In The Pandemic, We Were Told To Keep 6 Feet Apart. There’s No Science To Support That.

In a congressional appearance, infectious-disease expert Anthony S. Fauci characterized the recommendation as “an empiric decision that wasn’t based on data.”

The nation’s top mental health official had spent months asking for evidence behind the Centers for Disease Control and Prevention’s social distancing guidelines, warning that keeping Americans physically apart during the coronavirus pandemic would harm patients, businesses, and overall health and wellness.

Now, Elinore McCance-Katz, the Trump administration’s assistant secretary for mental health and substance use, was urging the CDC to justify its recommendation that Americans stay six feet apart to avoid contracting covid-19 — or get rid of it.

“I very much hope that CDC will revisit this decision or at least tell us that there is more and stronger data to support this rule than what I have been able to find online,” McCance-Katz wrote in a June 2020 memo submitted to the CDC and other health agency leaders and obtained by The Washington Post. “If not, they should pull it back.”

The CDC would keep its six-foot social distance recommendation in place until August 2022, with some modifications as Americans got vaccinated against the virus and officials pushed to reopen schools. Now, congressional investigators are set Monday to press Anthony S. Fauci, the infectious-disease doctor who served as a key coronavirus adviser during the Trump and Biden administrations, on why the CDC’s recommendation was allowed to shape so much of American life for so long, particularly given Fauci and other officials’ recent acknowledgments that there was little science behind the six-foot rule after all.

“It sort of just appeared, that six feet is going to be the distance,” Fauci testified to Congress in a January closed-door hearing, according to a transcribed interview released Friday. Fauci characterized the recommendation as “an empiric decision that wasn’t based on data.”

Francis S. Collins, former director of the National Institutes of Health, also privately testified to Congress in January that he was not aware of evidence behind the social distancing recommendation, according to a transcript released in May.

Four years later, visible reminders of the six-foot rule remain with us, particularly in cities that rushed to adopt the CDC’s guidelines hoping to protect residents and keep businesses open. D.C. is dotted with signs in stores and schools — even on sidewalks or in government buildings — urging people to stand six feet apart.

Experts agree that social distancing saved lives, particularly early in the pandemic when Americans had no protections against a novel virus sickening millions of people. One recent paper published by the Brookings Institution, a nonpartisan think tank, concludes that behavior changes to avoid developing covid-19, followed later by vaccinations, prevented about 800,000 deaths. But that achievement came at enormous cost, the authors added, with inflexible strategies that weren’t driven by evidence.

“We never did the study about what works,” said Andrew Atkeson, a UCLA economist and co-author of the paper, lamenting the lack of evidence around the six-foot rule. He warned that persistent frustrations over social distancing and other measures might lead Americans to ignore public health advice during the next crisis.

The U.S. distancing measure was particularly stringent, as other countries adopted shorter distances; the World Health Organization set a distance of one meter, or slightly more than three feet, which experts concluded was roughly as effective as the six-foot mark at deterring infections, and would have allowed schools to reopen more rapidly.

The six-foot rule was “probably the single most costly intervention the CDC recommended that was consistently applied throughout the pandemic,” Scott Gottlieb, former Food and Drug Administration commissioner, wrote in his book about the pandemic, “Uncontrolled Spread.”

It’s still not clear who at the CDC settled on the six-foot distance; the agency has repeatedly declined to specify the authors of the guidance, which resembled its recommendations on how to avoid contracting the flu. A CDC spokesperson credited a team of experts, who drew from research such as a 1955 study on respiratory droplets. In his book, Gottlieb wrote that the Trump White House pushed back on the CDC’s initial recommendation of 10 feet of social distance, saying it would be too difficult to implement.

Perhaps the rule’s biggest impact was on children, despite ample evidence they were at relatively low risk of covid-related complications. Many schools were unable to accommodate six feet of space between students’ desks and forced to rely on virtual education for more than a year, said Joseph Allen, a Harvard University expert in environmental health, who called in 2020 for schools to adopt three feet of social distance.

“The six-foot rule was really an error that had been propagated for several decades, based on a misunderstanding of how particles traveled through indoor spaces,” Allen said, adding that health experts often wrongly focused on avoiding droplets from infected people rather than improving ventilation and filtration inside buildings.

Social distancing had champions before the pandemic. Bush administration officials, working on plans to fight bioterrorism, concluded that social distancing could save lives in a health crisis and renewed their calls as the coronavirus approached. The idea also took hold when public health experts initially believed that the coronavirus was often transmitted by droplets expelled by infected people, which could land several feet away; the CDC later acknowledged the virus was airborne and people could be exposed just by sharing the same air in a room, even if they were farther than six feet apart.

“There was no magic around six feet,” Robert R. Redfield, who served as CDC director during the Trump administration, told a congressional committee in March 2022. “It’s just historically that’s what was used for other respiratory pathogens. So that really became the first piece” of a strategy to protect Americans in the early days of the virus, he said.

It also became the standard that states and businesses adopted, with swift pressure on holdouts. Lawmakers and workers urged meat processing plants, delivery companies and other essential businesses to adopt the CDC’s social distancing recommendations as their employees continued reporting to work during the pandemic.

Some business leaders weren’t sure the measures made sense. Jeff Bezos, founder of online retail giant Amazon, petitioned the White House in March 2020 to consider revising the six-foot recommendation, said Adam Boehler, then a senior Trump administration official helping with the coronavirus response. At the time, Amazon was facing questions about a rising number of infections in its warehouses, and Democratic senators were urging the company to adopt social distancing.

“Bezos called me and asked, is there any real science behind this rule?” Boehler said, adding that Bezos pushed on whether Amazon could adopt an alternative distance if workers were masked, physically separated by dividers or other precautions were taken. “He said … it’s the backbone of trying to keep America running here, and when you separate somebody five feet versus six feet, it’s a big difference,” Boehler recalled. Bezos owns The Washington Post.

Kelly Nantel, an Amazon spokesperson, confirmed that Bezos called Boehler and said the Amazon founder’s focus was the discrepancy between the U.S. recommendation and the WHO’s shorter distance. The company soon said it would follow the CDC’s six-foot social distancing guidelines in its warehouses and later developed technologies to try to enforce those guidelines. “We did it globally everywhere because it was the right thing to do,” Nantel said.

Boehler said he spoke with Redfield and Fauci about testing alternatives to the six-foot recommendation but that he was not aware of what happened to those tests or what they found. Fauci declined to comment. Redfield did not respond to requests for comment.

But challenging the six-foot recommendation, particularly in the pandemic’s early days, was seen as politically difficult. Rochelle Walensky, then chief of infectious disease at Massachusetts General Hospital, argued in a July 2020 email that “if people are masked it is quite safe and much more practical to be at 3 feet” in many school settings.

Five months later, incoming president Joe Biden would tap Walensky as his CDC director. Walensky swiftly endorsed the six-foot distance before working to loosen it, announcing in March 2021 that elementary school students could sit three feet apart if they were masked. Walensky declined to comment.

The most persistent government critic of the social distancing guidelines may have been McCance-Katz, who did not respond to requests for comment for this article. Trump’s mental health chief had spent several years clashing with other Department of Health and Human Services officials on various matters and had few internal defenders by the time the pandemic arrived, hampering her message. But while her pleas failed to move the CDC, her warnings about the risks to mental health found an audience with Trump and his allies, who blamed federal bureaucrats for the six-foot rule and other measures.

“What is this nonsense that somehow it’s unsafe to return to school?” McCance-Katz said in September 2020 on an HHS podcast, lamenting the broader shutdown of American life. “I do think that Americans are smart people, and I think that they need to start asking questions about why is it this way.”