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'Flatten the curve' is the buzzword of the season. But what does it mean?



Quick points:


  • India is recommending practicing 'social distancing' as a key strategy to 'flatten the curve'.

  • The curve being referred to describes the number of COVID-19 cases.

  • This is important because the capacity of the Indian health system is limited and therefore it is necessary to not overwhelm it.


'Flatten the curve', a concept that first came to light in a paper published by the CDC in 2007 as the 'Goals of Community Mitigation' was later popularized by Dr. Siouxsie Wiled this March. Essentially the graph displays a projection of the number of people who contract COVID-19 over a period of time. The graph represents the number of people who have the disease on the y-axes (vertical) for each day since the first case, on the x-axis (horizontal).


A high curve is created by a steep increase in the number of cases per day followed by a quick decrease. A flatter curve is created by a more gradual increase in the number of cases per day and a more gradual decrease. Over a long period of time, the number of people infected with the novel coronavirus might be about the same, but the difference is in the number of cases each day.


Why is this something to consider?


As Dr. Drew A. Harris describes, hospitals and health care facilities have a limited amount of resources such as ICU beds and ventilators with which to treat patients who get admitted. This limit can also be called the 'capacity' of the health system. A scenario where the population crosses the health systems capacity is characterized by long wait times and poor health outcomes. It makes logical sense then that an effective strategy in not combating the epidemic would be to lessen the rate of increase in number of cases.


How do we flatten the curve?


The WHO recommends social distancing as an important measure to flatten the curve. It involves avoiding people or places where it’s possible to come in contact with germs by droplets, direct contact or surfaces that are potentially contaminated with the virus. For many, that means working from home and staying in rather than going out to bars or restaurants. But while not everyone can or will be able to do that, public health officials are saying it's our best shot at slowing down the transmission of the virus.


Are we on the right track?


Well, possibly. As India tracks its progress along the epidemic curve it has made certain bold moves to foster social distancing. As we noted in an earlier article, the country has closed its borders to several countries and has begun strict medical checks at all ports of entry. Further, temples such as the Siddhivinayak and Mumbadevi temples in Mumbai, among others, have announced that they would be shutting down for devotees in an effort to discourage people from entering crowded areas. Further, large supermarkets, cinema theaters and shopping malls are taking the executive decision to suspend services temporarily all in the name of encouraging people to stay at home.


Will this be enough?


Evidence suggests that social distancing could work. For example, the Centers for Disease Control and Prevention (CDC) looked back at the lessons they learned from the response to the H1N1 pandemic in 2009. The study found that social distancing measures worked to some extent, citing a decrease in virus transmission in Mexico after school closures and other such measures and less absent students at Georgia schools that shortened school days.


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