The post-pandemic era: will physical distancing be a perceived way of life?

Introduction

The novel coronavirus (coronavirus disease 2019 [COVID-19]) belongs to the same family of viruses (coronaviruses) as the Middle East respiratory syndrome coronavirus (MERS-CoV) and severe acute respiratory syndrome coronavirus (SARS-CoV).^1,2 Many respiratory viruses are believed to transmit over multiple routes, including droplets, aerosols, and fomites.⁴ Respiratory droplets moving from one person to another and contact with contaminated surfaces and objects are the primary sources of transmission.^5,6 Presymptomatic transmission is the second type of transmission, in which the virus is transmitted from an infected person who has yet to develop symptoms to another person.⁷

The effectiveness of physical distancing is determined by individual behavior.⁸ The interventions most essential for control of pandemics necessarily disrupt social processes. Public measures were implemented in response to COVID-19; people were encouraged by authorities, media, and peers to voluntarily adopt “personal distancing” behaviors to reduce virus transmission (e.g., avoiding physical contact or close proximity with non-household members and reducing use of shared public spaces).⁹

Various guidelines have been issued to reduce the spread of the pandemic, including avoiding handshaking or any type of physical contact, avoiding social gatherings or visiting family or friends, wearing masks and gloves, closure of public venues, and tourism and travel restrictions.² Increasing handwashing, minimizing face touching, wearing masks in public, and physical distancing are the measures that have been adopted globally.¹ Because COVID-19 returns in waves, the psychological impacts of physical distancing will persist over time and may indeed become accentuated with repeated iterations of physical distancing. Given that physical distancing affects the types of activities in which one can engage and impacts how activities are carried out, it is likely that this accounts for some of the psychological impact.¹⁰

Nonverbal communication involves sending or receiving information without words. This form of communication is used across the globe; however, its usage varies from country to country. Cultures can be categorized as “high-context” or “low-context.” High-context cultures rely heavily on nonverbal communication, and low-context cultures rely little on nonverbal communication.¹¹ The present study population consisted of people living in Saudi Arabia, a Middle Eastern country, and Saudi society can be classified as a “high-context culture.” Saudi people rely heavily on nonverbal communication, such as kissing and hugging as a greeting or welcome and as a sign of respect.¹² In contrast, physical distancing measures can feel unnatural^11,13; however, regular practice of certain behaviors over a long period of time can make them automatic or habitual.¹⁴ In addition, people are becoming comfortable with limiting socialization and following precautionary measures due to the secondary reinforcement gained as a consequence.^13,15 To the best of our knowledge, the literature has yet to consider the possible post-pandemic-era lifestyles and behaviors of the people living in the Eastern Region of Saudi Arabia. Therefore, this study aimed to determine whether people living in the Eastern Region of Saudi Arabia would prefer to continue the practice of physical distancing after the coronavirus disease pandemic or to return to their previous way of life.

Methods

This cross-sectional study was conducted in the Eastern Region of Saudi Arabia. The study was conducted from August 2020 to October of 2020. Institutional approval was obtained from the College of Dentistry, Imam Abdulrahman Bin Faisal University (approval number 202162).

The inclusion criteria were as follows: (1) aged between 18 and 70 years, and (2) residing in the Eastern Region of Saudi Arabia. The exclusion criterion was not being able read and understand English or Arabic. To calculate the sample size, a simple random sampling technique was used, and the size of the sample was calculated using the online software Raosoft (Seattle, Washington, USA). The response distribution was set at 50%, the margin of error was set at 3%, and the confidence interval was set at 95%. The calculated sample size was 1066.

The questionnaire for the study included questions related to demographics and physical distancing. Precautions and instructions related to physical distancing provided by the World Health Organization and United States Centers for Disease Control, and these precautions were used to develop the items of the questionnaire. Initially, the questionnaire was written in English and translated into Arabic. The English version of the questionnaire was translated into Arabic by an Arabic language expert who was also proficient in English. Then the Arabic version was translated back into English by another expert in both languages. After developing the questionnaire, a pilot study was performed to test the validity of the questionnaire, and the kappa statistic was 0.79.

In line with COVID-19 precautions, the questionnaire was administered electronically. Questionpro software (Dallas, TX, USA) was used for preparing the survey online. The questionnaire contained a total of 16 questions; however, questions regarding personal identification were not included to keep the responses anonymous. Responses for each item were based on a 5-point Likert scale (1 = “Never,” 2 = “Seldom,” 3 = “Sometimes,” 4 = “Frequently,” 5 = “Always”). To simplify the analysis and presentation of results, the response categories (1 to 5) were grouped into three categories: disagree (after combining never and seldom), neutral (sometimes), and agree (after combining frequently and always). All authors of the study then sent the survey link to all their WhatsApp contacts. The authors also requested from their contacts to share the links further.

The data were collected in Excel and later transferred to and coded in SPSS version 23 (IBM Corp., Armonk, NY, USA) for analysis. Frequency distributions and bar diagrams were constructed for descriptive analysis and presentation of the data. Normality of the data was tested first using the Shapiro-Wilk test, and the results were nonsignificant, indicating that the data were normally distributed. Hence, parametric tests were used for inferential analysis. A one-sample chi-square test was used to analyze the significance of the proportion of responses for each question. A chi-square test was used to compare participants’ demographics with their responses to questions related to physical distancing. The level of significance was set at P < 0.05.

Results

The current study included 989 participants who completed and submitted the survey. A total of 1,350 individuals started the survey, and 989 completed it, resulting in a response rate of 73.5%. The mean age of the participants was 31.15 ± 11.93 years, with a range of 20 to 61 years. The majority of the participants were Saudi (705 [70%] Saudi participants and 284 [30%] non-Saudi participants). There were 435 (44%) men and 554 women (56%). Most of the participants were undergraduate students 474 (48.1%), followed by graduated 217 (22%), postgraduates 143 (15%) and 150 (15%) were undertaking qualifications at high school level. Overall, 677 (68%) lived with an average of 4 to 6 adults and 2 children.

Figure 1 shows the responses to the post-COVID-19 survey of the entire study population. The percentage of disagreement was highest for the item on using public transportation with strangers, and the difference between disagree and agree was statistically significant (87% vs. 13%) (P < 0.001). Similarly, the percentage of disagreement was significantly higher for the items on attending gatherings of close family/friends/other relatives (72% vs. 28%) (P < 0.001) and greeting family, friends, and colleagues with a hug (71% vs. 29%) (P < 0.001). The highest percentage of agreement among all items was observed for spending time with family or friends (43%), which was significantly high (P < 0.001).

Figure 1. Participant perspectives regarding post-coronavirus disease 2019 (COVID-19) physical distancing behavior.

Discussion

After the outbreak of the current pandemic, physical distancing was proposed and implemented as a primary method of reducing its spread. Recommended physical distancing measures can be divided into three categories: (1) avoid contact with others (e.g., handshakes and hugs), (2) avoid using or visiting publicly shared places, and (3) avoid participating in religious and non-religious gatherings. Studies evaluating the changes in lifestyle due to restrictions imposed as precautionary measures have been conducted across the globe.^16,17 However, the present study was conducted to evaluate the perceived post-pandemic lifestyle.

In the analysis of the questions related to physical distancing behaviors, it was observed that significantly high percentages of respondents either disagreed with or were neutral about discontinuing the practice of physical distancing. With regard to public transportation, only 13% agreed that they would use public transportation even after the pandemic. This cautious behavior will have a significant impact on the transportation industry. The industry must develop strategies to reduce this impact and plan well for the post-pandemic era. Hao et al., for example, have proposed a disaster management framework and post-pandemic agenda for the hotel industry.¹⁸ In the present study, over 70% of participants also showed their disagreement or neutrality when asked about attending gatherings of family and friends, or hugging them. The nature of these three questions (using public transportation, attending gatherings, and giving and receiving hugs) are relevant to many aspects of life after COVID-19; people will be in closed environments and will have more contact with one another. Similarly, as aerosols are known to be the primary method of spreading the virus, people will avoid hugging others.¹⁹ Another notable aspect of the study findings was that about one-third of the respondents were unsure about practicing physical distancing after COVID-19. Hence, if they decide later on to stop physical distancing, then the percentage of people who agree will become significantly higher compared with those who disagree (almost 70% vs 30%), or if they keep practicing then the outcome will be the reverse.

Participants who were Saudi citizens showed more resilient behavior than non-Saudis, and it was found that there was a significantly higher percentage of Saudi citizens who reported wanting to return to their normal ways of life. For almost all questions being asked, the percentage of individuals who wanted to behave as they did before the pandemic was higher among Saudis compared with non-Saudis. These findings may be due to high context non-verbal communication among Arabs¹²; the other groups of study participants were mostly non-Arabs. Hence, a significant difference in perspectives was observed.

The purpose of vaccines is to boost the human immune system in order for the body to better fight viruses. This is also true for COVID-19 vaccines.²⁰ Hence, the fear of getting infected or having any COVID-19 positive individual within 2 meters will remain even after the pandemic ends.²¹ In contrast, the minimum distances that have been maintained between an infected person and a potential host are disputable and are far from being established based on scientific evidence.²² In our study, those who were more educated indicated that they were more likely to continue practicing physical distancing after the pandemic. It may be that educated people are more aware of the virus and its effects even after vaccination or the end of the pandemic.

The present study had some limitations. First, it was conducted on a large scale, and data were only collected from the Eastern Region of Saudi Arabia. Hence, the study’s findings cannot be generalized to the entire population of the country. Second, this study did not include the religion of the participants, which could be an important factor. Religious factors could have an impact on post-pandemic physical distancing behaviors. Similarly, nationality was just noted as Saudi or non-Saudi, and future studies should examine the specific nationalities of the participants. This would facilitate the analysis and country-wise or region-wise comparison of the data. Finally, the data collection process was completed before the development of the vaccine, after getting vaccinated people may feel safer and their responses may be different.

The overall impression from the study findings was that practicing physical activities and adopting a normal lifestyle after the pandemic will vary due to cultural and social norms and values. Societies that more commonly use non-verbal communication methods will be more likely to stop practicing physical distancing; however, education level was found to be negatively associated, and hence more educated people perhaps adopt physical distancing even after this pandemic.

Therefore, it can be concluded that fear-related factors will not be eliminated soon after this pandemic. However, engagement in physical activities and the carrying out of normal life after this pandemic will vary due to cultural and social norms and values. It was also observed that people will be either hesitant or avoid closed environments and public transportation, and this will affect some businesses, especially the public transportation sector. Furthermore, it was found that a significantly higher proportion of more educated individuals compared with others will practice physical distancing after the pandemic. Future studies are recommended to evaluate the change in perception of post-pandemic physical distancing after the development of vaccines. In addition, if this perceived lifestyle remains for a long period, it will affect social life, and will have significant consequences on the culture and society.

Data availability