Flatten the Curve (why everything is closed)

The key concept to understanding the response of governments to the coronavirus (“COVID19”) pandemic is one that those in public health have termed “flattening the curve.” Many have written about this, so I will address it only simply.

COVID19 is a new virus in the human population. We have no immunity to it, and it is highly contagious. We have seen it can be exponentially contagious (1 person then passes it to 2, then those two to two others making 4, then 8). People without symptoms are able to transmit it to others. The calculations around potential cases, hospitalizations, and deaths are sobering even in the best case scenario. Many recall the Spanish Flu of 1918 which killed over 50 million people, more than World War I, and was less contagious than the pandemic we face now.

While we have made incredible progress in medicine in the past century, the resources to help people dying of coronavirus are limited. In a recent report by the Taub Center for Social Policy in Israel, we have in Israel fewer than 2.5 hospital beds per 1000 people, and far fewer ICU beds. If only 3% of people who catch COVID19 need hospitalization, that means we would need 3 beds for every 100 people with the disease, i.e. 30 beds for every 1000 – and there are less than 3. ICU beds and ventilators to keep people alive are many fewer. Not only that, but at any given time, hospital beds are 94% occupied. They are filled with non-COVID health emergencies: Heart attacks, strokes, car accidents, appendicitis, pneumonia, the list goes on. Thus we may easy face a crisis in which people are dying of treatable diseases and accidents because there is no health care.

Now this is where you come in.

When we practice social isolation – closing schools, work places, malls, etc – we prevent the Healthcare System from collapsing. We can decrease the number of people sick at any one time, ensuring that the resources are available for our loved ones or ourselves should they be needed. When we stop interacting, we stop passing it on, often unknowingly.  The population will still get sick from it, but gradually.  If we get sick one by one instead of all at once, doctors and treatments will be available to help us. This was famously illustrated in the graphic below, and termed “flattening the curve.”

While initially this was Public Health theory, it has been put into practice, and proven to work. China, South Korea, Hong Kong, are showing a decline in the number of new cases, hospitalizations and deaths since imposing strict social measures.

The greatest danger from coronavirus right now is not only the disease itself, but the threat to our healthcare system. If we want to have emergency rooms and hospitals available those with usual emergencies, in addition to those who may have severe COVID19and need advanced medical help, we need to get sick a few at a time, not all at once.  To combat a highly contagious disease for which we have no cure, no vaccine, and no natural immunity, we need to use the one thing we do have: our ability to protect each other by creating space.

About the Author
Dr Roth is a US-trained family physician with specialties in research and global health. She made aliyah five years ago to Ra'anana, and is mother to four young children. Dr Roth currently practices both in Israel and to the US via telemedicine, and directs the Clinical Reasoning Course at Sackler Medical School (Tel Aviv University).
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