COVID-19: The Case for Pursuing Total Infection Linearity at a Municipal Level

#FlattenTheCurve
Photo by Anna Shvets

I’ve come to realize that despite the fact that all of us share and repeat the catchy phrase, “flatten the curve,” not all of us are in agreement on what exactly that means. In fact, I’ve recently seen people start to say that we should bend the curve.

What curve are we trying to flatten (or bend), and why?

Well, when we saw the original reports of infection rates in China and Italy, the charts showing the number of infected patients were exponential (growth graphed as an upward curve). Their hospitals were overwhelmed, and people were dying because of it. In response, other countries began to implement social distancing rules in the hopes of keeping the number of new daily cases to a number that wouldn’t overwhelm the hospitals.

Source: HuffPost

Now that the virus has started to spread across the world, we are seeing a host of responses – some good, like implementing social distancing guidelines within grocery stores, and some bizarre, like people hoarding toilet paper and tonic water. We’ve also seen a large-scale shutdown of non-essential businesses, along with orders to stay at home unless picking up groceries or perhaps a prescription. The result of this has been a greatly reduced number of new infections per day in most areas, along with a huge number of layoffs, which has required the government to draft and distribute stimulus packages so that people who are laid off don’t starve to death and lose their homes.

But there’s more going on here. In many areas, we’ve so successfully slowed the rates of new infections that hospital workers are not just not overwhelmed, they actually have enough time, space, and energy to choreograph and record dance videos and post them on TikTok. And because many hospitals are now overstaffed due to non-essential surgeries and procedures being cancelled, those who aren’t dancing are even being laid off. So it’s working, isn’t it? This is great! I mean, this is a far cry from what happened in Italy, where hospital workers were dropping from exhaustion and patients were dying on the floors of hospitals because there wasn’t enough equipment to ventilate everyone. If we just keep this up, eventually the virus will disappear, right?

Nope.

In some areas, we’ve so successfully flattened the curve that there is no end of this pandemic in sight. To put it another way, if we graph our Y-axis not as daily new cases but as total number of cases, some cities have actually inverted the curve, making it logarithmic instead of exponential. And that’s a problem.

If the models are true, unless a vaccine is found, nearly everyone is going to get infected eventually. According to The Atlantic, “Soon, most everyone in the United States will know someone who has been infected.” The only way that we’ll make it through this pandemic is if we can find a balance. If we relax restrictions on citizens’ movement too soon and the total number of cases rises exponentially, the hospitals will be overwhelmed; if we restrict citizens’ movement for too long, and the cases rise logarithmically, we’re going to destroy the economy. “But hold on,” some people say. “Aren’t you just putting a dollar amount on peoples’ lives? Isn’t it better to stay in isolation than it is to put people at risk?” Given that the earliest we can expect a mass-produced vaccination is between 12 months and 18 months, I think that the long-term risk is too great, and here’s why:

In my opinion, if we keep up our current levels of mandatory isolation of those who are not high-risk for complications, the long-term cost will be incalculable. Based on past disasters, we can expect that 40% of businesses will not reopen even after restrictions are listed, and another 25% will fail in the year that follows. As of March 31, 32% of small business owners surveyed by BNN Bloomberg say that they will be unable to re-open after this crisis. What does this mean for the rest of us? The owners and employees of those small businesses are of course going to be directly affected first. Next, suppliers of those small businesses will take a hit, resulting in additional layoffs. Many employees may be unable to find a full-time job for years, according to CNBC. And until people find work, they are going to be without a paycheque, forcing them to rely solely on employment insurance and/or stimulus cheques. 78% of Americans and 53% of Canadians lived paycheque-to-paycheque before the COVID-19 outbreak; since employment insurance pays out significantly less than a worker’s regular paycheque, these people face an immediate financial deficit; even the addition of a stimulus cheque will be insufficient to support their needs for more than three months. This is going to put many families into a lower socio-economic status, which will have dire consequences. According to the American Psychological Association, a family’s socio-economic status “is a consistent and reliable predictor of a vast array of outcomes across the life span, including physical and psychological health.” In layman’s terms, we are facing a spike in alcoholism, drug abuse, domestic violence, gang activity, homelessness, suicides, and malnutrition. Not only will this affect our generation, it will also affect our children; their development in this environment will be severely impacted.

So what can we do?

First, we can ask our government leaders to continue implementation of mandatory isolation for those who are most at-risk of fatal consequences if they are infected. The elderly and those with underlying health conditions (heart conditions, morbid obesity, asthma, diabetes, etc.) need to be protected as long as possible – ideally until a vaccine is found, or herd immunity is achieved.

Second, cities and municipalities need to consider their populations and their hospitals’ catchments. Our goal should be a linear growth of the total number of people infected by COVID-19 – growth at a rate that the hospitals are able to keep up with without being overwhelmed, while allowing for enough “breathing room” that if an unexpected outbreak should occur, staff and equipment will be available. These considerations can’t be made at a provincial or state level; two cities next to each other might have wildly different economies, hospital staff levels, respiratory equipment, and population densities. Consider British Columbia. Implementing the same restrictions in Vancouver as in Hope does not make logical sense. Logically, travel restrictions between districts would also need to be enacted to prevent unexpected cross-contamination of different cities.

Third, cities and municipalities should implement a gradual “return-to-work” program, where businesses incrementally ramp up production again, while maintaining social distancing guidelines. If an unexpected outbreak should occur, the program can be scaled back until the hospitals again have the capacity to handle the next wave.

Fourth, those who are highest-risk for fatality if infected should be provided for by those who are lowest-risk and continuing to work. We should be delivering meals (and toilet paper) to their homes until such a time as a vaccine or cure is made available.

Only by making the total number of cases linear are we going to make it through this pandemic. If we err toward total exponential growth, many could die of disease. If we err toward total logarithmic growth, many could die of starvation, and we may face another Great Depression. When we consider both the short-term and long-term effects of our response to this pandemic, carefully calculated linear growth as determined by medical experts and statisticians is the only way to preserve as many lives as possible.


Simulated at ncase.me

Disclaimer: I am not a medical professional. This is my personal WordPress blog where I share my own opinions and thoughts. I am NOT advocating that any of us take matters into our own hands! Follow the guidelines put in place by your local health authorities. Our medical experts, first responders, and essential workers are doing everything that they can to keep us safe; let’s thank them for their service and do our part to protect each other, too.

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