The most important thing to know about social distancing

You're watching the numbers go up every day.

Yet, mayors and governors around the nation have ordered Americans to stay inside. Sports are canceled. Birthday parties are canceled. The Rolling Stones tour is canceled. Pick-up basketball in parks, canceled.

When will these unprecedented social distancing measures — intended to significantly reduce the uncontrolled rise in new coronavirus infections — work? When is the big payoff? The answer is to be patient, and expect to be patient for perhaps a month, if not considerably longer. Social distancing doesn't pay off immediately. It can't.

"People should hunker down for the long haul," said Henry Raymond, an associate professor in the Department of Biostatistics and Epidemiology at the Rutgers School of Public Health.

"For a while, we’ll see more and more cases every day," Raymond explained.

It's unknown, exactly, when infections will start to fall — if society actually follows social distancing orders, anyhow. That's because no one knows how many people are already infected. We only know who's been given a test and confirmed positive.

"In all diseases, you only see the tip of the iceberg," said Raymond. "Most of it is hidden underneath."

New York, for example, only instituted the state's most restrictive social distancing rules yet on Sunday night — 11 days after the World Health Organization finally confirmed that coronavirus is a pandemic. But an uncertain number of people are already infected and won't even know it for an average of five days, when the symptoms begin. During this time, they can continue to spread the virus to new people. So yes, the number of infections will almost certainly keep going up, even as you stay cloistered inside.

Right now, the aim of social distancing is to make this coronavirus outbreak manageable for nurses and doctors, who are already witnessing the grim, unsettling consequences of mounting infections. Hospitals can't manage a deluge of patients — many who can't breathe — from the relentless respiratory disease (called COVID-19) that results from this coronavirus.

"The immediate goal is to protect our healthcare capacity," said Amanda Simanek, an associate professor in epidemiology at the University of Wisconsin-Milwaukee.

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Flattening the curve. Credit: Carl Bergstrom / Esther Kim

Continued, prolonged periods of social distancing will be uncomfortable for us, a hyper-social species. But, we're up against a microbe that has easily spread around the globe, and will continue spreading if we present it with more willing hosts — us.

"[Social distancing] can seem daunting to the American people," said Simanek. "But it's better to overreact, than to lose time because we underreacted," which would mean more infections than we can handle.

Other nations, like South Korea and China, have been able to dramatically slow their rise in infections. South Korea has 8,961 total known infections following a rigorous month of nationwide containment. Meanwhile, New York City alone blew past 10,000 cases on Sunday. It's just getting started in the Big Apple.

It took several weeks for extreme social distancing efforts in places like South Korea to curb infections, noted Simanek. And it will likely take longer in the U.S., a nation that's generally less compliant about social rules and has repeatedly proven ignorant of the looming coronavirus threat, including continued public partying.

"We are not as compliant a culture as South Korea is," noted Rutgers' Raymond.

It's challenging to make a nationwide estimate for when social distancing — if we actually commit to it— will flatten the curve. But Raymond gave a rough estimate of when there might be results in New Jersey, where Rutgers University is located. The Garden State ordered most businesses closed on Saturday.

"With respect to New Jersey, Iwould say not to expect a flattening of the curve for another month," he said.

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That's a long time. But it's not as long as New York's projections, where Governor Andrew Cuomo doesn't expect infections to peak for another 40 days.

Epidemiologists, who investigate disease outbreaks, are focused on watching a particular number, to understand how well measures like social distancing are working. It's called "RO," pronounced "R naught," and it shows how many people (on average) an infected person infects.

With what epidemiologists know today, someone with coronavirus will infect around 2.5 to 3 other people, explained Simanek. To contain the virus, this number needs to fall below one, she said. That's why social distancing is so critical. Even if it takes longer than you ever imagined.

"That’s how we slow the growth of the infection," Simanek said.

So buckle up. There is no vaccine. There are no medications, yet, to deactivate this virus. There is, however, social distancing. And it takes time to work.

"It’s a hard thing for people to come to terms with and adjust to," said Raymond.