Flattening the curve won’t lead to coronavirus turning point, study finds

·5 min read

Attempts by authorities around the world to “flatten the curve” could be the worst way to fight the pandemic coronavirus, according to new projections by an international team of researchers.

The approach, which has been adopted by many countries in the hope that warmer weather and a future vaccine will help rein in the virus, could destroy economies while having little effect on cutting infections, the researchers led by Peking University Professor Liu Yu said.

“The turning point will never come, the peak value of case numbers will remain the same as if there are no such measures,” the team, which included scientists from Harvard University in the United States, said in a non-peer-reviewed paper released on preprint platform arXiv.org last week.

“We strongly suggest they reconsider [the approach].”

“Flattening the curve” involves using a range of pandemic-response measures, including shutting public venues, closing non-essential business and issuing stay-at-home orders, to stabilise the number of new infections and deaths so hospitals can cope with patients. The idea is not to eliminate new infections but to avoid a spike in new cases so that the health system is not overwhelmed. When the number of daily new cases and deaths plateaus, the curve is said to have flattened.

In their study, the researchers looked at daily infections, geographical spread of disease, economic output and public transport to assess the effectiveness of various containment policies, particularly the trade-off between epidemic control and economic development.

Only a few countries, including South Korea, Qatar, Norway and New Zealand, have so far been able to stop the spread of the virus with minimum disruption to business, according to the researchers.

Meanwhile some of the most developed countries – such as the United States, Britain, France, Italy and Spain – have suffered big blows to their economies while also dealing with soaring infections and death rates. These advanced economies were no better at containing the pandemic than developing nations such as Iran and Laos, the study found.

The researchers blamed this failure on the focus on flattening the curve, which depended heavily on public cooperation on social distancing.

The policy resulted in a major disruption to economic activity and social life but was not effective in isolating infected people from the rest of the population. To some extent, it was worse than doing nothing, they said.

“This choice still incurs 20-60 per cent loss of economic output, but only achieves a 30-40 per cent reduction in the number of cases, an extent which is insufficient to overturn the epidemic curve,” the researchers said. “Our results show that this is usually the worst scenario in terms of cost-effectiveness.”

Some leaders, including US President Donald Trump, have proposed lifting some of the pandemic restrictions, but the paper warned that doing so was a wrong and dangerous way to go.

The researchers said that relaxing the lockdown measures without significantly ramping up infection control capacity such as testing could create a humanitarian disaster in the US similar to that experienced by Ecuador, where corpses of coronavirus victims were wrapped in cardboard and left on streets because too many people died.

That conclusion is in line with forecasts by some senior American health officials, including Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases, who said that reopening the economy too soon would “backfire”.

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One solution, according to the study, was to tighten lockdown measures while rapidly increasing testing and patient isolation. If each patient infected less than one other person, the spread of the coronavirus would eventually be under control.

This meant a stricter ban on public activities and the construction of makeshift hospitals to house all patients so they would not infect others.

The study also indicated that travel bans had limited effect on the spread of the virus. In a roughly 10-hour window before the lockdown in the central Chinese city of Wuhan, more than 300,000 people “escaped” to other parts of the country but they did not cause a massive outbreak across China, the paper said.

The US ban on flights from Europe in March was not effective because outbreaks had already started in American cities, according to the researchers.

China’s strategy of “elimination” was the most effective way to suppress the outbreak quickly, but was unsustainable due to its high cost, with 40-90 per cent loss of economic output in a month, they said.

The researchers suggested authorities consider the less stringent but equally effective strategies adopted by South Korea and New Zealand, which maintained fewer than 10 daily cases and only suffered losses ranging from 0.5 to 4 per cent of their economy.

Jaymie Meliker, professor of public health with the Stony Brook University in New York, said the model had its limits because Liu’s team did not put a value on each life lost in the pandemic.

“I could not find how much they estimate a life is worth in their cost benefit model,” Meliker said.

“If the hospitals are overrun and more people are dying because of that, then we need to quantify that cost for a cost-benefit model.

“That is needed for us to be able to evaluate the pros and cons of the different containment strategies.”

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