> They mean to tell you that we can get away without severe lockdowns as we are currently observing them in China and Italy.
No, they don't. They mean to tell you that we need to slow the spread of the infection as much as possible, by whatever means we can sustain. That includes the potential of lockdowns.
We individuals can only do so much. What we must do is wash our hands, practise social distancing, wash our hands, interact with as few people as possible, wash our hands, and only go out if essential.
This graphic is telling people why they have to do this, it's not saying that to do so is enough to avoid lockdowns.
Much of the rest of the article is right, but that part is seriously wrong.
It concludes with:
> Flattening the curve is not an option for the United States, for the UK or Germany. Don’t tell your friends to flatten the curve. Let’s start containment.
That's just bizarre. Containment is part of flattening the curve, and the other measures that we personally can implement is also part of flattening the curve. Everything we do to slow and hinder the spread will help. Total containment is not possible, all we can do is slow the spread, and that is flattening the curve!
So wash your hands, go out as little as possible, interact with as few people as possible, and do your bit to help flatten the curve.
But "flattening the curve" means allowing exponential growth and waiting for most people to become infected. That would be a catastrophe, so no, containment is not a part of flattening the curve, and FTC is a wholly inadequate goal.
> Would you like to refute or respond to this plot?
"Flattening the Curve" is not and cannot be the entire story. It's a process to reduce the stress on the health services, but what seems clear from all the numbers is that the health services will be overwhelmed, we're just trying to reduce the number of concomitant deaths.
> But "flattening the curve" means allowing exponential growth ...
The cumulative number of cases will, barring exceptional intervention, be a logistic function, and the number of cases "in progress" will more-or-less be the derivative. And for a logistic function the first part is more-or-less an exponential.
So whether you "Flatten the Curve" or not, the first phase is always effectively exponential, and since containment is now effectively impossible, it's inevitable that most people (they're suggesting 80%) of people will eventually have been infected.
The way to reduce the catastrophe is to make the rate of infection as low as possible, thus stretching the logistic function and thereby reducing the maximum of the derivative.
There's something here you're really not understanding, and I don't know if it's because you're not reading carefully enough, or I'm not being clear enough.
I'm not saying that all we do is tell people to wash their hands. Flattening the Curve is not just telling people to wash their hands.
It's also saying self-isolate, where possible don't travel, where possible don't go out at all, when it's necessary to go out, stay a minimum of 2 metres away from people whenever you can.
Flattening the Curve is not about "Just wash your hands and we'll be fine", it's about making as many contributions in as many ways as possible to slowing the rate of infection.
I'm genuinely astonished if you think "Flatten the Curve" just means "Wash your hands".
And when I run the numbers, it looks to me like the US health services are going to be overwhelmed regardless, the point is to do every little thing possible to reduce the amount. That's what Flattening the Curve means.
And the article, which is maybe the thing you aren't understanding ;P, is saying that merely reducing the speed by social distancing--which most people, maybe not you but then that is your misunderstanding of the background concept being talked about being here, think is going to be sufficient to not overwhelm hospitals, and that life will be able to return to normal soon--is not going to be sufficient to get the peak of that curve under that line... which again, is what the vast majority of people talking about "flattening the curve" are meaning: if this data were correct (which is not your argument, so let's assume it is) and you showed them the chart of the curve being flattened requiring a decade for the cute little infographic to work, I think the vast majority of people sharing those graphs would have a dawning realization that something even more drastic than mere social distancing is required, such as active tracing and containment, which no one in the US even seems to be contemplating attempting (source: I am a local government official who gets to peek behind the curtains a bit of the regional government above me, and I am absolutely horrified). You really just seem to have an awkward model of what people clearly are thinking when they say "flatten the curve" and share those little graphs, and are using it to cause a massive equivocation battle to undermine the thesis of an article that is effectively saying "we need to be allocating some effort towards active measures and not assume passive ones will be 100% sufficient"; trying to assert this article is telling people not to self isolate is such an on purpose misread it is painful :/. (Now, are the numbers in this article correct? Dunno. Or is it just too late to bother and we are all doomed? Dunno. But again: not your arguments.)
>trying to assert this article is telling people not to self isolate is such an on purpose misread it is painful
Thank you saurik. I began to type out everything you say here in my own reply to ColinWright but gave up when I realized he either hasn't actually read the entire piece or is not interested in honest discussion.
The same people today saying active measures are "not needed" or are "too late" are the same ones who 2 months ago said shutting down the boarders or quarantining new arrivals was too expensive or too racist or too impractical.
Do you have any other insights into why the response in the US is particularly anemic? Why aren't local officials taking action given the reports out of Italy? (which no one can claim are fabricated by an 'authoritarian government')
I suspect that we agree on everything major about what should be done, but disagree about what we think people will take away from this article.
People I'm talking to don't understand how serious this is, and I think we (you and I) agree that this is a disaster unfolding. People are saying "Get it now and get it over with", and that's potentially a disaster.
But some people are looking at the original graphic and saying "Oh, so that's why we should self-isolate, practise social distancing, and wash our hands."
So the graphic is doing the right thing, it's telling people to wash their hands, practise social distancing, and stay home if they can.
The article ... which I have read all of ... is, I think, mostly correct. But I also think it's dangerously phrased. It says:
> Flattening the curve is not an option for the United States, for the UK or Germany. Don’t tell your friends to flatten the curve. Let’s start containment.
I think this is incredibly irresponsible. The actions individuals should be taking are to wash their hands, practise social distance, and stay home where possible. The people I'm talking to understand this to be the meaning and intent of "Flatten the Curve." But this article is saying "Don't flatten the curve."
If you can contain it ... great! But that's up to Governments to direct and enforce, it's not what individuals do. Individuals need to wash their hands, practise social distance, and stay home where possible.
Perhaps people's understanding of FtC is not the same where you are as where I am, perhaps people are interpreting it differently. Perhaps where you are, telling people to practise "containment" actually means something to them, and is not too late.
I seriously expect we are in violent agreement about what should be done by both Governments and individuals, and I suspect we are equally in agreement about the potential for disaster. I've already seen this specific article quoted with people saying ... "OK, this says it will take a decade if we flatten the curve, so let's just get it over with."
Yes, they're taking the wrong message away from it, but it's what people are understanding the article to be saying, which is why I think it's genuinely dangerous. The article may be correct, but from what I've seen, more people might very well die because of it. Not because it's wrong, but because the way it's expressed is leading people to the wrong conclusions.
I suspect we (you and I) have a different view of what people might take away from this, and as I result, discussing it further is most likely pointless. I've clearly failed (up to now, maybe this comment has helped) to make clear why I think this article is misguided and best and dangerous at worst, not because of its content, but because of the way it says it, and the way I've already seen it being misunderstood.
Let's agree this:
* This pandemic is potentially catastrophic;
* None of us want people to die needlessly;
* Immediate and drastic action should be underway;
* The best thing individuals can do it WtH, S@H, and PSD.
Finally, I don't trust the Governments to act in the best interests of individuals, because that's not really what they're for. So I'm personally going the hand-washing, social-distancing, staying home route, and urging everyone I know to do the same.
> And the article (...) is saying that merely reducing the speed by social distancing--which most people (...) think is going to be sufficient to not overwhelm hospitals, and that life will be able to return to normal soon--is not going to be sufficient to get the peak of that curve under that line...
Sorry but you're either oblivious to the concept of are making an effort to not understand it. Flattening the curve is not a panacea. Flattening a curve is a last resort approach to mitigate a logistics problem. It's patently obvious to everyone who is aware of the concept that it's highly unlikely that demand for intensive care due to covid infections will steadily remain under the service saturation levels. That's a laudable goal, but unrealistic.
What you are failing to understand is that the end goal of flattening the curve is that lowering the peak demand by distributing it throughout time will enable better resource utilization with less scarcity. The goal is that instead of experiencing a sharp increase of, say, 15% of the total population requiring intensive care concentrated in a 2 or 3 week timespan, you slow down the spread of the disease so that the nation's healthcare system can serve a larger portion of the population, thus avoiding unnecessary deaths due to lack of medical care.
> The health services will be overwhelmed if all we do is tell people to wash their hands.
Again, that's not what "flatten the curve means". It never was. It's governments declaring state of emergency or alarm or whatever, and require citizens to stay at home for a couple of weeks and avoid social contact.
People are hearing "flatten the curve" and thinking that a few small personal hygiene changes will save the day. It won't. Like you say, governments need to declare a state of emergency and require citizens to stay home. That's what this article is trying to say.
Telling people to wash their hands is less important than telling them to demand immediate government action.
> People are hearing "flatten the curve" and thinking that a few small personal hygiene changes will save the day.
That's your personal assertion, not the definition or what "people" think or say. You are insisting on a notion that you've made up as if it was a strawman. It's wrong and unsupported. Just let or go.
> But "flattening the curve" means allowing exponential growth and waiting for most people to become infected.
I really have no idea where and how you've created that definition, because it has absolutely no relation to the real meaning of flattening the curve and even completely ignores the problem.
Just to be clear, flattening the curve refers to limit the spread of the epidemic so that the amount of new cases are not an exponential spike but a smooth curve throughout time. Thus, the curve is flattened. That's it.
How do you do that? Well, by containing how the disease spreads by enforcing containment and self-isolate and avoid contact with everyone.
Washing your hands is great and makes up for a good scapegoat, but the reason why people are being sent to work from home, stock up on supplies, and not sey foot outside unless they really need to, is to contain how the disease spreads.
I understood this to mean flattening the curve is important, but not enough. Containment is the most critical intervention, but also the one that requires effective government intervention (South Korea).
> I understood this to mean flattening the curve is important, but not enough. Containment is the most critical intervention
Containment is enforced to flatten the curve. That's the whole point. It's not an either/or thing. And the whole point of flattening the curve is to avoid saturating healthcare services with an exponential increase in demand concentrated in a span of a couple of weeks. The article is crap.
The point he makes is valid and critically important. If it were titled "heard immunity is a dangerous delusion" then the "well actually" crowd here wouldn't be up in arms.
Agree with other commenters... this article is criminally stupid.
Author... Stop writing articles in an effort to appease your ego. You are contributing to the problem.
I have a PhD in chemical engineering and worked in biotechnology off and on for several years: aseptic filling, clean room design, microbiology contamination mitigation, bio-processing design) and I come from a family with a lot of medical doctors. Even though I have a fairly good grasp of our situation, you won't see me writing any articles about the pandemic because I'm not an expert.
Among many errors in the article, you can't blindly apply statistics from China or other parts of the world. It is a question of "data sample size" relative to the "actual population"; as a statistician, the Author should know that. The sample size, relative to population, is very small and highly skewed (mostly testing people who are sick). The question is: how many people came in contact with the virus vs. how many people got sick vs. how many people got really sick? This we don't know... China would have needed to randomly test a large percentage of the otherwise healthy population in Wuhan to figure this out BUT both PCR and immune antibody tests would need to be used (to my knowledge, these didn't exist in bulk a month ago)... and then there is difficult to know uncertainties in the percentage of false positives and false negatives.
As an extreme example, what if 3-5 million people in Wuhan had contacted the virus but only a small portion (~100-300k) became ill enough to seek medical care and get tested and about 3-4k died? That would complete change the statistics around the severity of the virus. Given the contagious nature of the virus and delay between community transmission starting and 'the recognition that there was a problem", the virus was almost certainly more widespread in Wuhan than a mere 100-300k people.... the question is 'how widespread'. We don't know the answer. But the more widespread it was, the less severe the severity/mortality rate would look.
Also, any comparison of statistical sample sets between countries should take into consideration other factors not included in the sample set: population density, severity of air pollution, percentage of people who smoke and how much, and other factors which negatively contribute to respiratory and immune system health (e.g. low-level heavy metal poisoning?, vitamin deficiencies?, etc.)
22 comments
[ 3.0 ms ] story [ 54.6 ms ] thread> They mean to tell you that we can get away without severe lockdowns as we are currently observing them in China and Italy.
No, they don't. They mean to tell you that we need to slow the spread of the infection as much as possible, by whatever means we can sustain. That includes the potential of lockdowns.
We individuals can only do so much. What we must do is wash our hands, practise social distancing, wash our hands, interact with as few people as possible, wash our hands, and only go out if essential.
This graphic is telling people why they have to do this, it's not saying that to do so is enough to avoid lockdowns.
Much of the rest of the article is right, but that part is seriously wrong.
It concludes with:
> Flattening the curve is not an option for the United States, for the UK or Germany. Don’t tell your friends to flatten the curve. Let’s start containment.
That's just bizarre. Containment is part of flattening the curve, and the other measures that we personally can implement is also part of flattening the curve. Everything we do to slow and hinder the spread will help. Total containment is not possible, all we can do is slow the spread, and that is flattening the curve!
So wash your hands, go out as little as possible, interact with as few people as possible, and do your bit to help flatten the curve.
Would you like to refute or respond to this plot?
> Containment is part of flattening the curve
But "flattening the curve" means allowing exponential growth and waiting for most people to become infected. That would be a catastrophe, so no, containment is not a part of flattening the curve, and FTC is a wholly inadequate goal.
"Flattening the Curve" is not and cannot be the entire story. It's a process to reduce the stress on the health services, but what seems clear from all the numbers is that the health services will be overwhelmed, we're just trying to reduce the number of concomitant deaths.
> But "flattening the curve" means allowing exponential growth ...
The cumulative number of cases will, barring exceptional intervention, be a logistic function, and the number of cases "in progress" will more-or-less be the derivative. And for a logistic function the first part is more-or-less an exponential.
So whether you "Flatten the Curve" or not, the first phase is always effectively exponential, and since containment is now effectively impossible, it's inevitable that most people (they're suggesting 80%) of people will eventually have been infected.
The way to reduce the catastrophe is to make the rate of infection as low as possible, thus stretching the logistic function and thereby reducing the maximum of the derivative.
That's my understanding.
I'm not saying that all we do is tell people to wash their hands. Flattening the Curve is not just telling people to wash their hands.
It's also saying self-isolate, where possible don't travel, where possible don't go out at all, when it's necessary to go out, stay a minimum of 2 metres away from people whenever you can.
Flattening the Curve is not about "Just wash your hands and we'll be fine", it's about making as many contributions in as many ways as possible to slowing the rate of infection.
I'm genuinely astonished if you think "Flatten the Curve" just means "Wash your hands".
And when I run the numbers, it looks to me like the US health services are going to be overwhelmed regardless, the point is to do every little thing possible to reduce the amount. That's what Flattening the Curve means.
Thank you saurik. I began to type out everything you say here in my own reply to ColinWright but gave up when I realized he either hasn't actually read the entire piece or is not interested in honest discussion.
The same people today saying active measures are "not needed" or are "too late" are the same ones who 2 months ago said shutting down the boarders or quarantining new arrivals was too expensive or too racist or too impractical.
Do you have any other insights into why the response in the US is particularly anemic? Why aren't local officials taking action given the reports out of Italy? (which no one can claim are fabricated by an 'authoritarian government')
People I'm talking to don't understand how serious this is, and I think we (you and I) agree that this is a disaster unfolding. People are saying "Get it now and get it over with", and that's potentially a disaster.
But some people are looking at the original graphic and saying "Oh, so that's why we should self-isolate, practise social distancing, and wash our hands."
So the graphic is doing the right thing, it's telling people to wash their hands, practise social distancing, and stay home if they can.
The article ... which I have read all of ... is, I think, mostly correct. But I also think it's dangerously phrased. It says:
> Flattening the curve is not an option for the United States, for the UK or Germany. Don’t tell your friends to flatten the curve. Let’s start containment.
I think this is incredibly irresponsible. The actions individuals should be taking are to wash their hands, practise social distance, and stay home where possible. The people I'm talking to understand this to be the meaning and intent of "Flatten the Curve." But this article is saying "Don't flatten the curve."
If you can contain it ... great! But that's up to Governments to direct and enforce, it's not what individuals do. Individuals need to wash their hands, practise social distance, and stay home where possible.
Perhaps people's understanding of FtC is not the same where you are as where I am, perhaps people are interpreting it differently. Perhaps where you are, telling people to practise "containment" actually means something to them, and is not too late.
I seriously expect we are in violent agreement about what should be done by both Governments and individuals, and I suspect we are equally in agreement about the potential for disaster. I've already seen this specific article quoted with people saying ... "OK, this says it will take a decade if we flatten the curve, so let's just get it over with."
Yes, they're taking the wrong message away from it, but it's what people are understanding the article to be saying, which is why I think it's genuinely dangerous. The article may be correct, but from what I've seen, more people might very well die because of it. Not because it's wrong, but because the way it's expressed is leading people to the wrong conclusions.
I suspect we (you and I) have a different view of what people might take away from this, and as I result, discussing it further is most likely pointless. I've clearly failed (up to now, maybe this comment has helped) to make clear why I think this article is misguided and best and dangerous at worst, not because of its content, but because of the way it says it, and the way I've already seen it being misunderstood.
Let's agree this:
* This pandemic is potentially catastrophic;
* None of us want people to die needlessly;
* Immediate and drastic action should be underway;
* The best thing individuals can do it WtH, S@H, and PSD.
Finally, I don't trust the Governments to act in the best interests of individuals, because that's not really what they're for. So I'm personally going the hand-washing, social-distancing, staying home route, and urging everyone I know to do the same.
Sorry but you're either oblivious to the concept of are making an effort to not understand it. Flattening the curve is not a panacea. Flattening a curve is a last resort approach to mitigate a logistics problem. It's patently obvious to everyone who is aware of the concept that it's highly unlikely that demand for intensive care due to covid infections will steadily remain under the service saturation levels. That's a laudable goal, but unrealistic.
What you are failing to understand is that the end goal of flattening the curve is that lowering the peak demand by distributing it throughout time will enable better resource utilization with less scarcity. The goal is that instead of experiencing a sharp increase of, say, 15% of the total population requiring intensive care concentrated in a 2 or 3 week timespan, you slow down the spread of the disease so that the nation's healthcare system can serve a larger portion of the population, thus avoiding unnecessary deaths due to lack of medical care.
Again, that's not what "flatten the curve means". It never was. It's governments declaring state of emergency or alarm or whatever, and require citizens to stay at home for a couple of weeks and avoid social contact.
Telling people to wash their hands is less important than telling them to demand immediate government action.
That's your personal assertion, not the definition or what "people" think or say. You are insisting on a notion that you've made up as if it was a strawman. It's wrong and unsupported. Just let or go.
I really have no idea where and how you've created that definition, because it has absolutely no relation to the real meaning of flattening the curve and even completely ignores the problem.
Just to be clear, flattening the curve refers to limit the spread of the epidemic so that the amount of new cases are not an exponential spike but a smooth curve throughout time. Thus, the curve is flattened. That's it.
How do you do that? Well, by containing how the disease spreads by enforcing containment and self-isolate and avoid contact with everyone.
Washing your hands is great and makes up for a good scapegoat, but the reason why people are being sent to work from home, stock up on supplies, and not sey foot outside unless they really need to, is to contain how the disease spreads.
Containment is enforced to flatten the curve. That's the whole point. It's not an either/or thing. And the whole point of flattening the curve is to avoid saturating healthcare services with an exponential increase in demand concentrated in a span of a couple of weeks. The article is crap.
Author: you are part of the problem. We don’t need more articles written by non-experts.
Author... Stop writing articles in an effort to appease your ego. You are contributing to the problem.
I have a PhD in chemical engineering and worked in biotechnology off and on for several years: aseptic filling, clean room design, microbiology contamination mitigation, bio-processing design) and I come from a family with a lot of medical doctors. Even though I have a fairly good grasp of our situation, you won't see me writing any articles about the pandemic because I'm not an expert.
Among many errors in the article, you can't blindly apply statistics from China or other parts of the world. It is a question of "data sample size" relative to the "actual population"; as a statistician, the Author should know that. The sample size, relative to population, is very small and highly skewed (mostly testing people who are sick). The question is: how many people came in contact with the virus vs. how many people got sick vs. how many people got really sick? This we don't know... China would have needed to randomly test a large percentage of the otherwise healthy population in Wuhan to figure this out BUT both PCR and immune antibody tests would need to be used (to my knowledge, these didn't exist in bulk a month ago)... and then there is difficult to know uncertainties in the percentage of false positives and false negatives.
As an extreme example, what if 3-5 million people in Wuhan had contacted the virus but only a small portion (~100-300k) became ill enough to seek medical care and get tested and about 3-4k died? That would complete change the statistics around the severity of the virus. Given the contagious nature of the virus and delay between community transmission starting and 'the recognition that there was a problem", the virus was almost certainly more widespread in Wuhan than a mere 100-300k people.... the question is 'how widespread'. We don't know the answer. But the more widespread it was, the less severe the severity/mortality rate would look.
Also, any comparison of statistical sample sets between countries should take into consideration other factors not included in the sample set: population density, severity of air pollution, percentage of people who smoke and how much, and other factors which negatively contribute to respiratory and immune system health (e.g. low-level heavy metal poisoning?, vitamin deficiencies?, etc.)