Since most states are rolling out prolonged (i.e 30 day) “Safer at Home” legislature and laws, I started to have some great conversations with people in my family and various past relationships. As a physician, I often get questions about various symptoms and rashes, but the topic of discussion recently has been on COVID-19. When I have conversations with both non-medical and medical people there is one major discussion point that continues to come up which is around the COVID-19 case number and why everyone is focused on “the curve”.
If you look through media posts and if you truly listen to medical experts, they use specific language as it relates to “Flattening the curve” and they are not saying phrases like “reducing total infections” or “reducing total number of deaths.” I would like to clarify this use of “Flattening the curve” so that my friends, neighbors and community have a deeper insight regarding the goal as stated by government and healthcare leaders.
It needs to be said that over the past 10 years hospital management has become a business to optimize patient care and optimize patient reimbursement with the goal of maximizing “per-bed” value. At baseline and over the past 12 months the hospital I work at has been at or above 92% capacity nearly every hour of every day. This is great for business when it comes to the hospital financial responsibility of paying bills and paying employees, but it limits the needed flexibility when it comes to a pandemic-level response of this nature. It is important to note that if you take the entire US population and you take an average of 50% infection of this population there will be a relatively small number of people who need hospital intervention and the vast majority of infections will be managed with Tylenol via an outpatient/telemedicine provider.
Since this virus is so efficient at spreading AND it is contagious prior to symptoms (survival of the fittest type of virus) it is reasonable to think that at least 50% of the US population will be infected over the next 3-6 months however we will never know the actual number due to lack of testing given the current supply limitation. Recently a study in Spain showed that nearly 70% of people who had the infection never had more than dry cough and a low grade fever for 1-2 days.
The sole purpose of the “flatten the curve” movement is to allow the hospitals to care for the critically sick patients but it is anticipated that the Area under the Curve (i.e. the total number of infections) will remain close to the original estimates even with social distancing and “Safer at Home” legislation. As a result of flattening the curve, this means that we will be seeing high levels of infections for the next several months instead of a peak of infections within a short period of time. As a healthcare employee I am actively seeing the hospital and the ICU fill up with COVID-19 patients but in general the critically sick percentage is relatively low at 3-5% of total infected individuals. We are seeing a 1-2% death rate of total infected however these patients are dying even with available ICU beds in the hospital which is critical to monitor. The point at which people are dying due to lack of ICU beds in a given city is the ultimate purpose of flattening the curve and it is the point in which we are trying to avoid through the use of social distancing.
While I have mixed feelings about the use of “Safer at Home” state-based mandates, I want to be clear that the use of the phrase “Flatten the Curve” is intentionally being used because of the potentially devastating effect this virus can have on the hospital system if in fact all critically ill patients were infected within a 2 week window of time. The current drive for social distancing is not to reduce overall infection, but it is to allow the healthcare system to care for the patients who are critically sick from COVID-19 in the best way possible with the assumption that non-COVID-19 patients are also being cared for in the best way possible without resource limitation. The unreported deaths related to COVID-19 will be due to non-COVID-19 patients who are not given proper standard of care due to lack of resources. This number will never truly be known, but if we can keep the critically ill patients within a manageable level, I have faith that the hospital systems will minimize these death rates. The ultimate measure will be in reducing the death rate due to lack of beds available in any given hospital.