Too late for containment, now we must flatten the curve of COVID19

We are past the point of containment, COVID19 is here. A travel ban from Europe (announced by Trump) is useless. It will cause harm by  diverting resources from truly effective measures. Yes, travel bans cost money and resources to implement, money and resources better spent elsewhere.

Experts advise that we must flatten the curve of COVID19 spread to prevent overwhelming our medical facilities and personnel. The US has a finite number of ICU beds, hospital beds, doctors, nurses and technicians. In fact the number of hospitals and hospital beds has dropped considerably compared to other countries.


“The limits of America’s hospital system are an unexpected downside of progress in efficiency, advances in technology and pharmaceutical breakthroughs that have made it easier to keep patients out of the hospitals. Insurers have accelerated the trend by steering patients to less-costly care, pushing for more procedures to be done on an outpatient basis, often outside hospital walls. The number of hospital beds—and hospitals—has contracted in recent decades, dropping 16% and 12%, respectively, between 1975 and 2018, according to survey data from the American Hospital Association. 

After years of consolidation and scaling back on construction, with the sector pouring more capital into outpatient centers, the system has less capacity for surges in demand.

U.S. hospital beds per American have declined in the past two decades to a ratio of 2.8 beds for every 1,000 people as of 2016. That ranks among the lowest across comparable countries, a Kaiser Family Foundation analysis of Organization for Economic Cooperation and Development data shows. The average across those countries, including Japan, Germany and Australia, is 5.4 beds per 1,000 people.”

So what does it mean to “flatten the curve?

We must take measures that will slow down the rise of cases and flatten the peak so that our resources can handle a lower and more widely spread peak. There will be a critical point where if more sick cases appear not everyone will get the care they need (no more ventilators, no more ICU beds, etc.) That point is represented by the Health care system capacity line below.

flatten curve 3.png


Social distancing includes avoiding crowded spaces such as theatres, museums, concerts, public gatherings. What size constitutes a “crowd”? The cutoff is arbitrary. The NBA and NHL have canceled their seasons. NYC has closed museums and Broadway theatres are closed. More stringent social distancing closes smaller venues. This sort of activity requires effective leadership which presently is coming from states and local governments. (Trump has failed to lead us. He has ignored and contradicted expert opinion from CDC etc. More about that another time.)


As indicated in the above graph depicting flattening the curve, we as individual citizens can help flatten the curve.

  1.  Wash hands frequently (at least 20 seconds with soap and water)
  2.  Work from home whenever possible
  3.  If you are sick, stay at home, do not spread the virus.
  4.  Cover your nose and mouth with your arm when coughing or sneezing
  5.  Immediately dispose of used tissue paper.

Many people do not have paid sick time. That is why immediate federal legislation to support sick people so they can stay home is vitally important. That leadership is thankfully coming from Nancy Pelosi.

FROM NPR: “House Speaker Nancy Pelosi says her chamber will move forward Friday with a legislative package to handle the coronavirus pandemicthough Republicans don’t fully support it. The deal taking shape includes paid sick leave, nutrition aid and assistance for states, including unemployment and Medicaid costs.”

THESE MEASURES ARE VITALLY IMPORTANT. WHEN FACED WITH A DECISION TO STAY HOME WHEN SICK MEANS NO FOOD ON THE TABLE AND NO RENT CHECK, PEOPLE ARE MORE LIKELY TO MAKE THE DECISION TO FEED THEIR FAMILY and go to work. But that will expose others to the virus and cause a peak in infections, potentially overloading our medical system. The federal government must take measures that make it economically possible for sick folks to stay home and avoid rapidly infecting others.

Closing schools and shifting to on-line classes can help slow the spread.

FROM NPR: Every day for the past week, more than 100 colleges and universities around the country have canceled in-person classes and have taken the unprecedented step of moving classes online

This is an important example of social distancing.

From NPR: “According to a report in Education Week, at least 10,600 schools have been closed or are scheduled to close for several weeks. That is a small but quickly growing fraction of the approximately 50 million K-12 students in the United States.”

But closing K-12 places some children at increased risk as discussed below.


FROM NPR: The Life Kit team looks at what you need to know about working from home and parenting young children.

And from that website link here are some important quotes.

“Luckily, public health officials in King County, Washington, offer this helpful guidance:

“Social distancing doesn’t mean you have to stay stuck in your house. … The current recommendation is to avoid large groups. That mostly means groups over 50 people but conservatively means anything more than 10 people. However, if you don’t fall into the high risk group, you can still certainly visit each other.”

Think of it as a good opportunity for one-on-one hangouts.

  1. What’s the single most important thing we can do to protect our kids?

Make sure they understand that hand-washing isn’t optional. And that means showing them how to do it properly: using soap, warm water and time. Washing should take 20 seconds, which means you may need to help them find a song they can sing (in their heads, maybe twice) — like the ABCs or “Happy Birthday” songs. Be sure they wash whenever they come in from outside, before eating, after coughing or sneezing or blowing their nose and, of course, after using the bathroom.


Just For Kids: A Comic Exploring The New Coronavirus

For younger kids, it can’t hurt to remind them that nose-picking is a no-go, and that they should cough into their elbows. If you’re feeling ambitious, clip their fingernails frequently, as they provide a sneaky hiding spot for viruses. Hand lotion keeps skin comfy and unbroken, which also helps prevent the spread of infection.

  1. Why is/isn’t my school being closed?

Closing schools is a complicated decision. Many school leaders and public health officials seem to be waiting for an infection or potential infection in their immediate school community before closing. While the science suggests closing schools earlier is more effective at slowing the spread of disease, it’s important to understand why so many school leaders are so reluctant to close schools.

For one thing, parents should understand that for many kids in the United States, being sent home from school is also a public health risk. Many children may not have parents who can take off work, or work from home, if school is canceled. They may also live in unsafe neighborhoods. Millions of U.S. children rely on schools for free or reduced-price meals, too, and 1.5 million schoolchildren nationwide are housing-insecure. For many of these kids, having to miss several weeks of school could be incredibly destabilizing.

A few more ideas: Try laundering things like coats, backpacks and reusable shopping bags more frequently and take off shoes when you come inside. For cleaning the house, the Centers for Disease Control and Prevention says “diluted household bleach solutions, alcohol solutions with at least 70% alcohol, and most common EPA-registered household disinfectants should be effective.”

If you have not read my first 2 posts about COVID19 please do so.

Remember, many infected people have no or little symptoms but they can still transmit the disease. High risk individuals include the elderly and those with chronic disease, especially cardiovascular disease, pulmonary (COPD, asthma, emphysema, smokers) and diabetics. Anyone on immune suppressive drugs is at very high risk.

Do everything you can to support your immune system:

  1.  Get adequate sleep
  2.  Practice stress reduction techniques
  3.  Walk outdoors in a greenspace
  4.  Eat an anti-inflammatory diet
  5.  Avoid environmental toxins
  6.  Avoid endocrine disruptors


Eat clean, drink filtered water, love, laugh, exercise outdoors in a greenspace, get some morning sunlight, block the blue light before bed, engage in meaningful work, find a sense of purpose, spend time with those you love, AND sleep well tonight.

 Doctor Bob



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