Friends and Family,

I am sharing recommendations from the esteemed public health physician Asaf Bitton MD, MPH |
Executive Director | Ariadne Labs, Brigham and Women's Hospital | Harvard T.H. Chan School of Public
Health:

"I know there is some confusion about what to do next in the midst of this unprecedented time of a
pandemic, school closures, and widespread social disruption. I have been asked by a lot of people for my
opinion, and I will provide it below based on the best information available to me today. This is my
personal and well-informed opinion, and my take on the necessary steps ahead.

What I can say as a physician and public health leader, is that what we do, or don't do, over the next
week will have a massive impact on the local and perhaps national trajectory of coronavirus. We are
only about 11 days behind Italy and generally on track to repeat what is unfortunately happening there,
as well as much of the rest of Europe very soon. At this point, containment through contact tracing and
testing is only part of the necessary strategy. We must move to pandemic mitigation through
widespread, uncomfortable, and comprehensive social distancing. That means not only shutting down
schools, work (as much as possible), group gatherings, and public events. It also means making daily
choices to stay away from each other as much as possible to flatten the curve.

Our health system will not be able to cope with the projected numbers of people who will need acute
care should we not muster the fortitude and will to socially distance each other starting now. On a
regular day, we have about 45k ICU beds nationally, which can be ramped up in a crisis to about 93k.
Even moderate projections suggest that if current infectious trends hold, our capacity (locally and
nationally) may be overwhelmed as early as mid-late April. Thus, the only set of interlinked strategies
that can get us off this concerning trajectory is to work together as a community to maintain public
health by staying apart.
The wisdom, and necessity, of this more aggressive, early, and extreme form of social distancing can be
found here. I would urge you to take a minute walking through the interactive graphs - they will drive
home the point about what we need to do now to avoid a worse crisis later.
So what does this enhanced form of social distancing mean on a daily basis, when schools are cancelled?
I can suggest the following:
1. No playdates, parties, sleepovers, or families visiting each other's houses. This sounds extreme
because it is. We are trying to create distance between family units and between individuals across
those family units. It is uncomfortable, especially for families with small children or for kids who love to
play with their friends. But even if you choose only one friend to have over, you are creating new links
and possibilities for the type of transmission that all of our school/work/public event closures are trying
to prevent. The symptoms of coronavirus take 4-5 days to manifest themselves. Someone who comes
over looking well can transmit the virus. Sharing food is particularly risky so I definitely do not
recommend that people do so outside of their family. We have already taken extreme social measures
to address this serious disease - let's not actively co-opt our efforts by having high levels of social
interaction at people's houses instead of the schools.
Again - the wisdom of early and aggressive social distancing is that it can flatten the curve above, give
our health system a chance not to be overwhelmed, and eventually may reduce the length and need for
longer periods of extreme social distancing later (see what has transpired in Italy and Wuhan). We need
to do all our part during these times, even if it means some discomfort.
2. Take walks/runs outside, but maintain distance (ideally 6 feet between people outside your family).
Try not to use public facilities like playground structures as coronavirus can live on plastic and metal for
up to 3 days, and these structures aren't getting regularly cleaned. Try not to have physical contact with
people outside of your family.
Going outside will be important during these strange times, and the weather is improving. Go outside
every day if you can but stay physically away from others. Try not to have kids play with each other
(even outside) if that means direct physical contact. Even basketball or soccer involve direct contact and
cannot be recommended. If people wish to go outside and have a picnic with other families, I strongly
recommend keeping distance of at least 6 feet, not sharing any food at all, and not having direct physical
contact. Invariably, that is hard with kids, so these shared, "distant" picnics may be tricky. Do not visit
nursing homes or other areas where large numbers of the elderly reside, as they are at the highest risk
for complications and mortality from coronavirus. We need to find alternate ways to reduce social
isolation in these communities through virtual means instead of physical in-person visits.

3. Reduce the frequency of going to stores/restaurants/coffee shops for the time being. Of course trips
to the grocery store will be necessary, but try to limit them and go at times when less busy. Consider
wearing gloves (not medical - but perhaps washable) and of course washing hands before and after
really well. Leave the medical masks and gloves for the medical professionals - we need them. Maintain
social distance from folks. Take-out meals and food are riskier than making food at home given the links
between the people who prepare food, transport the food, and you. It is hard to know how much that
risk is, but it is certainly higher than making it at home.

4. If you are sick, definitely stay home and contact a medical professional. If you are sick, you should try
isolate yourself from the rest of your family within your house as best as you can. If you have questions
about whether you qualify or should get a coronavirus test, you can call you primary care team and/or
consider calling the Partners Health Care hotline staffed 8AM-8PM every day - 617 724 7000, or the
Massachusetts department of public health at 617 983 6800. Don't just walk in to an ambulatory clinic -
call first. Obviously, if it is an emergency call 911.

5. We need to push our local, state, and national leaders to close ALL schools, events, gatherings, and
public spaces now. A local, town by town response won't have the needed effect. We need a statewide,
nationwide approach in these trying times. Contact your representative and the governor to urge them
to enact statewide closures. As of today, 6 states had already done so. We should be one of them. Also
urge them to fund emergency preparedness and make increasing coronavirus testing capacity an
immediate and top priority.
I realize there is a lot built into these suggestions, and that they represent a real burden for many
people, businesses, and communities.
Social distancing is hard and may negatively impact others, especially those who face vulnerabilities in
our society. I recognize that there is structural and social inequity built in and around social distancing
recommendations. We can and must take steps to bolster our community response to people who face
food insecurity, domestic violence, and housing challenges, along with the many other social inequities.

I also realize that not everyone can do everything. But we have to try our absolute best as a community,
starting today. It is a public health imperative. If we don't do this now voluntarily, it will become
necessary later involuntarily, when the potential benefits will be much less than doing so right now.

Asaf Bitton MD, MPH | Executive Director | Ariadne Labs Brigham and Women's Hospital | Harvard T.H.
Chan School of Public Health"
Reading comprehension questions:

A) Give answers to the questions in your own words as far as possible:

1. How do you understand the following sentence –“What we do, or don’t do, over the next
week will have a massive impact on the local and perhaps national trajectory of
coronavirus.”
2. What does the author mean by “the enhanced form of social distancing”?
3. What dangers may social distancing bring about in society?

B) Explain the meaning of the following words and phrases as they are used in the text:
1. one’s take on something -
2. to flatten the curve -
3. coronavirus testing capacity -
4. to muster the fortitude -
5. to enact statewide closures -
6. domestic violence -