As efforts to stop the spread ofescalate around the world, attention has turned to how individuals and communities can protect each other. The illness, , has made its way across every continent, besides Antarctica. The advice from health authorities has been constant: Wash your hands and don't touch your face. But more stringent measures are being suggested by medical experts, including increasing social distancing and restricting mass gatherings, in an attempt to "flatten the curve." What does that mean?
You've likely heard the term "flattening the curve" (or its feline-based Twitter-sibling, #catteningthecurve) and seen the graphs shared widely on social media. The graphs contain two curves -- the first tall and thin, like Mount Everest, and the second thick and flat, more like a speed bump.
The graph has been adapted from the CDC's pre-pandemic guidance for mitigating the spread of infectious disease, which was mostly recently revised in 2017, and shows the "epidemic curves" of two different pandemic scenarios.
The sharp curve denotes how a pandemic caused by an infectious disease -- like COVID-19 -- would spread through a community with no intervention strategies in place. Without mitigating the spread, cases would rise rapidly, peaking when the community is almost wholly infected, before dropping back down. The second curve is much flatter and denotes a pandemic scenario where there has been intervention.
What's most notable with the "flattening the curve" idea is the addition of a single dashed line to denote the capacity of public health systems. This addition appears to have been first added by Drew Harris, a population health analyst at Philadelphia's Thomas Jefferson University, and is adapted in the graph here.
At present, many graphs in countries like the US, Italy and Australia are showing rapid growth in confirmed positive cases -- their epidemic curves are beginning to look like the red curve. This is a worst-case scenario, and would overburden critical systems.
Health authorities and governments are now adopting strategies and measures that will -- hopefully -- see nations look more like the blue curve.
Here's why that is so important.
Why it's important to flatten the curve
Flattening the curve is the idea that communities and countries can delay the peak of the outbreak and thus relieve some of the stress on the health care system.
"By intervening early in an epidemic we are wanting to limit the spread of an infection," says Hussan Vally, an epidemiologist in public health at La Trobe University, Australia. "This reduces the number of cases that will present at any one time as the epidemic progresses and it also reduces the number of cases at the peak of the epidemic."
"This changes the shape of the epidemic curve and flattens it out. By flattening out the epidemic curve we are aiming to reduce the load on the health system at any one time to prevent a situation where the sheer number of cases means the health system is overwhelmed."
As the epidemic curves show, intervention is critical in responding to a pandemic because it drives the number of cases down and frees up the health care system to deal with an outbreak. The community mitigation strategy for COVID-19 from the Centers for Disease Control and Prevention outlines two major reasons for flattening the curve:
- To protect individuals at increased risk for severe illness, including older adults and persons of any age with underlying health conditions
- To ensure the safety of health care and critical infrastructure workforces
The responsibility for slowing down new cases doesn't fall just to the vulnerable or those infected with COVID-19, but extends to the wider community.
Governments and health authorities are asking people to change their behaviors to prevent a spike in cases that would send admissions to hospitals skyrocketing and stretch resources thin.
"Hospital services have limited numbers of health care workers, such as nurses and doctors, limited numbers of beds [and] a limited number of specialist equipment, such as ventilators," says Ian Henderson, director of the institute for molecular bioscience at the University of Queensland, Australia. "By flattening the curve, it allows health care workers and the available infrastructure, time to cope with the number of patients."
Those resources are going to be critical in combating any extensive outbreaks. We're already seeing the consequences of not flattening the curve fast enough in places like Italy, where hospitals are overwhelmed. Patients with severe disease and breathing difficulties require mechanical assistance from ventilators but, according to a report by the Financial Times, there is a lack of equipment in the country due to the huge influx of COVID-19 cases. Ventilators are scarce.
And it's a problem not limited to Italy. The US may have to battle a shortage of ventilators if the outbreak reaches levels like those seen in Wuhan, China, according to NPR.
The good news is that such a reality can be avoided -- but it will require some shifts in behavior in the short-term.
What can you do to flatten the curve
No matter where you are in the world, everyone fulfills a critical role of the response to a COVID-19 outbreak. Always keep in mind these two pieces of constant advice from health professionals to best protect yourself from being infected:
Now more stringent protective measures are required -- and the early response by governments and industry has been telling. The US has announced closures across the nation, , and schools. In addition, by the spread of the coronavirus, and huge sporting bodies like the NBA, NHL and MLB have suspended or postponed seasons to stop unnecessary public gatherings.
Such efforts attempt to aid the practice of "social distancing" -- an idea that's gained as much traction as "flattening the curve" in recent weeks and that's recommended by the World Health Organization. Social distancing is a protective measure that attempts to reduce the close contact people have with each other during an epidemic.
An incredible piece of data journalism by the Washington Post is perhaps the best display of how social distancing can help slow the spread of disease. The piece shows exactly what it means to increase social distancing and self-isolate and how those measures can reduce the overall load of infections. Limiting movements and contact with others to a minimum greatly reduces the ability for a disease to spread through the community.
What does that mean for you? How should you navigate this new world of self-isolation and small gatherings? Should you go to bars? Restaurants? Weddings? The gym? Parties? BBQs?
The information coming through differs depending on where you are in the world, so it's important to refer to the relevant local health authorities for how to best maintain social distancing practices. For instance, as of March 15, the CDC recommends that large events and mass gatherings with 50 or more people be postponed across the United States. Australian authorities suggest gatherings of 500 should be canceled. Countries like France and South Africa suggest gatherings of over 100 people be cancelled.
Officials and authorities have to balance a whole host of concerns outside of epidemiological concerns. However, medical experts are suggesting people stay home as much as possible. Even if you're young and healthy and may not be severely affected by COVID-19, you should reduce contact with others. Perhaps one of the best resources for US residents comes from The Atlantic and explains the various social situations one should look to avoid in the coming weeks.
The measures may seem extreme, but they are backed by hard data. Social distancing has helped save lives in the past -- most notably during the 1918 flu pandemic. The lessons from that pandemic over a century ago are just as important today.