Misunderstanding Flattening the Curve

Over the weekend, I saw a spate of tweets and other commentary along the lines of ‘we should end lockdown because we’re all going to get COVID-19 anyway, so why destroy the economy too.’ A slightly more sophisticated version argues that most of our hospitals aren’t overwhelmed (yet…), so we can reopen things. While I’ve seen these arguments more from the right, there is a wing of the left that’s also embracing these arguments. Unfortunately, these arguments ignore the goals–note the plural–of what social distancing and ‘lockdowns‘ are designed to do.

One reason for this is that the public communications, messaging, or whatever else you want to call it have been nearly uniformly horrible, in no small part, because the executive branch of the U.S. had a message of ‘there is no problem.’ (PROTECT TEH STONKS!) The one success appears to be handwashing (and it took a global pandemic to do it). Because of this gap early on, much of the void was filled in an uncoordinated way (and that’s before we consider the disinformation). It doesn’t help that the Trump administration, to say the least, pissed away seven weeks we desperately needed, and moves like relying on slumlord Jared Kushner don’t exactly instill confidence: if we’re going to be fucked by incompetence anyway, why not lie down and die restart the economy?

All that said, flattening the curve has multiple goals, all of which we still need to be pursuing:

  1. Reducing the COVID-19 patient mortality rate due to overwhelmed hospitals. This is the one that got the most publicity. It’s obviously important: if COVID-19 patients are dying because the medical system is overstretched, reducing the number of cases will decrease the mortality rate. It’s better to have half of X percent of patients die than X percent. Outside of New York City, we seem to have accomplished this for now, though there now are reports of smaller communities getting overwhelmed.
  2. Related to the previous point, flattening the curve means patients will be treated later (i.e., weeks or months from now), and their death rates, as well as long term complications, will be lessened if they are treated months from now. We are learning more about how to treat these patients, everything from lying patients on their stomachs (not the usual procedure) to when to ventilate. Importantly, we’re also learning what not to do.
  3. Flattening the curve allows us to get ‘test and trace’ systems up and running, which is the only way we’re going to get people back to work safely. While there has been a lot of discussion about the failure to get testing working, we also need workers who do contact tracing. It’s not enough to identify someone who is sick. We also need to track down whom infected people interacted with (‘contact tracing’). That allows us to quarantine them when needed, and to follow up on their status. It also allows us to understand which relaxed restrictions are killing people, and which ones aren’t. Maybe half-empty restaurants are fine, but gyms aren’t? We won’t know until we have testing and tracing.

    Instead of broad restrictions, restricting individuals or groups of people for shorter periods of time is obviously preferable.

    Since it seems like the Trump administration has gone AWOL on this, states and counties, with limited resources will have to build their own systems. Which leads to next point.

  4. Testing and tracing only works if we lower the number of currently and recently infected people. It is labor-intensive* and can be overwhelmed by high numbers. We still have to cut the numbers down, even if we can’t test and trace many cases, especially since most of the contact tracing will have to be done at the state and local level (whose budgets are getting hammered by lower revenues and who can’t deficit spend), with public health departments that are already hollowed out. As it stands right now, most states don’t have enough testing capacity for modest test-and-trace, and the states that do are the ones that haven’t been hit hard (yet).
  5. High numbers of COVID-19 patients have bad effects on other parts of the medical system. These include inadequate care for non-COVID-19 patients, early discharges of patients, a reluctance to send recovering patients to rehabilitation centers, inability to visit patients, sick people waiting too long to go to the emergency department, and parents delaying childhood vaccinations. There are probably other things I’ve left off the list.
  6. Finally, we need to use the time flattening the curve provides to build up stockpiles of hospital medical equipment as well as essential ‘non-medical equipment’, such as cloth masks (we need billions), cleaning solutions, pulse oximeters, and therometers, for use by ‘civilians.’ People will resist going back to work until that happens.

So flattening the curve does a lot of important things, not just for patient survival, but also for reopening the economy. Yes, much of what I’ve discussed involves a somewhat functional government, and, at the federal level certainly, it’s hard to put much faith in the response**. But I would prefer to give some local and state governments a fighting chance, and not fatalistically roll over and die.

*Though given the collapse of the restaurant industry, we do have a lot of unemployed people who are used to asking strangers information, so mobilize them.

**As to the economics, there are ways to keep households, businesses, and payrolls afloat. Whether Trump et alia and their Republican enablers will let that happen is another question. It did take three years of the Great Depression before Democrats had the chance to fix things, so we’ll probably, at best, have to wait until next February to significantly repair the Republican damage. Remember: they don’t care if workers die, because they never care if workers die (ditto environmental protections).

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2 Responses to Misunderstanding Flattening the Curve

  1. Joey says:

    But how do we square this with closing hospitals?

    Does this not make us more vulnerable to a second peak

  2. Reblogged this on silverapplequeen and commented:
    A very good read

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