Irfan Dhalla is a general internist and Vice-President of Physician Quality, and Director of the Care Experience Institute at Unity Health Toronto.
I emailed 10 people on Monday morning – 5 physicians and 5 people who don’t work in health care – and asked them each to say, in one sentence, what the term “flattening the curve” meant to them.
By Tuesday morning I had 9 responses. Most were similar to this:
“Flattening the curve means we have a steady number of new cases of Covid-19 per day, that isn’t increasing day-on-day, and that the spread of infection is sustained but manageable, and it isn’t going to overwhelm our healthcare system.”
By that definition, we’ve succeeded. We have flattened the curve of incident cases.
In Ontario, the number of new cases per day has stabilized, as has the number of patients with COVID-19 being cared for in hospital. Some Canadians have sacrificed much more than others to achieve this success, but we all deserve to give ourselves a pat on the back. Our success, as we all know, has come at a huge cost. We no longer allow people to visit loved ones in hospitals. We’ve dramatically scaled back elective surgeries. We’ve closed schools. Many people have lost their jobs.
Some people believe that our recent success means we can relax restrictions. The governor of Georgia recently announced that hair salons, fitness centers and restaurants in the state can all re-open, even as cases in Georgia continue to increase. While it’s easy to look south of the border and think that we wouldn’t be as foolhardy in Canada, the premier of Ontario has said, “I’m getting lobbied hard by so many groups and organizations saying Open, Open, Open.” Fortunately, he and other Canadian leaders have resisted these lobbying efforts so far.
We should be proud of our collective achievements. We have avoided a New York- or Italy-style crush on our hospitals.
But lasting success will not come from flattening the curve of incident cases. Lasting success will come when we flatten a different curve: the curve of cumulative cases.
One of the people who replied to my email recognized this. His straightforward response: “Flattening the curve if it applies to total cases means there are no new cases.”
He’s right. “No new cases” has to be the goal.
Sure, we might have to live with occasional outbreaks here and there, but the goal has to be that where you live, on more days than not, there are no new cases.
Only “no new cases” will allow us to relax most restrictions. The slogan “no new cases” is one that can be applied locally. If there are no new cases in Thunder Bay but ongoing outbreaks in Toronto, children in Thunder Bay can probably go back to school while children in Toronto will have to stay at home.
The World Health Organization says that success means that “transmission [needs to be] controlled to a level of sporadic cases and clusters of cases.”
I interpret that as “no new cases” in most communities on most days.
If we do that then we will have flattened the curve that really matters.
The whole effort to “flatten the curve” (and the virtue signalling around it in the media and social media) also assumes that there are no ill effects to the lockdown. Here in NS we have clearly had more “lockdown-induced deaths” than COVID deaths. The lockdown deaths are often in young people with many QALY potentially ahead of them, whereas the COVID deaths have been almost entirely in NH patients who are in the last months or year of their life. I’m not sure if we’ve made an intelligent bargain, even if it feels virtuous. Estimates as of a few days ago were that 35 people have died in Ontario due to waiting longer for cardiac surgery. Extrapolate that number to waits for cancer care, transplants, knee and hip replacements, heart and lung rehab, etc…..
This is a shockingly naive and dangerous opinion piece that shows no understanding of viral transmission in the context of respiratory viral infections. Dr. Dallah’s goal of total eradication is impossible and even if it were, it would need to be at the cost of our entire world. This desire for no new cases flies in the face of what we know about this virus, which is that it is much less deadly than initially predicted by flawed mathematical models, more in line with annual influenza. We need to protect at specific risk populations and the health care system, and let this virus move through our population in a manageable way.
I agree Dr Dallah that no new cases would be a clear indication that we can open up but is there an example of a country with Canadian style distancing measures that has been able to achieve this? It is a great goal but it is a daunting one.