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 dayon-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.