The idiom “flattening the curve” has temporarily became the buzz word in U.S. media as the challenge of responding to the Coronavirus pandemic has continued to escalate.  With no vaccine or effective treatment for COVID-19, the use of social distancing measures attempts to delay the spread of infection and keep the need for intensive, hospital-based health services within the capacity of our already strained health care system. “Flattening the curve”, is a term that public health officials use all the time but that many Americans just heard for the first time this week.   But is all of this really necessary for COVID-19? Are public health officials overreacting to the threat posed by the virus that causes the disease COVID-19?  Besides lowering the peak demand for health services, the “flattening the curve” approach includes raising the baseline of available resources, such as COVID-19 tests, hospital and ICU beds, ventilators, personal protective equipment, and trained health care workers. In short, we need greater surge capacity. Although a lack of funding for public health infrastructure and personnel is evident, another key reason for a lack of surge capacity is that excess capacity is inconsistent with the business models of for-profit hospitals, bottom-line sensitive nonprofit hospitals, and underfunded public hospitals. Most hospital administrators and executives traditionally have sought to increase utilization rates and eliminate excess capacity, such as empty beds and unused equipment and supplies.

I believe that “flattening the curve” is absolutely necessary, because it’s worked very effectively in the past.  An outbreak anywhere can go everywhere, and right now, we all need to pitch in to try to prevent cases both within ourselves and in our communities.  “Flattening the curve” means delaying the spread of infection and expanding the time needed to impose social distancing measures. To be clear, it does not mean that the virus will not spread.   It means that when and if you become infected you will have more availability of healthcare resources. 

The economic and social consequences are distressing to contemplate, as schools, businesses, houses of worship, and entire sectors of society will be unable to operate normally. Sports, entertainment, civic, and cultural events with even modest attendance will be unsafe so long as the virus is present and transmissible in communities.  If you look at the image above, you can see two curves – two different versions of what might happen in the United States, depending on next steps. The tall, skinny curve is bad – it means that a lot of people will get sick all at once, in a short period of time because we don’t take enough steps to prevent the virus from spreading.  This scenario has a much higher morbidity and mortality rate.  People will die because they do not have immediate access to emergency healthcare.  

The good news is that by prolonging the peak of transmission we have time to ramp up resources and accommodate those that will need hospitalization.   Most people won’t get sick enough to need a hospital. But those who do could overwhelm the number of beds and care teams that our nation’s hospitals have available.  The flatter, lower curve is a much better one – but it will take working together to make it happen.   Public health measures can only succeed if there is a high degree of social solidarity, which requires trust in public health agencies and their leaders. It is imperative that the U.S. develops a nonpartisan leadership model for our public health system.  If we as a nation,  fail to take “social distancing” serious, it won’t just be the transmission curve that will be flattened.

Stay Safe!  

Ed Bolden, President