There are always checks and balances to be discussed and decided in relation to shaping health-related behaviours; including those between individual rights and ownership of such behaviours and awareness and acknowledgement of contextual influences. The fight against the current Covid-19 pandemic is not immune to such considerations. The UK government and NHS have chosen to focus their messages on the individual’s behaviour and to strongly encourage the wearing of face masks, regular hand washing and 2 metre social distancing (face, hands and distance). This message has been made clearly and strongly reinforced.

However, in a sense, only employing this focus on the individual’s behaviour risks diverting attention away from people understanding the risks inherent in the different situations that they encounter in their everyday lives. In turn, this could also result in a sense of invulnerability. As we know from many different areas of safety-concern, avoidance of high risk situations is essential and this may not be achieved with sole reliance on the current UK face, hands and distance message.

Professor Jonathan Van-Tam (below) has offered an important addition to the current UK guidance on Covid-19 safety. Drawing on Far Eastern experience, he also recommends that people adopt an approach that draws attention to avoiding high-risk situations characterised by the Three Cs. These Three Cs are:

Closed spaces: The advice is that one cannot assume that large rooms are safe or that small rooms are unsafe. Instead, their ventilation is the important consideration.
Crowded places: The advice is to avoid crowded spaces and always, where ever you are, make room for other people – two metres or more.
Close contact settings – The advice is to avoid conversations or similar in close contact settings: the virus can be spread through the droplets created by speech.

Prof Van-Tam has said that as well as the Three Cs, people need to be aware of two further risk factors: their duration of exposure (D) to contact with other people, and the volume of noise (V) generated by the people to whom or with whom one is exposed (talking, shouting and singing).

Professor Van-Tam’s enhanced advice is both timely and required and, hopefully, will help people to assess the Covid-19 risk to themselves and to others from exposure to everyday situations. Using this enhanced approach is to be strongly recommended.

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Professor Jonathan Van-Tam MBE is a British specialist in virus epidemiology and transmission, antiviral drugs and vaccinology, and pandemic preparedness. In October 2017 he took up the role of Deputy Chief Medical Officer for England.