“Safe Circles” a tool for social distancing to combat COVID-19 in Sri Lanka

Flattening the curve. A combination of vaccines and social distancing might be the solution for many countries facing nasty outbreaks

The purpose of “Safe Circles” is to prevent patients from acquiring COVID-19 and to minimise the spread of viral infection

Safe Circles” although not a miracle cure, is a straightforward documentation scheme that utilizes the psychology of human interactions

Social distancing has proven to be the ultimate saviour in the current COVID-19 pandemic. It’s a time tested and reliable mechanism which has succeeded in “Flattening the curve. A combination of vaccines and social distancing might be the solution for many countries facing nasty outbreaks. 

Coaching the concepts of social distancing among the general public might be a difficult task as we do not have a mind map on who and where to avoid. If it is  possible to visually portray the social distancing limits using the remarkable picture processing ability of the brain, people are bound to retain these regulations. 
Therefore we launched a novel COVID-19 preventive measure titled “Safe Circles” in a group of rheumatology outpatients in Sri Lanka a few months back.  The purpose of “Safe Circles” is to prevent patients from acquiring COVID-19 and to minimise the spread of viral infection. Although we advocated this scheme for patients with arthritis, it can easily be used by the general public. 
This concept of “Safe Circles” relies on four basic principles.

1. Creating awareness of whom to associate with on a daily or weekly basis and categorising them to four social relationship levels/circles. 
2. Minimising or even avoiding prolonged contact with people whose safety standards are not known and adhering to COVID-19 guidelines during these encounters.
3. Assessing how your close associates follow the COVID-19 safety precautions.
4. Keeping a record of various “levels” of people whom you encounter for future reference.

The psychology of human relationships represent four basic levels of social interaction which are intimacy, friendship, participation and exchange. Each of these relationship categories have their own unique characteristics. In “Safe Circles” we encouraged individuals to first of all identify the people who they interact with and then sort them in to these four levels. They were provided a printed description of these interactions and also a diagram which had four concentric circles to fill in.

Within the “Intimacy circle” people are expected to include their immediate family members, loved ones and those who live within the same household. As they are encountered on a daily basis it is impractical to carry out COVID-19 safety precautions within “Intimacy circle”. When members of “Intimacy circle” interact with the community they should carry all the general safety guidelines. 

Outside “Intimacy circle” is the “Friendship circle”. As the name implies, individuals should add friends that they wish to associate with, within this circle. Post-lockdown phase triggered a wave of unsafe friendship reunions in many countries. “Safe Circles” is meant to promote psychological support through its “Friendship circle” in a safe manner. We have appealed to our group of patients to maintain safe distancing and avoid physical contact when they explore their “Friendship circle”. Alternate means of communication such as phone calls, and social media platforms are preferred over meeting friends in person. Those who do not follow COVID-19 safety regulations are ideally excluded from the “Friendship circle”. 

“Participation circle” which lies outside the “Friendship circle” is reserved for close associates whom people regularly interact with but not exactly friends. These are the co-workers, members of the local community and acquaintances. This circle should include individuals who are reliable. We have discouraged regular meetings with members of “Participation circle”. They were instructed to list all the tasks that are done within this circle and then complete them in a single encounter. Technological methods of meeting the members of this circle, such as through communication platforms were encouraged. 

The outermost circle is named as “Exchange circle”. Some examples of its members are the local hairdresser, grocery shop vendor, taxi-driver, doctor or even a customer of the patients at their workplace. The safety standards of “Exchange circle” participants are unknown. It was considered impractical to make inquiries on these during the limited meet ups. Our group was told on the risk of associating with any member of the “Exchange circle”. Detailed explanation was given on planning and limiting the number of outings to this circle. E.g.- One “Exchange circle” outing to perform several tasks like shopping, doctor check-up reduces the risk of contracting COVID-19.

Instructions were given on adhering to COVID-19 safety precautions like wearing face masks, maintaining hand hygiene, limiting the duration of encounter to less than 15 minutes and safe distancing when meeting people outside “Intimacy circle”. We also integrated colour codes in to the “Safe Circles” diagram to create an impression in people’s minds of safety within each circle. The colour codes are also expected to discourage large numbers in outer circles.

People within each circle can be moved to another provided that the person meets the prerequisites of the new circle. E.g. - If a person at “Participation circle” becomes a close friend, his name can be shifted to the “Friendship circle”. We also encouraged the patients to promote a single person in the “Exchange circle” to their friends and family for exchange of services. E.g. – A common grocery vendor or a hair dresser who maintains COVID-19 safety standards in the “Exchange circle” can reliably shifted to “Participation circle”.
A chart that keeps track of daily encounters at all four levels is also provided to our patients. This will be important in understanding the percentages of people in each category. The chart also functions as a diary and might be useful in contact tracing. 

“Safe Circles” although not a miracle cure, is a straightforward documentation scheme that utilizes the psychology of human interactions. We began promoting this among rheumatology outpatients last year. We are planning an app on “Safe Circles” with a digital rewarding scheme for patients who do not prefer pen and paper. Our scheme once regularly practiced, will create a mental note of whom we associate with. We expect “Safe Circles” to significantly bring down the COVID infectivity rates.

Dr Himantha Atukorale, Consultant in Rheumatology & Dr Ruchika Senevirathne, Medical Officer Rheumatology Unit, Anuradhapura 
Teaching Hospital