#flattenthecurve is the synonymous hashtag for the coronavirus pandemic. This concept has been making the rounds because it easily communicates our options for dealing with a public health crisis. Each choice comes with its own perils.
The problem
This pandemic caught the world off guard. A few countries were the unlucky ones to get hit with this crisis first. We should learn from their experience to better prepare ourselves.
China, Iran and Italy have been hit hardest. It’s hard to trust the information coming out of China and Iran, but we should watch Italy’s experience with Covid-19 closely. Italy, population 60 million, is a modern Westernized democratic society much like Canada. It has the eighth largest economy, Canada is tenth.
Roughly three weeks ago Italy had 322 confirmed cases of coronavirus.
A week later it was 2,502.
On March 11 it was 10,149.
As of March 19, it was 35,000.
Exponential growth is a scary thing. This spike in sick people has already overwhelmed the Italian healthcare system in some areas. For those critically ill there aren’t enough ventilators to help them breathe. Doctors are making hard decisions about who gets one and who doesn't.
Our options
We can hopefully avoid a similar situation. The travel bans and social distancing measures are hoped to slow the spread enough so that not everyone gets sick at the same time. However, these mitigation measures essentially shuts down large parts of the economy.
In either scenario the number of infected people may not change. Even with mitigation measures the number of cases will grow, only more slowly. The latter buys us more time. More time gives our healthcare system the ability to treat the sick. More time to increase our capacity to treat this illness. More time to develop and mass produce a vaccine.
Effect of different measures. Imperial College COVID-19 Response Team
The collateral damage to the economy and our social lives may be so severe that it may cause us to rethink this calculus. The slower the spread the longer we face economic pain. Most businesses will see a reduction in sales and revenue. This will be especially tough on small business and the self-employed. Governments are asking many of us for a serious sacrifice and it’s not clear how we’ll be able to help those negatively affected. Many families live month to month. There will be a serious short term money crunch for many. As of March 18, both provincial and federal governments have announced extensive supports to individual families. Earliest supports will be available next week.
The economic and social cost of these mitigation measures should not be underestimated. How our governments try to help those economically affected will be an evolving story.
Dr. Neil Ferguson, part of the Imperial College Covid-19 Response Team, authored a forecast being relied upon by the British and American governments. “We don’t have a clear exit strategy,” Dr. Ferguson said of the recommended social distancing measures. “We’re going to have to suppress this virus until we have a vaccine.”
How serious is Covid-19?
The average fatality rate for Covid-19 ranges from 0.5% to 3%. Mortality depends on a number of factors:
If the healthcare system is overwhelmed the mortality rate for Covid-19 (and every other sickness) goes up.
Older adults and people with compromised immune systems are at high risk with fatality rates of 8-9%.
In comparison, Ebola's mortality rate is 50%. But what makes a virus successful? If a virus kills the host more efficiently does that make it a better pathogen? Should we fear Ebola more than Covid-19?
The goal of every living being is to survive and reproduce. From this perspective Covid-19 is way more successful than Ebola. It may be milder than Ebola, but Covid-19 has already killed 4x as many people as Ebola did in 2014.
The relative mildness of Covid-19 is its secret weapon. The milder the disease, the easier the spread. With more serious diseases the symptoms are easily visible and identification and quarantine is easier. Some infected with Covid-19 barely knew they were sick.
Most of us don’t have to worry about dying from Covid-19. But the mild symptoms means that we’re likely to spread the virus to our parents or grandparents or other loved ones susceptible to the disease. Those with immune deficiencies can be seemingly young and healthy, but invisibly at risk. I’m not worried about myself. I am worried for my wife and my parents. The bravado of those not worried about Covid-19 aren’t thinking about vulnerable members of their extended family. That’s who we’re trying to protect.
Comparisons with the flu
Do the projected deaths from Covid-19 outweigh the economic losses from mitigation measures? It’s a tough question, but governments must perform these types of social calculus.
34,000 people died in America in 2019 from the flu and 60,000 died from it the year before. However, because Covid-19 is a new disease we don’t know exactly how many lives it will claim. So it’s hard to know where the line is—between overreacting and underreacting is. We do know that Covid-19 spreads easier than the flu and has a higher mortality rate.
We’ve gotten used to influenza in our lives, but with Covid-19 we haven’t yet conceded this war. Humanity is trying to stop a new disease from permanently entering our lives. But there is a good chance Covid-19 will become another disease we have to continually fight.
How does Covid-19 spread?
Information from Alberta Health and the Centre for Disease Control in America:
Covid-19 is transmitted mainly through person-to-person contact:
Between people who are in close contact with one another (within about 6 feet). Through respiratory droplets produced when an infected person coughs or sneezes. These droplets can land in the mouths or noses of people who are nearby or be inhaled into the lungs. (This is why social distancing helps reduce transmission risk.)
Covid-19 is not airborne and cannot spread through the air over long distances or times, like the measles.
The virus generally only survives for a few hours on a surface. It may be possible that a person can get Covid-19 by touching a surface or object that has the virus on it and then touching their own mouth, nose, or possibly their eyes, but this is not thought to be the main way the virus spreads. Increased cleaning measures in public spaces have been instituted to further minimize this risk.
People are thought to be most contagious when they are most symptomatic (the sickest).
Some spread might be possible before people show symptoms; there have been reports of this occurring with this new coronavirus, but this is not thought to be the main way the virus spreads.
Local measures
Alberta Health has the lead in coordinating our community’s response to the coronavirus. City Hall works with them and assists however we can:
Check here for up-to-date information from Alberta Health.
It has a helpful online self-assessment tool to ease the burden on 811-Healthline. Keep in mind phone services are overwhelmed. The self assessment tool will communicate testing options to you if required. Alberta Health Services is currently testing 1,000 samples daily.
Medicine Hat has its first confirmed case, but the risk remains low.
The City of Medicine Hat has initiated its emergency planning measures. We closed recreational facilities when the order to close schools came in. Otherwise we would have seen an increase in traffic to recreational centers. The subsequent crowds would have defeated the purpose of disbanding schools.
To reduce the risk of any disruption to essential city services we’ve implemented procedures to protect staff in those departments. Check this page for up-to-date city information.
Risk literacy
Older adults and those with pre-existing medical conditions.
You are at a higher risk. Given that this situation will play out over months not weeks, it’s not practical to expect everyone at risk to self-isolate. Follow Alberta Health guidelines. Understand how the virus spreads and what you can do to minimize your risk.
Talk to your employer about options and precautions. If you are concerned about running an errand, call ahead to the business to get a sense of when might be a good time to come. Some stores are running hours only for older adults. There are community groups like this Facebook page with people who want to help.
Local senior residences as well as Alberta Health Services have implemented stricter controls for visitors. At risk populations should take greater measures.
Young and healthy.
Your risk is lower, but not zero. If you’re young and healthy what is the right balance to strike with this situation? Perspective is important. Your goal is to not be a community spreader, but that doesn’t mean you can’t leave the house. Practically, we all need to continue with our lives as best we can, while following Alberta Health guidelines. When you are out, just remember how the virus is spread and how to lessen the risk of community spread. When you visit your older relatives be mindful.
Good self discipline for basic hygiene and social distancing can greatly help.
Hoarding
The natural herd panic has helped us in a way. The sometimes hysteria of media reports or Facebook comments have made everyone take this issue seriously. The downside of this reaction is no toilet paper on the shelves. The run on toilet paper has spread to many communities because it has been hard to contextualize the nature of this risk.
Let’s say the number of cases exploded in Medicine Hat similar to what we see in Italy. Italy has instituted the harshest conditions of any open democractic country, but still allows people to travel to and from work. Bars and restaurants are closed, but grocery stores remain open. So even if things get worse you’ll be able to get your essential supplies. There are no issues with supply chains. The supplies of toilet paper should return to normal soon.
Next two months
We should be careful about making too many predictions about the future right now. Things are moving too quickly and we don’t have enough information yet. We will have a better idea of the effectiveness of current social distancing measures in two weeks.
A sobering thought from the Imperial College Covid-19 Response Team. “No public health intervention with such disruptive effects on society has been previously attempted for such a long duration of time,” they added. “How populations and societies will respond remains unclear.”
The challenge with this pandemic is that social distancing works opposite to our natural instincts in an emergency. This will make it difficult to sustain this social distancing behaviour over months. That plus the building economic pain might get society to re-balance our response to this epidemic.
Best case scenario is that in two weeks the number of cases slow down and we can think about tweaking our mitigation measures. Remember we’re trying to buy time for our healthcare capacity to expand and for a vaccine to be developed. Until then we’ll have to choose what concessions to make to our normal lives.
The slow moving crisis will make people restless. Like any plan we will constantly review and reassess. Government help will not reach some people and it would be helpful to identify those that are falling through the cracks. Consumer confidence has taken a serious hit. It will take time to recover.
Small businesses and the self-employed are the most vulnerable. Buying gift cards to support them would help. Your favourite restaurants are still open. If you’re not comfortable sitting down and eating you can order take out. That would help them survive this period.
Of course you could make the argument that the economic pain of these countermeasures isn’t worth the lives we save. Society always balances public safety with economic efficiency. Neither choice in dealing with this pandemic is good.