Did We Actually Flatten the Curve?

by | May 27, 2020

Did We Actually Flatten the Curve?

by | May 27, 2020

Concerned Young Man In Medical Mask On Urban Street During 3983404

“The most brilliant propagandist technique will yield no success unless one fundamental principle is borne in mind constantly…it must confine itself to a few points and repeat them over and over.”- Adolf Hitler (Mein Kempf, Chapter 6: War Propaganda)

From the start of the COVID-19 panic, we have been met with admonitions from roadside signs, from well-meaning friends, from talking heads on TV, and from trending hashtags on social media. These pleas have generally had the same form, albeit using different words. Some of them said, “Stay Home and Save a Life.” Some of them were more aggressive, with “Stay The F*&K Home!” All of them were predicated on the belief that by taking individual action we could “Flatten The Curve and Save Lives” during the COVID-19 Pandemic. This author has attacked that premise in multiple essays. As a mathematical and statistical fact, flattening the curve can possibly save lives in one case and in only one case: if there is overloading of the hospital resources. Given that these resources were not overwhelmed, at least outside specific pockets, we did not save any lives by attempting to flatten the curve.

What if the curve was not flattened? Here is my assertion: Not only did we not need to flatten the curve, we did not actually do much, if any, flattening of it. This despite the aggressive marketing and puffery used to convince the populace to “Stay Home. Save a Life.” While this is not an indictment of the concept of social distancing—particularly intelligent, voluntary approaches—it is an attack on the approaches marketed during the current pandemic. It is intuitively attractive to think staying home and away from everyone who could transmit the disease must necessarily lead to you not being infected. Further, if we lock up an entire population, the spread of a virus should be stopped. If those two points are true, why should it be that locking down as much as possible would not help slow the spread and/or prevent at least the sequestered from getting sick? Well, as a game show host might exclaim, “I am glad you asked!” The answer comes down to three factors:  Timing, Methodology, and (maybe surprisingly) Epidemiology.

Timing:  The mainstream media (MSM) has been vocal about the timing of the U.S. response to the COVID-19 outbreak. The liberal arm of the MSM has been particularly unrelenting in its assertion that POTUS acted too late in calling for social distancing generally and supporting lock-downs in particular. Jacquelyn Corley writes in Fortune Magazine:

As the data…show, the U.S. government was slow to respond and hesitant to escalate the stringency of its public policies compared to other countries in similar situations. One can’t help but think of the lives that might have been saved had we responded the way other countries, like South Korea, did.

Despite the fact that this author is no fan of Donald Trump, such arguments are specious. My previous articles discussed the statistical fact that flattening the curve via social distancing and lock-downs cannot be expected to save lives unless there is overloading of the medical system. There was no widespread overloading, so Ms. Corley’s premise is incorrect. (Ms. Corley must have missed the fact that South Korea did not impose a lock-down.) The data shows that the United States was something like 40 days late in aggressively embracing curve-flattening strategies. How then does one account for the fact that few, if any, of the expected negative outcomes occurred? Again, almost universally, hospital overcrowding was not a factor.

Not that there have not been hotbeds during the COVID-19 outbreak. In New York City the conversion of the Jacob K. Javits Convention Center into a field hospital resulted in about 2/3 occupancy at peak. Interestingly, New York is one of the “heavy lock-down” states. However, most other locales saw no such need—including another heavy lock-down state, Pennsylvania. Dr. Steven Shapiro, chief medical and scientific officer of the University of Pittsburgh Medical Center, was quoted as saying:

We indeed saw a steady stream of patients but never “surged.” At peak in mid-April, COVID-19 patients occupied 2% of our 5,500 hospital beds and 48 of our 750 ventilators. Subsequently, admissions have been decreasing with very few patients now coming from the community, almost all now being from nursing homes. Of note, in the 36 UPMC-owned senior facilities we have had zero positive cases.

This is far from the only example. Seems we can conclude that few people, if any, died due to lack of availability of care. How does it happen that the U.S. was simultaneously slow in beginning to flatten the curve yet also benefited from it being flatter? Maybe it was already as flat as it was going to get.

Consider a hypothetical scenario. A couple decides to have a child, and sets about having routine sex for six weeks straight. At some point, they change their minds. They begin to use a condom. At the end of eight weeks total, can any conclusion be drawn about the efficacy of the condom? If the woman is pregnant, was it the fault of the condom? If she remains not pregnant, was it because the condom was the key? That is exactly where the U.S. was regarding timing, the effects of social distancing, and curve flattening.

Methodology. The skin biome of a typical human is a cornucopia of bacteria, virus, mites, and all manner of other biological and inert material. When we say, “that made my skin crawl,” not only do we not know how correct we are, we are also a tad late with the admission! Put in the terms of a cartoon, although admittedly somewhat overstated, one could think of the Peanuts character “Pig Pen” and that floating cloud of dirt that surrounds him. Do you think having Pig Pen put on an N95 mask changes that cloud enough to worry about? A similar conclusion regarding one’s skin biome and the presence of a homemade mask seems apropos.

Early on as the pandemic moved through the U.S. population, there was little concern about social distancing, with even luminaries like Dr. Anthony Fauci suggesting that such measures were unnecessary. Then later, even shaking hands became too dangerous according to the good doctor. As recently as April 23, 2020, Bill Bryan of the DHS science and technology directorate shared the results of a federal study indicating that coronavirus is weakened by exposure to sunlight, heat, and humidity. So why were events such as running races, typically enjoyed by healthy adults and held outside, subject to closure? The methodology employed to mitigate the transmission was in the wrong direction.

Statewide mandates in places such as New York, supported by CDC recommendations made in mid-March, made it illegal to hold events with greater than 250 people. Then it became 10 people. At some point, it became blanket cancellation of all group activities and lawful opening of only businesses deemed “essential.” The rubric for establishing which businesses were non-essential varied state-to-state, with some states (like New York) including liquor stores, and some states (like Pennsylvania) characterizing liquor stores as non-essential. (No real science to be found, just guessing—and politics.)

What about widespread use of masks? The typical COVID-19 virus particle is supposedly 0.125-micron sphere, with a range of 0.06 microns up to 0.14 microns. An N95 mask filters down to 0.130 microns. One does not need to be a math whiz to see that COVID-19 virus particles are actually smaller. However, studies suggest that the N95 mask is approximately 95% effective. The size of the holes in the overwhelming majority of homemade masks are orders of magnitude larger than the N95. Even with multiple layers, a cloth mask will be approximately 2% effective in stopping virus flow according to the same study. Even surgical masks are ineffective in stopping virus flow, performing in the range of 55% effectiveness.

What about reports from places (such as Hong Kong) where it is believed that usage of masks made the difference? Some have suggested that this must be true since the only continued outbreaks were from 1: a restaurant where everyone eats from the same tray and 2: a Buddhist shrine where everyone takes their masks off. It seems safe to assume that the typical mask-wearer touches both his mask and his face repeatedly during the day and during each wearing.

Consider the typical pre-operation protocol. Every attempt is made to mitigate the unintended transmission of biological material. Despite this protocol, there is still debate about how much biological material could be transferred from doctor to patient. Writes Chris McCullough:

Another study, “Disposable surgical face masks: a systematic review,” published in 2005, also identified ways that masks might contribute to surgical site contamination. The conclusion of their systematic review was that, “it is unclear whether wearing surgical face masks results in any harm or benefit to the patient undergoing clean surgery.”

Not exactly a ringing endorsement. Further in Mr. McCullogh’s piece he cites an NIH paper, entitled “Reducing Surgical Site Infections: A Review,” by Drs. Reichman and Greenberg, wherein they reviewed a number of studies and concluded:

Several other practices, such as the standard use of “scrub suits,” surgical caps, and shoe covers have never been definitively demonstrated to reduce rates of surgical infection, although surgical site infection (SSI) outbreaks have been traced to hair or scalp organisms (regardless of whether a cap was worn), and increased foot traffic through the operating room has been demonstrated to increase ambient microbial levels and ensuing infection risk.

Multiple studies show that even in an operating room, with strict protocols followed by trained practitioners, there are still SSI outbreaks with “no definitive demonstration of reduction” despite the protocols noted above. Contrast that with our typical social distancing experience at any store. You pull up to a parking spot, having driven a bacteria-laden car. You reach into your bacteria-laden pocket with your bacteria, virus, mite-laden hands to get your bacteria-laden homemade mask, which you inoculated with virus the last time you wore it. You place that mask about your face, inoculating the outside of the mask with the plethora of bacteria and viruses present on your skin. How can such haphazard measures possibly “stop the virus in its tracks” rather than actually help spread the virus? Add to that the fact that mask use was mandated even later than was strict social distancing! There was not the application of a consistent, scientifically-supported methodology over the course of the virus progression through the population.

Let us return to our hypothetical. What if some of the condoms used by our couple had a hole in them? Again, can any conclusion be drawn? If the woman is not pregnant, is it because the condom worked anyway? If she is pregnant, was it the condom’s fault?

In fact, timing, biology, and methodology are confounded (to use a statistical term) in this analysis of the response to COVID-19. Given the lack of a consistent application of a measurably effective technique, the biological make-up of humans, and the admittedly late implementation of strict social distancing, making any assertion about how much the curve was flattened seems suspect. What if we compare epidemiological models to the actual data collected during the pandemic? Maybe the curve was just the curve?

Epidemiology. What if the virus was already relatively prevalent? This is exactly what people such as Sunetra Gupta, Professor of Theoretical Epidemiology at the University of Oxford, have concluded. Even more interestingly, Dr. Gupta’s initial model did not support the draconian response embraced after the Neil Ferguson model drove many politicians crazy. Her model was released one week after Ferguson’s. More recently, and in stark contrast to depending upon a model to be predictive, she is using emergent data to confirm her model. Dr. Gupta notes on a recent interview for UnHerd.com:

In almost every context, we’ve seen the epidemic grow, turn around and die away—almost like clockwork. Different countries have had different lockdown policies, and yet what we’ve observed is almost a uniform pattern of behavior that is highly consistent with the SIR Model. To me that suggests that much of the driving force here was due to the build-up of immunity. I think that’s a more parsimonious explanation than one which requires in every country for lockdown (or various degrees of lockdown, including no lockdown) to have had the same effect.

Apparently, the progression of COVID-19 though the population was typical for a virus already present and not a function of purposeful curve flattening via social distancing or lock-downs. Seems clear that continued reliance on so-called strict social distancing via lock-downs, needs to stop. An immediate reversal of any shelter-in-place orders or draconian closures of non-essential businesses, not a step-wise release, is warranted. Returning to Dr. Gupta:

Remaining in a state of lockdown is extremely dangerous from the point of view of the vulnerability of the entire population to new pathogens. Effectively we used to live in a state approximating lockdown 100 years ago, and that was what created the conditions for the Spanish Flu to come in and kill 50 million people.

Not only does remaining in lock-down hurt the economically vulnerable, it could hurt the entire population going forward. It seems clear that the damage done because of the lock-down has far outstripped even the imagined benefit from flattening the curve.

The problem is that while quarantining the sick has a long history in fighting a contagion, the approach of locking down the healthy is not nearly as tried-and-true. In a blog post from April 5, 2020, Tucker Goodrich cited a 1951 paper from the Journal of School Health:

Anderson and Arnstein in “Communicable Disease Control,” 1948, in discussing poliomyelitis, say: “School closure, as well as closure of moving picture theaters, Sunday schools, and other similar groups, is frequently attempted in response to popular demand that ‘something be done.’ Although tried repeatedly, it is of no proved value, never altering the usual curve of the epidemic: nor has the disease been more prevalent or persistent in those communities with the courage to resist those demands.”

The data indicates that Italian compliance with the lock-down orders was far higher than in the U.S. Yet, the progression of the disease showed no impact due to those lock-downs.

No one wants to minimize the current danger of COVID-19 or the deaths that have already occurred. Certainly not this author. Frankly, the severity with which the virus attacks an individual can appear to be random, with cases of healthy people with no underlying conditions being severely stricken. That said, our immune system was all we had at our disposal for the 6 million years since humankind began walking upright.

This is all we had at our disposal since the start of the COVID-19 panic. Fortunately, it appears—at least in the overwhelming majority of cases where underlying conditions are not present—to be enough. Let us do all we can to enhance it. Let us stop thrusting half-assed behavioral approaches, in some cases supported by a high school science experiment, upon the population as if they worked, despite a dearth of supporting evidence, and despite the massive longer term danger of further extending the lock-outs.

Wilt AlstonWilt Alston [send him mail] lives in Rochester, New York, with his wife and three children. When he’s not training for a marathon or furthering his part-time study of libertarian philosophy, he works as a safety engineer in transportation safety, focusing primarily on the safety of subway and freight train control systems.

About Wilton Alston

Wilton D. Alston is a biomedical engineer turned transportation safety engineer who, when not training for a marathon or enjoying fine whiskey, loves hanging out with his (college sweetheart) wife and their three children in Upstate New York.

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