March 18, 2020

Dear HopeCentral Families,

As we start to settle into the rhythms of this season, one of the phrases that has commonly been in the news is “flattening the curve.” I wanted to share a few more thoughts about this idea in hopes that it helps you understand the events unfolding around us. For further reading, please see this New York Times article and this Washington Post article.

What is “Flattening the Curve”?

The “curve” in “Flattening the Curve” refers to the graph of the number of cases plotted over time:

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Source: New York Times

“Flattening the curve” is the idea that without protective measures, the rate of infection and subsequent disease would rise rapidly, exceeding the capacity of the health system. To avoid this situation, Washington State, and many other places, are engaging in “social distancing” efforts to flatten the curve. These efforts, aim to slow the spread of the virus such that the rate of infection and disease rises more slowly, keeping the number of ill people within the health system’s capacity to care for them.

Why “Flatten the Curve,” and why now?

If cases of disease exceed the capacity of the health system, people would die from lack of access to hospital resources such as ventilators. A strained health care system would also be less able to care for people with other ailments. Action is required now due to the mathematics of the coronavirus’ high transmission rate and significant fatality rate. Flattening the curve is an attempt to slow a process that is growing exponentially. This Washington Post article has a great interactive illustration of this dynamic and why time is of the essence when attempting to slow an exponential growth process.

What does this mean?

One of the oddities of “Flattening the curve” is that the dramatic measures to contain the coronavirus are very visible, while the actual number of cases of Covid-19 is quite small and thus the people affected are not very visible. Also, from everything we know thus far, the coronavirus is not having significant effects on young, healthy individuals. These are my takeaways:

  • Individual risk is low for most young, healthy people. For most people, the individual risk of directly contracting the coronavirus and developing a serious case of Covid-19 is small. Precise modeling is difficult, but in a recent presentation, Dr. Michael Lin at Stanford University used these figures for sake of argument: 30% infection rate, 5% of infected require hospitalization and 2.5% of infected require the ICU. Of those requiring hospitalization, the majority are likely to be the elderly or those with chronic health conditions.

  • But in a large country, many are at risk. Even though our personal risk may be small, there are a lot of people in the USA and in the world. At a 30% infection rate, 5% rate of hospitalization and 2.5% rate of ICU usage, if many people fall ill within a short amount of time, we could easily exceed our hospital capacity.

  • Our efforts towards Social Distancing are to protect our neighbors at risk. Ultimately we are serving those like our Executive Director Dave Kwok’s mother and mother-in-law who are in quarantine at their assisted living facilities.

  • There is no need to hoard supplies. Essential businesses like grocery stores, pharmacies, and transportation companies can still operate safely to provide for our basic needs.

I hope these thoughts are helpful food for thought as you are making sense of this season. I will be hosting a Facebook live event on Monday, March 23rd and would welcome your participation and questions (facebook.com/hopecentralhealth).

Thankful to be your pediatrician!

Chris Jones, M.D.