The Coronavirus: Flattening The Curve

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As viruses spread, they tend to infect increasing numbers of people at high rates. The initial side of the curve over time, or rate of new infections, will naturally increase rapidly as more and more people are infected. If left unchecked, the total number people requiring health care will quickly rise well above the capacity of our US health care system.

By taking certain steps – canceling large public gatherings, for instance, and encouraging some people to restrict their contact with others – governments have a shot at stamping out new person-to-person transmissions, while also trying to mitigate the damage of the spread that isn’t under control.

The epidemic curve, a statistical chart used to visualize when and at what speed new cases are reported, could be flattened, rather than being allowed to rise exponentially. “If you look at the curves of outbreaks, they go into big peaks, and then come down. What we need to do is flatten that down,” stated Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases. “That would have less people infected. That would ultimately have less deaths. You do that by trying to interfere with the natural flow of the outbreak.”

Stop the spread of coronavirus by flattening the curve

The notion that the curve of this outbreak could be flattened began to gain credence after China took the extraordinary step of locking down tens of millions of people days in advance of the Lunar New Year, to prevent the virus from spreading around the country from Wuhan, the city where the outbreak appears to have started.

The quarantines, unprecedented in modern times, appear to have prevented explosive outbreaks from occurring in cities outside of Hubei province, where Wuhan is located.

Since then, spread of the virus in China has slowed to a trickle; the country reported only 19 cases on March 9th. And South Korea, which has had the third largest outbreak outside of China, also appears to be beating back transmission through aggressive actions. But other places, notably Italy and Iran, are struggling.

On any normal day, health systems in the United States typically run close to capacity. If a hospital is overwhelmed by Covid-19 cases, patients will have a lower chance of surviving than they would if they became ill when the hospital’s patient load was more manageable. People in car crashes, people with cancer, pregnant women who have complications during delivery – all those people risk getting a lesser caliber of care when a hospital is trying to cope with the chaos of an outbreak.

“I think the whole notion of flattening the curve is to slow things down so that this doesn’t hit us like a brick wall,” said Michael Mina, associate medical director of clinical microbiology at Boston’s Brigham and Women’s Hospital.

“It’s really all borne out of the risk of our health care infrastructure pulling apart at the seams if the virus spreads too quickly and too many people start showing up at the emergency room at any given time.”

The U.S. has about 2.8 hospital beds per 1,000 people (South Korea and Japan, two countries that have seemingly thwarted the exponential case growth trajectory, have more than 12 hospital beds per 1,000 people; even China has 4.3 per 1,000). With a population of 330 million, this is about 1 million hospital beds. At any given time, about 68% of them are occupied. That leaves about 300,000 beds available nationwide.

Most people with Covid-19 can be managed at home. But among 44,000 cases in China, about 15% required hospitalization and 5% ended up in critical care. In Italy, the statistics so far are even more dismal: More than half of infected individuals require hospitalization and about 10% need treatment in the ICU. As cases spiked, Italian hospitals quickly couldn’t keep up with the patients coming in.

Countries and regions that have been badly hit by the virus report hospitals that are utterly swamped by the influx of sick people struggling to breathe.

Alessandro Vespignani, director of the Network Science Institute at Northeastern University, is gravely worried about what he’s hearing from contacts in Italy, where people initially played down the outbreak as “a kind of flu”. Hospitals in the north of the country, which the virus first took root, are filled beyond capacity, he said.

By limiting exposure to others, also known as “social distancing“, epidemiologists believe the curve could be meaningfully flattened. Social distancing means avoiding contact with others. This is crucial from a global health perspective. Limiting coronavirus cases not only has the obvious benefit of keeping the elderly and vulnerable safe, but it lessens the single biggest public health issue: overwhelmed hospitals.


Why should you get the flu vaccine?

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By Ben Hess, M.D., Chief Medical Officer

 

As we look ahead to peak influenza season in Minnesota, now is a good time to consider getting your annual flu vaccine. The vaccine is absolutely safe and can protect you from contracting the virus and suffering severe symptoms that can put you down and out for one to two weeks.

 

Cold and Flu Season Street SignAbout this year’s vaccine

This year’s vaccine contains four strains of influenza, including H1N1 or swine flu. The strains included in the vaccine change every year based on extensive research and well-documented flu migration patterns in other parts of the world.

On average, about once every seven years, there is a bad match or the virus changes from the time of production to when flu season actually arrives. This is why the vaccine is not very effective some years.

In the U.S., the peak flu season is approximately November to February. However, in Minnesota, the peak is from January to February. The virus typically affects coastal states and large metro areas first, which is why I recommend that snowbirds and those who travel get their vaccinations early.

Check out this map that shows the steady progression of the virus.

 

Feeling sick after getting the vaccine?

One argument I commonly hear for why people opt out of the flu vaccine is they are worried they will get the flu from the vaccine. Here are some important things to consider:

Dead virus. The flu vaccine that we give here at TCHC is a dead virus. You would never get the flu from this vaccine.

Delayed effect. The vaccine takes about two weeks to become fully effective. It is possible to contract the flu in this time period, which is why it’s important to get the vaccine early.Sick woman sneezing to tissue. Medicine, hot beverage and dirty paper towels in front. Girl caught cold. Cough syrup and handkerchiefs on table. Very ill person feeling bad and having fever.

Specific strains. The vaccine contains specific strains of the flu that researchers believe will be most prevalent during the current season. It is possible to contract a strain that is not included in the vaccine.

No response. A certain percentage of people simply don’t respond to the vaccine. The reasons are unclear, and because the vaccine changes every year, it is hard to research.

Already infected. The flu has an incubation period of up to four days. If you were already infected with the flu before you get the vaccine, then the vaccine will be ineffective.

Immune response. It is possible to have an immune response to the vaccine, which can give you muscle aches and pains or a mild fever for two to three days. This is reassuring because it means your immune system is responding to the vaccine and you are likely more protected from the flu.

 

Influenza – a serious illness

Influenza is extremely contagious and is spread through droplets when people talk, sneeze or cough. Typical symptoms last about one week and include high fever, muscle aches, upper respiratory infection and fatigue. Most people will experience weakness and fatigue for another one to two weeks after the actual illness.

Those most at risk are the elderly, people with weakened immune systems and children, especially infants younger than 6 months old because they can’t be vaccinated.

Flu vaccine calendar noteTo a certain extent, the younger you are, the more severe your reaction will be. Most symptoms that come from the flu are caused by your immune system, so the healthier your immune system, the potentially more severe your symptoms will be.

If you come down with the flu, your best course of action is to stay home from work or school, drink plenty of fluids, get lots of rest, and take anti-inflammatory medications such as Ibuprofen or Aleve.

The flu is also a fairly significant cause of mortality in the U.S. From the 1976-1977 season to 2006-2007 season, flu-associated deaths ranged from as low as 3,000 to as high as 49,000 annually, according to the CDC’s Morbidity and Mortality Weekly Report.

Because the severity of the virus is unpredictable, I highly recommend getting the vaccine as soon as is convenient for you. By doing so, you potentially avoid illness for yourself while ultimately preventing the spread to vulnerable individuals.

 

For additional information about influenza, visit www.cdc.gov.

 

About the Author: A board-certified family practitioner and Chief Medical Officer at Tri-County Health Care, Ben Hess, M.D., was inspired to study medicine because he wanted to make a difference in people’s lives every day. While not at work, Hess enjoys hunting, fishing, bowling and listening to public radio. He and his wife have three daughters and make their home in Verndale.Dr. Hess