COVID-19 Healthcare Challenge - what does “flattening the curve” mean?

14th May 2020 by Asimina Pantazi

What is “flattening the curve”, how can it be achieved and what are the benefits?
What is “flattening the curve”, how can it be achieved and what are the benefits?

4.35 million. This is the number of total confirmed cases of COVID-19 globally as of today, 14th May 2020.1 Our world is facing an unprecedented challenge, potentially affecting everyone, but particularly certain vulnerable groups of the population.2 The WHO has underlined the importance of “flattening the curve” in order to control the coronavirus outbreak3 and you may be wondering “what does that mean?”

In epidemiology, an epidemic or “epi” curve is an illustrative way to demonstrate how an illness or outbreak progresses over time, using a simple diagram.4 The horizontal axis (x-axis) is the time when infection cases are confirmed, while the vertical axis (y-axis) is the number of cases confirmed.4 Each data point of the line represents the number of cases detected at a certain time. Due to the “bell” shape of the line, we call it “curve”.5 During ongoing outbreak investigations, the epi curve is updated as new data become available.4 When the infection rate is high, the curve appears sharp and its peak is higher, as many new cases are detected day after day within a short period of time.

The coronavirus infection rate is particularly high, with only 7 days needed for the cases to double.1 The problem healthcare services across the world are facing is that when the coronavirus infection curve goes up, it skyrockets.6 Too many people are infected at the same time. This means that all medical resources and supplies for testing, treating and managing those patients are used up instantly. 6 During an outbreak like the COVID-19 one, without a functional public health intervention, the demand exceeds what the healthcare system can offer and the outbreak is out of control.

Following the WHO guidance, public health systems worldwide are putting measures in place to “flatten the curve”. Governments aim to decrease the infection rate, so that the number of cases does not peak rapidly, and fewer people are infected at the same time.7 In a “flattened curve” the cases increase more gradually, reaching a lower peak. This doesn’t necessarily mean fewer people will eventually become infected, but that these infections will be distributed over a longer period of time. A slower infection rate means a less stressed healthcare system, fewer hospital visits on any given day and fewer sick people being turned away. 7 Overall, “flattening the curve” allows capacity and time to treat the ones in need.

The question is “How to achieve a flattened curve?”. As there is no current safe and effective treatment or vaccine specific to COVID-19, the main way to achieve this is through certain interventions. “Social distancing” and quarantine of confirmed or suspected cases are the main ones and the sooner they take place, the better. The UK, among many other countries, has announced strict measures to tackle the spread of the virus and has advised people to stay at home as much as possible and avoid unnecessary social interactions.8 Moreover, the NHS advises you follow some simple steps to prevent viral expansion, such as:9

  • Wash your hands well and regularly or use sanitizer
  • Cover your mouth and nose with a tissue or your sleeve and not your hands when you cough or sneeze
  • Put used tissues in the bin immediately and wash your hands afterwards
  • Do not touch your eyes, nose or mouth if your hands are not clean
  • If you feel any suspicious symptoms call 111

Another measure that helps prevent transmission is testing, testing (and) testing!10 Early detection is key, especially in asymptomatic cases. Apart from enabling early initiation of the right treatment before severe pneumonia occurs, it also allows isolation of those cases. For example, South Korea followed massive testing approaches which led to a drop of viral spread and the number of new cases per day has quickly reached a plateau.1

Are there any real benefits in “flattening the curve”? To answer this question let’s take a look at China. The first cases in China were recorded at the end of December 2019 and by January 23rd 2020 the city of Wuhan was placed under quarantine. Hubei province followed within days.11 Moreover, China put in place extensive public monitoring of citizens, as well as various methods of punishment and rewards to encourage adherence to such measures.12 According to the WHO, China’s most effective measures were “extremely proactive surveillance” to detect cases with extensive testing and immediate isolation of patients, rigorous tracking of close contacts and an “exceptionally high degree of population understanding and acceptance” of such measures.12 Thanks to these interventions, China today counts 0 new cases daily.1

In conclusion, measures to “flatten the curve” are essential in order to sustain a pandemic like COVID-19. But strict measures are not enough. It is important that you take them seriously, stay disciplined and follow them. Health officials predict many more people will become infected, but let’s not let this all happen at once!  Consider this a personal responsibility, a little sacrifice you can do now that will save lives in the long-term.