COVID-19 Day 22: A Bumpy Curve

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As the COVID-19 death toll continues to rise in NYC, the nation looks to California for a model of how to avoid NY’s fate. CA enacted the nation’s first shelter-in-place order weeks before NY. The results are promising, CA appears to be is “flattening the curve” in new COVID-19 cases. 

As CA’s governor, Gavin Newsom,  said on Wednesday, “We are in a completely different place than the state of New York…I hope we continue to be. But we won’t unless people continue to practice physical distancing and do their part and we continue to meet this moment.” 

[SPOILER ALERT: If you don’t like bad news, stop here. The rest is only for those that can deal with some unpleasant facts.] 


Flattening the Curve’s purpose is to reduce COLLATERAL DEATHS when Critical Cases overwhelm the local Health Care Systems’ capacity (the number of ICU beds, respirators, and specialists.)

Imagine a tall lump of dough. If you put it in the oven, the top will burn. If you flatten it and spread it out, it will cook evenly. But a flatter curve means a longer one.

Whenever COVID-19 Taskforce Officials have been asked, ‘How long before this ends?’
They usually answer, ‘It depends on how well we do with our measures…We will know better in [insert number] weeks.’ 

The inconvenient answer is: longer than anyone wants to admit. 

The Imperial College, London published a paper in March 16, which has heavily influenced the US’s COVID-19 strategy. Scientists modeled various approaches of mitigation and suppression (stay-at-home, shutting down non-essential business, social distancing, etc.) over a period of 5 months. In another they modeled Adaptive Suppression that would ease off and then reimpose suppression when and where peaks occurred creating lower peaks stretched out over 12 months. Yes, months.

But shutting down a country for 5 months is not a realistic option. We will have to let large parts of the country get back to work and school. If the country doesn’t return to work, shortages in food and basic goods that would put Venezuela to shame. The malnutrition and poverty could last years and would cause more deaths and illness than COVID-19 itself. 

CA was one fo the first states to become a hotspot in late February. It was also the state to first impose strict suppression methods and will likely be the first state to reach a peak and decline in cases. At some point CA officials will feel confident enough that the epidemic has declined enough, to relax its restrictions and send people back to work and children to school. New infection spikes will likely occur from lax personal-safety compliance, or fresh infections from travelers from other states or other countries. Whether by accident or design, this sounds very much like the Adaptive Suppression model described by the Imperial College paper. A long curve but not a smooth one.

An epidemic doesn’t end until 100% of the infected are removed (quarantine) or until 50%-60% of a static population has achieved immunity creating a condition called “Herd Immunity.” At that point, a contagion can no longer reach an un-infected host before its current host dies or it dies. Herd Immunity can only be achieved through vaccination or the natural immunity gained after recovering from that infection.  

The hardest truth of all is this: Until a vaccine is developed (which could take months or years) we will not see the end until at least half of us have contracted and recovered from COVID-19.  

The curve is not smooth. Ready yourself for a long and bumpy ride. 

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REFERENCES
https://time.com/5814139/coronavirus-state-data-tracker/

https://calmatters.org/newsletter/is-ca-bending-the-curve-enough/

https://www.govexec.com/management/2020/04/what-happens-if-social-distancing-covid-19-ends-too-soon/164270/

https://thehill.com/homenews/administration/488965-trump-hints-at-changes-to-restrictions-we-cant-let-the-cure-be-worse

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4943153/

https://medium.com/@tomaspueyo/coronavirus-the-hammer-and-the-dance-be9337092b56

https://www.imperial.ac.uk/media/imperial-college/medicine/sph/ide/gida-fellowships/Imperial-College-COVID19-NPI-modelling-16-03-2020.pdf