Explaining the Dire Need to ‘Flatten the Curve’

Dr. David Nash of the Jefferson College of Population Health delves deeper into the phrase that’s come to define COVID-19 prep.

Amid preparations for dealing with the COVID-19 pandemic, the phrase “flatten the curve” has become both a rallying cry and shorthand for how the public can best help healthcare professionals at Jefferson and beyond be ready to treat patients.

As the founding dean emeritus of the Jefferson College of Population Health, Dr. David B. Nash is in a unique position to explain both the importance of flattening the curve and how what’s happening should prompt a soul-searching discussion about reshaping the healthcare system as one designed to protect and improve health.

“This crisis is a cause for major self-evaluation when we get out of the tunnel,” Dr. Nash says. “The healthcare system is not designed to improve health and not designed to protect health. This is a huge failing and a call for a major re-evaluation of the system. This is not meant to scare people. Everybody is going to have a voice in this important conversation, which I hope we’ll be able to have this summer.”

To describe the importance of flatting the curve, he shared explainers by Dr. Asaf Bitton, executive director of Ariadne Labs in Boston, and Dr. John Peabody of QURE Healthcare as the best he’s read regarding COVID-19 to date.

“Our health system will not be able to cope with the projected numbers of people who will need acute care should we not muster the fortitude and will to socially distance each other starting now,” writes Dr. Bitton of the essence of flatting the curve. “The only strategies that can get us off this concerning trajectory are those that enable us to work together as a community to maintain public health by staying apart.”

People practicing social distancing on the train

Dr. Peabody delves into the uncertainty related to those projections.

“There are two critical pieces of missing information: What is the natural history of the disease in our neighborhoods? The answers will come from expanded testing, which should accelerate this week and next,” Peabody writes. “The other thing that we will learn is how effective we have been in our neighborhoods at adopting the classic public health measures of social distancing, quarantine and tracing infectious sources. We know from other countries that these measures work.”

Building on that baseline of factors, Dr. Nash explains flattening the curve at its definitional essence.

“What we’re trying to do here is delay everyone coming to the healthcare system at the same point in time,” he says. “It’s not a new phrase. It’s been in medical literature for a long time, but it’s getting more attention now. The best way to describe it so people truly can appreciate it is that it’s a delaying tactic to hold off a crowded and overwhelmed emergency department. It’s a way to parcel out time and energy available from the system to care for patients.”

The hope is that social distancing and other precautionary steps prove effective in helping healthcare professionals do their jobs effectively.

We bought ourselves two weeks by shutting down. If we don’t do this, we will become Italy, where life-and-death decisions are being made in triage tents. We cannot get to that point. –Dr. David Nash

“If we’re able to flatten the curve, people should be able to get the care they need when they need it,” Dr. Nash says. “If we fail to do this, everyone will come for treatment at once and no one will get the care they really need. It is similar to the ‘tragedy of the commons.’ If everyone plants his plants at the same time, no plants will grow. If we are respectful of the system, everyone will be fed.”

“If everyone cooperates, they will get the great Jefferson care that they need,” Dr. Nash continues. “If everyone acts selfishly, we will all suffer. If we don’t follow the rules, we will overwhelm the exact people we need to help us. It’s not that complicated.”

On the plus side, he believes experts have done a good job explaining how flattening the curve works. However, in a city featuring both a wealth of healthcare options but high levels of poverty, he worries about how strictly the messages have been adhered to.

“Everyone who went to the bar around Saint Patrick’s Day puts the rest of us at risk,” he says. “We bought ourselves two weeks by shutting down. If we don’t do this, we will become Italy, where life-and-death decisions are being made in triage tents. We cannot get to that point. Just look at Italy beyond what you see on TV, doctors making decisions on who will get a ventilator and who won’t. We don’t want it to ever come to that in Philadelphia.”

To that end, Nash says the next two weeks are critical.

“We are hoping to cut it off at the pass, with everybody working together to obey the rules,” he says.

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