Here's Why CF Patients Have To Remain Six Feet Apart

The new movie Five Feet Apart explores a love story between two young cystic fibrosis patients. And the relationship between the two main characters, played by Cole Sprouse and Haley Lu Richardson, has people asking about the "six feet apart" rule. The movie's name is a reference to a rule that people with cystic fibrosis must remain six feet away from one another, and it's a pretty important rule.

Cystic fibrosis is a genetic disorder that affects the lungs, pancreas, and other vital organs, according to the Cystic Fibrosis Foundation. In people with cystic fibrosis, the mucus in the body becomes thick and sticky. This can cause clogged airways and increase the likelihood of the body trapping germs and bacteria, which can lead to infections, respiratory failure, inflammation, and other serious complications. Around 1,000 people are diagnosed with cystic fibrosis each year, with most being diagnosed by age 2, and there are 70,000 people living with cystic fibrosis worldwide.

While people with cystic fibrosis are more susceptible to getting sick from germs from everyone, they are at particular risk for contracting infections from each other. It's recommended that people with cystic fibrosis remain at least six feet away from one another as that's how far respiratory droplets can travel when someone coughs or sneezes. Because people with cystic fibrosis can all have different kinds of bacteria in their bodies, not staying six feet apart may put other people with cystic fibrosis who don't have that strain of bacteria at risk for contracting it, Dr. Mike Boyle, senior vice president of therapeutics development at the Cystic Fibrosis Foundation, tells Bustle.

If people with cystic fibrosis spread these different strains of bacteria to each other, which is known as cross contamination or cross infection, they can develop serious and potentially life-threatening complications. Aside from respiratory infections, those with cystic fibrosis are at risk for complications in other areas of the body, including the pancreas and liver. Cystic fibrosis can also cause reproductive problems in men. People with cystic fibrosis also need to be careful about exposing themselves to common illnesses like cold and flu.

"To reduce the risk of spreading one's germs or getting them, it is recommended that not only should they keep a six-foot distance from other people with cystic fibrosis, but also avoid other activities that would put them in close physical contact [with people who are sick]. This includes hugging, kissing, and shaking hands," Betsy Bryson, a pediatric nurse practitioner who works with cystic fibrosis patients at Akron Children’s Hospital in Ohio, tells Bustle.

People with cystic fibrosis are also discouraged from sharing objects with others. "Another way germs can spread from coughing or sneezing is when the respiratory droplets land on a horizontal surface. Germs can stay alive on these surfaces for hours, even days." Bryson explains. "For this reason cystic fibrosis patients should not share common objects likes computers, pens, and toys."

Dr. Gregory Omlor, director of pulmonology at Akron Children’s Hospital, tells Bustle that in people who don't have cystic fibrosis, mucus plays an important role in reducing and spreading germs. However, this system doesn't work properly in people with CF. "People with cystic fibrosis have very thick mucus in their lungs. It is so thick that coughing cannot completely clear it so germs do not come out either." He adds that frequent use of antibiotics to fight these infections can lead to antibiotic resistance.

Dr. Drucy Borowitz, senior vice president of community partnerships at the Cystic Fibrosis Foundation, tells Bustle that people with cystic fibrosis do not need to stay six feet away from people without the disease unless they have a cold or other contagious illness. Following these protocols can help people with cystic fibrosis stay healthy, which in turn can increase life expectancy. According to the Cystic Fibrosis Foundation, in the 1950s, most people diagnosed with cystic fibrosis didn't live to age 18. Now, half of all cystic fibrosis patients are over 18.

While the movie is bringing attention to a chronic and often misunderstood illness, some people have criticized Five Feet Apart for its alleged romanticization of cystic fibrosis. The six feet apart rule, in particular, "really is a life-and-death situation, which the movie reduces to a plot device," Jenn Whinnem, who lives with cystic fibrosis, told Refinery29. Though the film was informed by director Justin Baldoni's conversations with the late YouTuber Claire Wineland, who candidly discussed her experience with cystic fibrosis until her death in 2018, it's important to listen to people who live with cystic fibrosis about how they want to be represented. It's also worth understanding the medical basis for this rule — and the seriousness of following it — as viewers absorb the message of the film.