Like the ubiquitous presence of masks on people in public places, a defining feature of the COVID-19 pandemic is the lack of physical contact between people. Physical distancing requirements have stopped us from hugging or kissing friends or family, except those we live with.

As some countries ease their lockdown restrictions, and some like Italy even open their borders to allow international travel on 3 June, what isn’t clear is when people can have physical contact with those they don’t share a house with. The UK Health Secretary suggested that people won’t be able to hug friends or family until there is an effective vaccine or treatment for COVID-19. While there have been reports that a vaccine could be ready by October this year, many scientists are sceptical that one could be developed and rolled out that fast.

The rollercoaster ride that is vaccine development means that one could be ready by 2021 or 2022 - or never. Given this uncertainty, it’s unclear when we might be able to safely hug people again. If transmission slowed greatly and the number of cases dropped significantly, governments may re-examine measures. But infectious disease experts expect the new coronavirus to stay with us for many months or possibly years to come, and predict future outbreaks in 2020 and 2021.

The need for connection

Many people have reported an intense emotional and mental backlash from being under strict lockdown for weeks on end, with few outlets other than video calls and minimal exercise outside. Mental health experts have wondered whether suicide and self-harm rates would rise during lockdown. Although the correlation with the pandemic is yet unknown, mental health professionals are paying close attention to people potentially at risk.

It’s clear that lockdowns have caused many people significant emotional distress. Not being able to see friends or family has been challenging, but many people have died of COVID-19 without their loved ones nearby, to avoid spreading infection. Countless people have been unable to attend the funerals of their own family.

Creating social bubbles

Countries that have had strict lockdowns for several months, such as Spain, are now easing restrictions to allow people to socialise with small groups of people. In New Zealand, for example, people can see friends and families who are in their ‘social bubble’ of up to about ten people. The idea is that a household could create an extended household of friends and family, provided the arrangement is exclusively reciprocal – i.e. it wouldn’t work if each other group then met up with different groups.

The thinking behind this was to continue to keep the risk of transmission relatively low, yet address mental health and wellbeing issues that can arise from isolating for prolonged periods. It would also mean that parents could get much needed childcare support.

Contactless human contact

The social bubble, or social clustering as it’s sometimes called, may still be too risky for people older than 60 years or those who have underlying health conditions. Some families are coming up with innovative ways to see each other. A Dutch care home created a social contact pod for an 85-year-old resident to see her children in a room divided with a glass partition so that there would be no risk of infection. Another family created a plastic ‘cuddle curtain’ – a plastic sheet with gloved extensions – so that an older lady could hug her grandchildren without having actual contact.

For many people, this may be the first time they’ve had to go without physical contact with their loved ones, but there are lessons to be learned from the way people with cancer or Ebola, and healthcare workers attending them, have maintained emotional connections. For example, as Ebola can be particularly deadly to very small children, parents who are infected have to be separated from their babies. In the Democratic Republic of the Congo, healthcare workers found ways to create nurseries with walls made of protective plastic so that parents could still see their children. This connection is as psychologically profound for the children as it is for their families.

People have begun applying these forms of no-contact or reduced-contact innovations with plastic sheeting to other situations as well, in restaurants, beaches and schools.

Analyses of super-spreader events in the past few months of the pandemic suggest that the virus is far more easily spread indoors, compared to outdoors, especially in unventilated spaces. Safe hugging may still be some way off, but we will hit milestones in the meantime such as being in bars and restaurants, having parties and exercising – they just may have to stay outdoors for the time being.

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