X Close

Was the two-metre rule one big lie? By covering up complexity with nice round numbers, public health officials treat us like children

People social distancing at Cardiff's stadium-turned-hospital. Credit: BEN BIRCHALL/POOL/AFP via Getty Images

People social distancing at Cardiff's stadium-turned-hospital. Credit: BEN BIRCHALL/POOL/AFP via Getty Images


June 24, 2020   5 mins

You know who I feel sorry for? All the people who’ve printed millions of stickers, signs and banners saying KEEP TWO METRES APART. Are they now going to overprint TWO with ONE and scrub out the S with marker pen? Or just add a smaller sticker saying “if you can. Otherwise ONE METRE PLUS.” Plus a bit? Plus a face mask? Plus one?

The question is not why the UK government originally adopted the 2 metre rule. Very little was known about Covid-19 when the pandemic first reached the UK, and 2 metres was the standard recommended distance for infectious diseases that seemed to spread through the air in droplets or a fine aerosol of fluids, inhaled or otherwise absorbed by the next victim. In a lockdown, and in the absence of any other evidence, why not adopt the standard?

The question is why, as new evidence emerged, Britain was so slow to follow France, Denmark, Singapore, Hong Kong, China and indeed the WHO in dropping the minimum recommended distance to just one metre? Emerging research suggested that Covid tends to travel by heavier, larger droplets. Physics, not biology, shows they fall to the ground rapidly, so the risk reduction of one metre separation is significant, but adding another metre has less impact. Some other countries decided to stay on the safe side with 1.5 metres, but the UK held out till this week at 6ft 6in.

Of course, the virus doesn’t follow rules. If somebody is infectious, there is no hard limit beyond which you are safe. And, since people can be infectious before showing any symptoms, anyone represents at least a theoretical risk of infection. We are looking at degrees of risk, and what measures we’re willing to take to reduce them. Outdoors is safer than indoors. Wearing a mask is safer than not. Facing the same way and talking like spies meeting on a park bench is safer than face to face. And all this is provisional, as we’re not putting patients in labs and letting them breathe on volunteers to find out.

It could just be that the British Government wanted to wait until the disease was less prevalent before letting us get a little closer. Or it could be the latest in a long history of telling us, not what the science says, but what the public health officials think we need to be told.

Take “5 a Day”, the guideline that tells us all to eat five portions of fruit and vegetables every day (potatoes don’t count, despite being so rich in Vitamin C that their introduction to Britain ended endemic scurvy). That has a number in, so surely it must be based on scientific research? Indeed, the NHS “Why  5 A Day?” page says the campaign is based on WHO advice to eat 400g of fruit and vegetables to lower the risk of heart disease, stroke and cancer.

There is research linking more fruit and vegetables to lower risks of some diseases, but that’s not the origin of the campaign. In 1980s California, the state’s Department of Health Services found a happy harmony between the desire to improve public health through diet, and the economic benefit to the region’s farmers from increased sales. In the American Journal of Preventive Medicine, the Department’s then Director, Ken Kizer, summarised its success:

The 5 a Day-for Better Health! Campaign had several distinctive features, including its simple, positive, behavior-specific message to eat 5 servings of fruits and vegetables every day as part of a low-fat, high fiber diet; its use of mass media; its partnership between the state health department and the produce and supermarket industries; and its extensive use of point-of-purchase messages.”

Professor Tim Lang was advising the UK government in the late 1990s when he was told of the US campaign and felt “we needed something”. Tony Blair’s Labour government was looking for specific policy targets, and five was “a nice round number”. The scientific precision of 400g was retrofitted later to give the “simple, positive, behaviour-specific message” more scientific authority.

Or take government guidelines for how much alcohol we should drink, revised in 2016 to “You are safest not to drink regularly more than 14 units per week.” This was cut down from the old guidelines, which were 14 units for women and 21 for men, recognising the differences in average physiology. They in turn were revised downwards in 1984 from 56 units per week, almost a bottle of wine per day. Our parents were made of sterner stuff.

But the new guidelines are based on better science, right?

Well, it depends what you mean by science. Like most public health questions, it would be unethical to apply randomised controlled trial methods to habits that you suspect are unhealthy. Nobody assigned human adults randomly to drink nearly a bottle of wine a day or no alcohol at all, and recorded their time and cause of death. Health advice is based on a mixture of ‘ecological’ observation (real humans drinking in the wild and then reporting their intake) and mathematical modelling.

The new guidelines took an extreme position on the protective effects of small amounts of alcohol (around a unit a day) against cardiovascular diseases, for which there is robust evidence. Light drinkers are around 20% less likely to die of anything in a given period than teetotallers, even excluding people who have stopped drinking because they’re ill.

Arguing that deaths from cardiovascular disease have fallen significantly, the Chief Medical Officers argued that this made the protective effect less important, and that it was only significant in women over 55. They may have based this on a paper published in the BMJ claiming that such benefits were limited to women over 65, a claim that the statistician Professor David Spiegelhalter described as misleading, commenting that “a more appropriate headline would have been ‘Study supports a moderate protective effect of alcohol’ … This is a poor use of statistics, and I am surprised it got past the referees and into the journal.”

The new, lower drinking guidelines are not a change in public message that reflects a change in scientific research. The research has been selected, or even commissioned, to justify new, lower guidelines. A more honest public health message would be: “Depending on who you are, a drink a day is probably good for you, and every subsequent drink increases your risk of illness and death”. But that would muddy the “simple, positive, behavior-specific message”.

Public health campaigns are, by nature, broad brush and aimed at mass populations. Most of us want rules of thumb, not scientific papers, when we’re weighing up what to eat, drink or smoke, whether to go for a run, how close to stand in the supermarket queue. We understand that advice is to be taken in context, not as a protective spell that will guard us from all harm.

In a pandemic, as new understanding emerges by the day, clarity is even more important. As early as February, scientific advice to the government about how to handle the Covid-19 pandemic included the importance of being clear and definitive, coherent and consistent, not only to improve compliance with helpful actions, but to discourage pointless or counterproductive ones.

But this is no excuse for dishonesty about the basis for official advice or rules. Where the scientific basis for policies was uncertain, it would have been far better to say that the science was uncertain, but the government had made a decision for these reasons: erring on the side of caution until more was known, or recognising that human life is about more than medical health.

When the WHO switched its advice to one metre, what was the rationale for sticking with two? Fear of looking indecisive? Lack of faith in British people to know what a metre looks like? In mid-March, the UK’s scientific advisory group, SAGE, was invoking behavioural science to argue that the public is mostly rational and altruistic in a crisis:

The behavioural science points to openly explaining to the public where the greatest risks lie and what individuals can do to reduce their own risk … Greater transparency will help people understand personal risk and enable personal agency, send useful signals about risk in general and build public trust. Citizens should be treated as rational actors, capable of taking decisions for themselves and managing personal risk.”

Of all the expert advice given to the government, it’s a pity this paragraph has been so often ignored.


Timandra Harkness presents the BBC Radio 4 series, FutureProofing and How To Disagree. Her book, Technology is Not the Problem, is published by Harper Collins.

TimandraHarknes

Join the discussion


Join like minded readers that support our journalism by becoming a paid subscriber


To join the discussion in the comments, become a paid subscriber.

Join like minded readers that support our journalism, read unlimited articles and enjoy other subscriber-only benefits.

Subscribe
Subscribe
Notify of
guest

39 Comments
Most Voted
Newest Oldest
Inline Feedbacks
View all comments
Richard Pinch
Richard Pinch
4 years ago

I don’t think the headline “Was the two-metre rule one big lie?” really does the article any favours. Firstly, of course, a rule can’t really be a “lie”, since a rule is an imperative, not an indicative. If you read it as “Was [the claim that] the two-metre rule [was based on science, or the science that it was based on,] one big lie?”, then the author answers the question herself: No (in accordance with Betteridge’s Law)

The headline might have read “Did the Government change the two-metre rule as soon as the science behind it became clearer?” A reasonable question, to which the answer is “Probably not”. But even so, the underlying implication that there is some distance, be it one or two metres, which is somehow “safe” whereas some other smaller distance is “unsafe”, is too simple. The question, too long for a headline, might be “What are the risks involved in 1 versus 2 metre separation, compared to all the other factors, and did the Government time its shift correctly to accord with current understanding of all those risks and balance them against other risks and benefits?” To which the answer is: Nobody knows.

A Spetzari
A Spetzari
4 years ago
Reply to  Richard Pinch

Yeah the article is trying to have its cake and eat it.

The 2m rule was brought in as a rough guide that’s easy to follow. Waiting for the “truth” would have meant no action and nothing – we still don’t have the answer now.

In short these guidelines are what you expect – guidelines for things where there is no empirical answer available but some action is required. Question them by all means as a general point – but what is your alternative? There is none.

Bill Gaffney
Bill Gaffney
4 years ago
Reply to  Richard Pinch

“Science”? Oh, you mean the pulling a piece of paper from a chapeau once a week or so with the new “science” on it. BravoSierra! Science! Laughable.

Richard Pinch
Richard Pinch
4 years ago
Reply to  Bill Gaffney

No, by “science” I mean conclusions drawn from reproducible experiments and published in peer-reviewed literature which can be understood be reasonably competent and literate people.

d.tjarlz
d.tjarlz
4 years ago
Reply to  Richard Pinch

Fair enough, except science does not have to be experimental. For example, finding and describing a new species of Banksia.

Robin P
Robin P
4 years ago
Reply to  Richard Pinch

published in peer-reviewed literature

And what is so good about that? Read some actual facts about “peer review” in http://www.pseudoexpertise.com/ch-...

Lee Johnson
Lee Johnson
4 years ago
Reply to  Richard Pinch

You are missing the point Richard.
The game these days is to rant and rave as much as possible so as to attract clicks to yourself.
So if you invert all the substance of the article ( UK stuck to 1m while WHO raised it to 2) then the screaming from this journo would have been exactly the same.

d.tjarlz
d.tjarlz
4 years ago
Reply to  Richard Pinch

Do you know who formulates the headlines at Unherd? Sometimes it is completely out of the author’s hands.

Dougie Undersub
Dougie Undersub
4 years ago

When the message was changed from Stay at Home to Stay Alert, the media complained it was confusing. We can be sure the media would have criticised a reduction from 2m to 1m as confusing, against the science, reckless. The Government can only take on so many fights at a time. The media has a lot to answer for.

David Bell
David Bell
4 years ago

The problem is there have been to many political decisions for political reason. You only have to look at Scotland and Wales to see how two national assemblies are trying to differentiate themselves from Boris Johnson by ramping up fear. Covid 19 has been sighted by remainers as a reason to extend the EU transaction period by 2 years!

Covid 19 has become a reason to do (or not do) so many things which are completely unrelated to the virus and public health!

paul chandler
paul chandler
4 years ago

While not disagreeing with the thrust of the article, I note that the writer says ‘2 metres was the standard recommended distance…’. Where does this come from? The only standard reference I can find is the Centre for Disease Control suggesting 3 feet. We mustn’t let the government off this hook so easily.

Fraser Bailey
Fraser Bailey
4 years ago

Of course it was a big lie. Everything they told us was a big lie. Everything the state says and does is a big lie. if you have reached the age of 30 and not understood this you are an idiot. Even worse, our eternally useless and self-serving state apparatus – particularly the revolting and sanctimonious NHS – completely failed to protect the very people who were most vulnerable. Namely, the old and public transport workers etc. Really, the headline is perhaps the most absurd statement of the obvious in the entire history of ‘journalism’.

Alvaro MoVi
Alvaro MoVi
4 years ago
Reply to  Fraser Bailey

I understand why people don’t see the lies they’ve been told.

Even though I understand it frustrates me and leaves me with a feeling of despise and sometimes anger towards whom defend the most absurd idiotic portrays of reality and the characters that represent that reality.

The problem of calling them “idiots” “zombies” or any preferred adjective it doesn’t solve anything, on the contrary makes it worst. Creates more division among us, and thats exactly how they win by creating this tribal wars. 1984 in a nutshell

andy young
andy young
4 years ago
Reply to  Fraser Bailey

I agree, but here’s a bit of hyperbole going on there I think (rather like some politicians perhaps?). Sometimes we’re told (an approximation to) the truth, but everything you’re ever told needs treating with a degree of scepticism. Including the above comment (& this one!).

Roger Inkpen
Roger Inkpen
4 years ago
Reply to  Fraser Bailey

I’m intrigued that you think the need for social distancing is a ‘big lie’.

If there was no need for any rule, how could we have protected the old and, erm, bus drivers?

Maybe it’s a lie that all those old and infirm people have actually died. If the govt lie about everything, why believe the death stats?

jmitchell75
jmitchell75
4 years ago
Reply to  Fraser Bailey

The revolting and sanctimonious NHS. Wow, you sound angry.

The problem is with the NHS is that it has been used as a political play thing for far too long, and we haven’t yet had the chance to have a national conversation about what we want from the system and how much people are willing to pay for it, and how they are willing to pay. Until then it will be the political football it’s always been, and the enormous layers of bureaucracy and management will still exist. We need a clear direction and vision.

The ‘failure’ to protect the vulnerable was coming for years, the crisis in social care provision, particularly community care has been acute for years, probably back to the Blair government and further. Every government and health minister from then has failed to do anything to solve it, though Andy Burnham did come close before Labour were booted out of office

unconcurrentinconnu
unconcurrentinconnu
3 years ago
Reply to  jmitchell75

The NHS as a model of delivering healthcare to a population is the worst i have across anywhere – and I have lived in four different countries. Its record on successful treatment levels across a whole range of diseases is one of the worst in the developed world. Healthcare should be denationalised and we should be allowed to choose the providers and level of care we want, via a minimal state subsidy and private insurance. We could have a better service at less cost (the NHS is one of the largest consumers of our taxes).

Further, I am highly irritated by the condescending and patronising tones that doctors (& even nurses) use towards me, as if I am lucky to be treated, and i must not question anything. Give me a service with choice, and I could leave these beings to their inevitable economic decline, and pay instead those in the profession who treat one as an adult.

Trevor Law
Trevor Law
4 years ago

Probably not a lie, in the sense of a deliberate deception, but you are right to point out the (sometimes unhinged) reality of public health advice. After all, possibly the biggest mass murderer in recent history was Ancel Keyes, whose dishonest findings from his Seven Countries study ultimately led to a huge (and still growing) increase in diabetes and related illnesses as millions were persuaded to leave off the animal fats and instead gorge on grains, High Fructose Corn Syrup and manufactured vegetable oils. The problem with “independent experts” is that they are seldom as expert or as independent as we (or they) think they are.

benbow01
benbow01
4 years ago
Reply to  Trevor Law

It was a deliberate deception. SAGE minutes show that. It was accepted that the so-called science indicated 1 metre, but it was decided that the UK population would not really follow that, so 2 metres was implemented to introduce a wider safety margin in the event of poor compliance.

Thus a lie.

Richard Pinch
Richard Pinch
4 years ago
Reply to  benbow01

Just remind us which of the 38 meetings minutes you’re referring to?

Neil Stanworth
Neil Stanworth
4 years ago

I have always found the 2m rule irritating because in the official guidance we were told to maintain distance of 2m or (brackets) 6 feet. But 2 metres is not six feet – it is about 6ft 7ins; as anyone who has bought timber in modern metric lengths knows, six feet is about 1.8m. This may seem excessively pedantic but there was then debate about whether the limit should be dropped to 1.5 m – or almost exactly 5 feet. So we were basically arguing about one foot or 30 cms – depending on your metric v imperial preference.
It has also been apparent to me for weeks that few if anyone one standing in a supermarket queue knows what 2 metres is – or 6 feet come to that – and most tend to stand much closer. But it didn’t much matter because there is clear evidence that the risk of transmission outdoors is low, even at 1 metre.
Meantime the BBC science editor never missed a chance to run his ridiculous animation (based on dubious US research) showing how we were in mortal peril from a sneeze at up to 8 metres.
I’m sure 2m was never that scientific, and derived from the assumption that we would default to 1 – 1.5m, due to a mixture of insouciance and ignorance. Now we are at I metre I am happy: it is plenty close enough for me, and i have no desire to get closer than that to anyone other than my wife and children.

Roger Inkpen
Roger Inkpen
4 years ago
Reply to  Neil Stanworth

Personally I’d always assumed 2m spacing as a ‘rule of thumb’ rather than some precise measurement. Walking down the street it’s impossible to avoid other pedestrians by 2m, unless you want to jump into the road! Most supermarket aisles are the same – even if it’s one-way, some people stop while others pass.

When you are moving you need a bit of a buffer, so 2m makes sense for those times when you can’t avoid getting closer. But when it comes to people sitting down – whether in offices, classrooms or cinemas for that matter, you can keep them spaced out, albeit with the occasional reminder!

I agree with the gyms that it seems an odd message to send that pubs can open but not sports facilities. As long as gyms use staff to disinfect regularly, why not open? Pubs and restaurants will need to do the same with tables, chairs, etc.

mccaffc
mccaffc
4 years ago

“Citizens should be treated as rational actors, capable of taking decisions for themselves and managing personal risk.” Problem: That is precisely what many citizens reject. They do not want to be so treated. They demand to be infantilised with no risk, no uncertainty, no debate. Now, pretending that a republic of thinking citizens exists might still be a good idea as – following J.S. Mill – there is the hope that confronting great debates may improve people.

benbow01
benbow01
4 years ago

Yes.

Along with all the other lies about this virus.

Paul Theato
Paul Theato
4 years ago

Some more valid questions:

“Was the destruction of the economy and the ending of civil liberties worth it to avoid bringing forward the deaths of extremely frail people (with a tiny number of exceptions) by two or three months?”

“What are we doing about China? Full stop”.

“Why is the BBC still allowed to charge a licence fee?”

“How is it that we did not elect a coalition of the Marxist Labour Party, the LibDems and the Green Party and and yet ended up with their government?”

Andrew Hall
Andrew Hall
4 years ago

You cannot get behind the wheel of a car in the UK without infringing the Highway Code, as a seasoned police driver or driving instructor will tell – or at least, they have told me.In Oxford, the city authority created 20mph speed restrictions in the central area where before there was a 30 mph limit. Why not 10mph? We all vary speed according to circumstance – sometimes zero mph is appropriate and sometimes 30mph in town. So with the “2 metre rule” when negotiating a narrow aisle or busy pavement. It’s all about nudging us around to behaving safely and considerately. I don’t like being nudged and I hate faux scientific argument but I don’t want a loved one run down by a speeding drunken driver either. Government cannot win the argument (tho’ they may punish non-compliance). But better poor governance than none at all and good government is an oxymoron as any fool knows.

Lorelei Hunt
Lorelei Hunt
4 years ago
Reply to  Andrew Hall

There is no sound evidence that 20mph speed limits reduce accidents involving pedestrians. Evidence from the first area where this was piloted (Portsmouth) showed an increase in pedestrian casualties. My own local authority introduced 20mph limits in spite of this and has subsequently admitted that they have been found not to be effective in reducing accidents involving pedestrians – but they cannot now afford to reverse the work! Traffic and transport is another area where evidence based policy making is sadly lacking and little use is make of behavioural science.

Scott Carson
Scott Carson
4 years ago
Reply to  Lorelei Hunt

It will be interesting to see what happens when the powers that be finally admit the dangers of “smart” motorways. Those will take a lot more ripping out than a few 20 signs and speed humps.

d.tjarlz
d.tjarlz
4 years ago
Reply to  Lorelei Hunt

Abstract

https://doi.org/10.1136/bmj.b4469

Objective: To quantify the effect of the introduction of 20 mph (32 km an hour) traffic speed zones on road collisions, injuries, and fatalities in London.

Design Observational study based on analysis of geographically coded police data on road casualties, 1986-2006. Analyses were made of longitudinal changes in counts of road injuries within each of 119″‰029 road segments with at least one casualty with conditional fixed effects Poisson models. Estimates of the effect of introducing 20 mph zones on casualties within those zones and in adjacent areas were adjusted for the underlying downward trend in traffic casualties.

Main outcome measures All casualties from road collisions; those killed and seriously injured (KSI).

Results The introduction of 20 mph zones was associated with a 41.9% (95% confidence interval 36.0% to 47.8%) reduction in road casualties, after adjustment for underlying time trends. The percentage reduction was greatest in younger children and greater for the category of killed or seriously injured casualties than for minor injuries. There was no evidence of casualty migration to areas adjacent to 20 mph zones, where casualties also fell slightly by an average of 8.0% (4.4% to 11.5%).

Conclusions 20 mph zones are effective measures for reducing road injuries and deaths.”

David Goldsmith
David Goldsmith
4 years ago

I have to say that the idea that a single distance “does it” in all situations and in all countries is frankly bizarre. Literally, one size fits all. Only it doesn’t. Given the totally shambolic lamentable failure to contain the virus in February and March due to incompetence and incapacity in centralised health bureaucracies in the UK, we were left with little option but to go for “safety plus” 2 metres. No-one can argue that the infectious risk is reduced at 2 m than at 1 m, even if the benefits are perhaps exaggerated by 2 m extollers. But as we know, and has been admitted, there are extenuations and mitigations. Nuances, if you will. Inside versus outside. Facing apart, facing together. Singing Medieval plainchants or Rolling Stones classics. Etc. We now know that if we take mitigations – say, a mask – and apply these correctly, we can be roughly as safe at 1 m as we were at 2 m. I will agree that this is ALL researchable and the fact that no-one has bothered to do much research on this, or as much as we need, is yet another black mark against Public Death England, and many similar smug organisations. This type of research COULD now be urgently undertaken in the brief pause between the first and any subsequent viral infection surges. We’ll see.

Tom Hawk
Tom Hawk
4 years ago

What I see is a complete lack of science and research.

It was obvious from the outset that this is an airborne contagion. Therefore good science would start by investigating the mechanics of the contagion. Is exhailed breath contagious or is it just sneezing and coughing? How much virus does an infected person exhale per cough, heathy breathing, normal breathing.

Such research would inform separation rules with facts … but we see none of that sort of thing.

Michael Upton
Michael Upton
4 years ago

The striking fact that this solid chunk of commendable British common sense was actually written by someone whom the B.B.C. employs, might almost restore a little bit of one’s lost childhood faith in the now-seemingly malign B.B.C. But perhaps that would be to rush to judgment.

rob oregan
rob oregan
4 years ago

The book entitled “Introducing Martial Law into a Country” stresses that one indicator of blind acquiescence to silly rules is a indicator of probable blind acceprence !

randomnamepot
randomnamepot
4 years ago

If the reason of large portion of population is not susceptible to covid-19 is cellular immunity that cross reacts with common cold coronaviruses that we were exposed in the past, then reducing spread of common cold coronaviruses will reduce our cellular immunity to covid-19 just because any immunity fades away. This is a problem. With low prevalence of covid-19 we may harm ourselves with these masks.

Robin Lambert
Robin Lambert
4 years ago

In all this media hype and hysteria, No one has Asked the 3 Main political parties,why they Closed Isolation hospitals and have Increased Towns,Villages with ‘Endless suburbs” Areas with Less populous ,tend to have less SARS2…I have Seen nothing from opposition parties to say they Would have done better or different, remainers still prattle on about Yet more Extensions,and prop up failing EU

Derek M
Derek M
4 years ago

Yes

mattclarke153
mattclarke153
3 years ago

A lot of viral replication occurs in the mouth – where are the mouth sprays???

TONY.ARKINSTALL
TONY.ARKINSTALL
4 years ago

The difference in risk between 2M vs 1M is unknown. Writing articles about untested opinions is pointless. However, the risks of transmitting virus by touching a contaminated surface is well understood and the most likely way of getting a virus. For example when SARS reached Hong Kong only the residents of floor nine were infected by touching the elevator button, I queued at the cash point waiting for four other people to use it. Not one person sanitised their hands before or after using the machine, When is the media and government going to realise that is the ignorance of much of the public that is the real risk?? We should have a campaign and stickers on all doors,hand rails, buttons etc.. NOW SANITIZE YOUR HANDS & DON’T TOUCH YOUR FACE IN A PUBLIC PLACE

Bill Gaffney
Bill Gaffney
4 years ago

Miss you asked a question. Yes is the answer.