Flattening the Curve and other Meaningless Phrases
"Flattening the Curve" is catchy and it has meaning for the people that developed and promoted it but over the last weeks it has become evident that although everyone knows the phrase, many people don't understand the implications. Math is hard. Calculus is harder, and most of us don't find it intuitive. Without novel treatments such as a vaccine (which is at least a year away) the number of people who get infected (represented by the area under the curve) will be the same whether we flatten it or not. The time course is what we are attempting to change.
"Everyone will get this virus, we are just trying to make sure everyone doesn't get the virus at once"
This is a gross oversimplification but I think it gets at the heart of what "flattening the curve" means. Everyone is sacrificing a lot by going into home isolation but I think it will be easier to endure if we understand the reasons why. There have been pictures of hospital wards that are mostly empty and some have thrown their hands up in disgust because the hospitals aren't being overrun like we were told they would be. There are a handful of reasons for this (some more valid than others):
1) It's working. Because of social distancing the spread of the virus has been slowed down massively. This has allowed more contact tracing (working to find out where the virus is hiding) which further curtails the spread.
2) There has been a corresponding drop in all sorts communicable diseases. For this reason there will likely be a drop in flu related deaths this flu season. There has also been a drop in work related and vehicular injuries because less people are working and driving. All of these small drops are having a measurable effect when seen on a population level.
2) There are fewer post-operative patients. A massive portion of typical inpatient loads are people who have recently had surgery of some type. There are a few bottleneck resources such as masks and ventilators that have put a stop to all but life saving surgery. (This backlog will have to be addressed when things get back to normal) This includes screening endoscopies (which catch the majority of bowel cancers), hip replacements, hernia repairs and some gall bladder removals.
3) Many people who would normally show up at the Emergency Room are being brave and staying home even when they should definitely be going to the hospital. There have been reports of patients coming in to hospital after a week of chest pain. They report staying at home feeling guilty that they might put a burden on the medical system only to finally realize that they have had a heart attack and that the effects are much worse because they didn't seek treatment. If you are in need of medical assistance "GO TO THE HOSPITAL!!" If you have an eyelash stuck in your eye (based on a real case) instead of thinking twice about going to Emergency consider thinking 3 or 4 times about going in.
4) Everything we are doing now is so that we are not overwhelmed at the future peak of demand. Many nations currently in lock down have not hit their peak demand. It is the proverbial calm before the storm. For every nurse standing around now, they will be doing the work of 2-3 nurses when we get to peak demand in the near to medium future. Even those countries (such as Australia) that have plateaued somewhat will inevitably start to climb when the populace is released from quarantine.
There will be a Nobel prize (or some sort of prize that still means something) for the person that comes up with some sort of system that will facilitate a gradual return to normalcy. Whether that is a lottery to see which surnames get to leave the house on certain days of the week or a clear algorithm where you can enter your profession and find out where on the scale of essential your profession lies. Without some sort of orderly process the dam will break all at once and we will be back in the same place we are now.
The question is not whether isolation is working, it is whether or not isolation is worth it. We will reach a tipping point some time in the next few months where the economic cost will outweigh the cost in lives lost to CV-19. We have to remember that a stagnant economy has healthcare costs as well, with rising rates of depression, chemical dependence, screen addiction, domestic abuse, obesity etc. We will have to accept that some people will die of CV-19 so that other people don't die of cancer because they have finally undergone screening. That tipping point is coming and many people don't understand what good leaders go through when forced to decide between two negative options.
We also need to become even more vigilant than ever that our rights are not being curtailed in the name of public health. This doesn't mean flaunting the rules just to make a point. That isn't brave. It is selfish. It means becoming more involved in the decision making process and keeping a close eye on those who may want to control for control's sake.
Whenever you start to get cabin fever and your bills are mounting and you feel like the cost is too high don't look at where your country is currently but remember Italy and what your city could look like in a few months without the health measures now being taken and think about how you can be creative, and adapt and contribute.
"Everyone will get this virus, we are just trying to make sure everyone doesn't get the virus at once"
This is a gross oversimplification but I think it gets at the heart of what "flattening the curve" means. Everyone is sacrificing a lot by going into home isolation but I think it will be easier to endure if we understand the reasons why. There have been pictures of hospital wards that are mostly empty and some have thrown their hands up in disgust because the hospitals aren't being overrun like we were told they would be. There are a handful of reasons for this (some more valid than others):
1) It's working. Because of social distancing the spread of the virus has been slowed down massively. This has allowed more contact tracing (working to find out where the virus is hiding) which further curtails the spread.
2) There has been a corresponding drop in all sorts communicable diseases. For this reason there will likely be a drop in flu related deaths this flu season. There has also been a drop in work related and vehicular injuries because less people are working and driving. All of these small drops are having a measurable effect when seen on a population level.
2) There are fewer post-operative patients. A massive portion of typical inpatient loads are people who have recently had surgery of some type. There are a few bottleneck resources such as masks and ventilators that have put a stop to all but life saving surgery. (This backlog will have to be addressed when things get back to normal) This includes screening endoscopies (which catch the majority of bowel cancers), hip replacements, hernia repairs and some gall bladder removals.
3) Many people who would normally show up at the Emergency Room are being brave and staying home even when they should definitely be going to the hospital. There have been reports of patients coming in to hospital after a week of chest pain. They report staying at home feeling guilty that they might put a burden on the medical system only to finally realize that they have had a heart attack and that the effects are much worse because they didn't seek treatment. If you are in need of medical assistance "GO TO THE HOSPITAL!!" If you have an eyelash stuck in your eye (based on a real case) instead of thinking twice about going to Emergency consider thinking 3 or 4 times about going in.
4) Everything we are doing now is so that we are not overwhelmed at the future peak of demand. Many nations currently in lock down have not hit their peak demand. It is the proverbial calm before the storm. For every nurse standing around now, they will be doing the work of 2-3 nurses when we get to peak demand in the near to medium future. Even those countries (such as Australia) that have plateaued somewhat will inevitably start to climb when the populace is released from quarantine.
There will be a Nobel prize (or some sort of prize that still means something) for the person that comes up with some sort of system that will facilitate a gradual return to normalcy. Whether that is a lottery to see which surnames get to leave the house on certain days of the week or a clear algorithm where you can enter your profession and find out where on the scale of essential your profession lies. Without some sort of orderly process the dam will break all at once and we will be back in the same place we are now.
The question is not whether isolation is working, it is whether or not isolation is worth it. We will reach a tipping point some time in the next few months where the economic cost will outweigh the cost in lives lost to CV-19. We have to remember that a stagnant economy has healthcare costs as well, with rising rates of depression, chemical dependence, screen addiction, domestic abuse, obesity etc. We will have to accept that some people will die of CV-19 so that other people don't die of cancer because they have finally undergone screening. That tipping point is coming and many people don't understand what good leaders go through when forced to decide between two negative options.
We also need to become even more vigilant than ever that our rights are not being curtailed in the name of public health. This doesn't mean flaunting the rules just to make a point. That isn't brave. It is selfish. It means becoming more involved in the decision making process and keeping a close eye on those who may want to control for control's sake.
Whenever you start to get cabin fever and your bills are mounting and you feel like the cost is too high don't look at where your country is currently but remember Italy and what your city could look like in a few months without the health measures now being taken and think about how you can be creative, and adapt and contribute.
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