Flattening the curve

In a widely shared graphic, a tan curve represents a scenario without social distancing measures and where the U.S. hospital system becomes inundated with coronavirus patients.

 Many individuals saw their hours cut or were laid off all together when Governor John Bel Edwards mandated that certain businesses, especially those in the hospitality world that draw huge crowds, be closed.

All due to the coronavirus.

Those businesses and gathering sizes included:

  • Gatherings are limited to no more than 50 people.
  • Casinos and bars will be closed.
  • Restaurants will be closed to patrons eating on site. Take-out, drive-through and delivery orders are allowed.
  • Movie theaters will be closed.
  • Gyms and studios

Social distancing helps 'flatten the curve,' the governor explained, which allows health care infrastructure to keep up with demand. One of the main concerns from health care providers is the lack of Intensive Care Unit beds, as well as ventilators to help combat the pneumonia portion of the virus.

Good practices for social distancing and hygiene include:

  • No gatherings of 10 or more
  • Wash hands for 20 seconds or more
  • Sneeze and cough into a tissue or elbow
  • Disinfect common surfaces

But why? A Harvard doctor gives his opinion on social distancing.

The original statement from a 'respiratory therapist from Nashville' could not be cited appropriately and has been removed from this story.

From Dr. Asaf Bitton, MD, MPH (physician and public health leader from the Harvard School of Public Health) on social distancing:

“I know there is some confusion about what to do next in the midst of this unprecedented time of a pandemic, school closures, and widespread social disruption. I have been asked by a lot of people for my opinion, and I will provide it below based on the best information available to me today. This is my personal and well-informed opinion, and my take on the necessary steps ahead.

What I can say as a physician and public health leader, is that what we do, or don't do, over the next week will have a massive impact on the local and perhaps national trajectory of coronavirus. We are only about 11 days behind Italy and generally on track to repeat what is unfortunately happening there, as well as much of the rest of Europe very soon. At this point, containment through contact tracing and testing is only part of the necessary strategy. We must move to pandemic mitigation through widespread, uncomfortable, and comprehensive social distancing. That means not only shutting down schools, work (as much as possible), group gatherings, and public events. It also means making daily choices to stay away from each other as much as possible to Flatten The Curve (see below).

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. On a regular day, we have about 45k ICU beds nationally, which can be ramped up in a crisis to about 93k. Even moderate projections suggest that if current infectious trends hold, our capacity (locally and nationally) may be overwhelmed as early as mid-late April. Thus, the only set of interlinked strategies that can get us off this concerning trajectory is to work together as a community to maintain public health by staying apart.

The wisdom, and necessity, of this more aggressive, early, and extreme form of social distancing can be found here. I would urge you to take a minute walking through the interactive graphs - they will drive home the point about what we need to do now to avoid a worse crisis later.

So what does this enhanced form of social distancing mean on a daily basis, when schools are cancelled?

I can suggest the following:

1. No playdates, parties, sleepovers, or families visiting each other's houses. This sounds extreme because it is. We are trying to create distance between family units and between individuals across those family units. It is uncomfortable, especially for families with small children or for kids who love to play with their friends. But even if you choose only one friend to have over, you are creating new links and possibilities for the type of transmission that all of our school/work/public event closures are trying to prevent. The symptoms of coronavirus take 4-5 days to manifest themselves. Someone who comes over looking well can transmit the virus. Sharing food is particularly risky - I definitely do not recommend that people do so outside of their family. We have already taken extreme social measures to address this serious disease - let's not actively co-opt our efforts by having high levels of social interaction at people's houses instead of the schools. Again - the wisdom of early and aggressive social distancing is that it can flatten the curve above, give our health system a chance to not be overwhlemed, and eventually may reduce the length and need for longer periods of extreme social distancing later (see what has transpired in Italy and Wuhan). We need to all do our part during these times, even if it means some discomfort.

2. Take walks/runs outside, but maintain distance (ideally 6 feet between people outside your family). Try not to use public facilities like playground structures as coronavirus can live on plastic and metal for up to 3 days, and these structures aren't getting regularly cleaned. Try not to have physical contact with people outside of your family. Going outside will be important during these strange times, and the weather is improving. Go outside every day if you can but stay physically away from others. Try not to have kids play with each other (even outside) if that means direct physical contact. Even basketball or soccer involve direct contact and cannot be recommended. If people wish to go outside and have a picnic with other families, I strongly recommend keeping distance of at least 6 feet, not sharing any food at all, and not having direct physical contact. Invariably, that is hard with kids, so these shared, "distant" picnics may be tricky. Do not visit nursing homes or other areas where large numbers of the elderly reside, as they are at highest risk for complications and mortality from coronavirus. We need to find alternate ways to reduce social isolation in these communities through virtual means instead of physical in-person visits.

3. Reduce the frequency of going to stores/restaurants/coffee shops for the time being. Of course trips to the grocery store will be necessary, but try to limit them and go at times when less busy. Consider wearing gloves (not medical - but perhaps washable) and of course washing hands before and after really well. Leave the medical masks and gloves for the medical professionals - we need them. Maintain social distance from folks. Take-out meals and food are riskier than making food at home given the links between the people who prepare food, transport the food, and you. It is hard to know how much that risk is, but it is is certainly higher than making it at home.

4. If you are sick, definitely stay home and contact a medical professional. If you are sick, you should try isolate yourself from the rest of your family within your house as best as you can. If you have questions about whether you qualify or should get a coronavirus test, you can call you primary care team and/or consider calling the Partners Health Care hotline staffed 8AM-8PM every day - 617 724 7000, or the Massachusettes department of public health at 617 983 6800. Don't just walk in to an ambulatory clinic - call first. Obviously if it is an emergency call 911.

5. We need to push our local, state, and national leaders to close ALL schools, events, gatherings, and public spaces now. A local, town by town response won't have the needed effect. We need a statewide, nationwide approach in these trying times. Contact your representative and the governor to urge them to enact statewide closures. As of today, 6 states had already done so. We should be one of them. Also urge them to fund emergency preparedness and make increasing coronavirus testing capacity an immediate and top priority.

I realize there is a lot built into these suggestions, and that they represent a real burden for many people, businesses, and communities. Social distancing is hard and may negatively impact others, especially those who face vulnerablities in our society. I recognize that there is structural and social inequity built in and around social distancing recommendations. We can and must take steps to bolster our community response to people who face food insecurity, domestic violence, and housing challenges, along with the many other social inequities.

I also realize that not everyone can do everything. But we have to try our absolute best as a community, starting today. It is a public health imperative. If we don't do this now voluntarily, it will become necessary later involuntarily, when the potential benefits will be much less than doing so right now. “

(5) comments

worldwidethunder

I keep seeing this post and it reads the same, but I have been trying to track its origins (in your post, it is attributed to "Ryan Beaumont," and, as I near as I can tell, he is actually a Registered Respiratory Therapist and COPD Educator) according to LinkedIn

But, it was published yesterday on Tom King's blog for WSAU Wausau, WI and attributed to a "Kat Storti," here:

https://wsau.com/blogs/tom-kings-blog/54/its-not-just-the-flu/

So I finally found a fb post from March 13 from a Kimberly Dawn Barker, an RN in Oakland, CA, that seems to have started it all here:

https://www.facebook.com/Sailboatdog/posts/3051612344906616?hc_location=ufi

While most of the information is pretty benign and actually makes a lot of common sense, there is a lot wrong with it as well. Novel viruses do not, by definition, come from animals (that's a "zoonotic disease"; a "novel virus" is a new one). RNA sequencing has little to do with how well the body's immune system deals with an infection (though prior exposure does). "Slippery" does not refer to the speed at which a virus mutates, but rather a structure within RNA where frame shifting events occur. And two strains do not necessarily make it "twice as hard" to develop a vaccine; vaccines sometimes work for different strains of the same flu (depending on how large the mutation is).

The oddest thing is, twice I have seen this attributed to people by, at least, semi-reputable sources (The Livingston Parish News in your post and WSAU in Wausau, WI). From what appears to have been a facebook post from an RN in Oakland. Which leads me to believe reporters are just pulling sh*t off their friends facebook pages because it "sounds about right" and reporting it as authoritative.

You need to do better.

TNBassGirl

I just completed tracing the same path. This article is most definitely plagiarism. In the words that I saw, the piece was attributed to a virologist from Johns Hopkins. And you're right about Ryan Beaumont, a BS in respiratory therapy. I appreciate your clarification on the Novel Virus WorldWideThunder. I will continue to try to search for verified facts.

Lynkim1

David, would you mind if I copied your response (with a link to your message) to respond to the people who keep sharing this rubbish with me on facebook?

I have no formal qualifications at all, I am just a stay at home mum to 5 pretty smart kids, but I still know enough to see how wrong the information in the post was.

Lyn Morgan

lynkim1@gmail.com

DanOfOmaha

WWT - I'd love to have you listen to a Fox MD and tell me if it's BS. How do I contact you?

Will Cooke

Yes, please, help those scientifically-un-inclined of us to best understand this better. It is written well enough to make a layman like myself consider it to be credible information. Thank you. Be well.

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