long dining room table over dinner. Also, ten feet just slightly obscures our ability to read each other’s nonverbal facial cues, making us more dependent on verbal communication than the nuances of in-person communication. Ten feet serves as just enough space that even with outstretched arms or legs, two people cannot physically touch. Unlike nine or eleven, ten feet is also psychologically familiar to all of us because it has deep historical roots in our language itself. How many of us have used or at least familiar with the phrase “I wouldn’t touch it with a ten-foot pole”? This idiom can be traced as far back as the mid-1700s when it replaced an earlier phrase “not to be handled with a pair of tongs.” In the 1800s, references to barge poles were sometimes substituted for a ten-foot pole. Later a Spanish burial practice of pushing a body into the bottom of a tomb with a ten-foot pole was thought to have popularized the phrase. Regardless of the precise origin, the ten-foot psychological distance provides a useful way of understanding how online platforms can best be used to meet certain communication needs, while also understanding their inherent limitations in meeting needs that require closer connection. Facebook and Skype just don’t fully replicate the hug, handshake, or shared meal together.
While online platforms can bring us together across great distances, it regards to filling our six-foot social gap; online communication has added another four feet of distance to create a “ten-foot problem.” In fact, thought leaders like Dr. Donald Berwick at the Institute of Health Improvement (IHI) have also identified the urgency of addressing prolonged social isolation measures. The IHI proposes that leaders stop advising social distancing, but rather recommend physical distancing while seeking new ways to remain socially connected. As we ultimately wait for the day an effective vaccine is developed for global distribution, we need to find ways of reclaiming the lives we once cherished despite prolonged physical distancing measures. The “ten-foot problem” provides us a tangible way of thinking about taking steps forward in this pandemic. Even if those steps are as small as the 120-nanometer coronavirus itself, if 25 million of us just take one step forward, we will have walked over three billion nanometers which is equal to our ten-foot goal! We all have a unique step to take whether it be in leadership, compassion, service or creativity. Imagine if all 7.8 billion of us took one 120-nanometer step forward together. We would overcome the “ten-foot problem” 300 times over! Each one of us has a 120-nanometer step within our power. While no one person has the answer to our seemingly insurmountable problems from social isolation, together our steps will collectively lead us forward to new beauty and meaning that far surpasses this present suffering.
Warren Yamashita is a family medicine chief resident.
