“Flattening The Curve” — Coronavirus Containment 101

When it’s too late to stop an outbreak, focus on “flattening the curve”

Written by Anna Fagre — PhD Candidate, Microbiology; DVM / MPH; Colorado State University.

Colorado State University just announced it is moving to an online-only platform until mid-April, and many other universities around the US have done the same. I’m hearing some folks say, “This is overkill. I’ll just expose myself and get it over with. It’s just like a cold or the flu. It’s not that bad.” On the opposite end of that spectrum, I went to the grocery store last night to buy toilet paper and got one of the very last packages.

Are we over-reacting? Are we under-reacting? How worried should we be?

LAKE SUCCESS, NY – MARCH 11: A lab technician begins semi-automated testing for COVID-19 at Northwell Health Labs on March 11, 2020 in Lake Success, New York. An emergency use authorization by the FDA allows Northwell to move from manual testing to semi-automated. (Photo by Andrew Theodorakis/Getty Images)

I’ve been trying to figure out how best to articulate why 1) panicking and becoming hysterical isn’t necessary, and 2) we should all still give a damn about the course this outbreak takes. There’s a lot we don’t know about the virus, but there are a few patterns that scientists and doctors are identifying and those patterns tell us this:For most young-middle aged healthy individuals, you catch the virus and you get a bad cold or mild respiratory illness. You’ll feel like trash, but you’ll be okay if you stay home, drink water, and sleep.

For individuals that are older (60+ years) or immunocompromised for other reasons, there is a real risk posed. These are the people that will likely end up in the hospital, or seeking diagnostics and treatment from healthcare professionals.

However, there’s this middle group in between – the group that could maybe be alright staying home but might feel so bad that they go in to the hospital. What we’re learning from other countries (and what’s likely to occur based on the United States’ handling of case detection/testing early on), is that this group of people seeking medical care will likely be QUITE large (meaning *lots* of hospital visits in a short amount of time).

Without proper preventive measures, and measures taken to decrease transmission early on in the outbreak (or “flatten the epidemic curve” as shown in the image below), the huge number of people seeking medical care is likely to completely overwhelm our healthcare system capacity.

What does this look like?

— Running out of facemasks (which are not known to protect you from virus transmission UNLESS you are a doctor or nurse working VERY closely with infected patients – on the contrary, they may heighten your risk since you have not been properly “fitted” and you will probably be touching it and moving it around on your face more)

— Running out of hospital beds and ventilators

— These two factors ultimately leading to reduced workforce in the healthcare industry (when doctors, nurses, and pharmacists get sick, there’s no one to run the tests or prescribe the medications)

I don’t mean to fear monger and scare everyone, as I’m sure you’ve all seen/read enough “doomsday” scenarios. (Note: you don’t need to go buy out the last of the toilet paper at the grocer— Seriously). More simply, I want to emphasize that at this given moment, the absolute most IMPORTANT thing we can focus on is SLOWING the spread of the virus and “flattening this epidemic curve”.

So what does that look like?

— Cancelling classes, meetings, and gatherings (or moving them online… time to buy stock in Zoom or Skype!)

— Practice social distancing and wash your hands frequently (or use an alcohol-based hand-sanitizer— apparently Tito’s doesn’t count)

— If you’re considered high-risk (older adults, or those with heart disease, diabetes, and lung disease), ensure you have enough food and medications on hand so as to avoid unnecessary trips to the store and avoid crowds as much as possible. If you need medicine or food, contact a friend or family member to deliver it to you.

Every year, I get the flu vaccine primarily for the purposes of protecting young, elderly, pregnant, and immunocompromised people.

In other words, the vaccine helps me to protect them. Since we don’t yet have a vaccine for this disease and thus, no “herd immunity”, I think the most respectful and responsible thing to do is focus on modifying our own behavior to “flatten the curve” (e.g. wash hands, etc.)

Here is the thing to understand about flattening the curve.

It only works if we take necessary measures before they seem necessary.

And if it works, people will think we over-reacted.

We have to be willing to look like we over-reacted.
— Kaila Colbin (@kcolbin) March 12, 2020

Speaking of respect and responsibility, I would like to take a moment to thank all of the doctors and nurses working tirelessly to answer the public’s questions when they should be at home resting, all the epidemiologists generating real-time maps and infographics to increase public understanding and knowledge (see Johns Hopkins map – linked below), and all the microbiologists working around the clock to better understand how this virus behaves so we can get a better grasp on which antiviral medications may be most effective and begin the long and arduous process of vaccine development.