Our current goal as a nation is to “flatten the curve.” Government and Healthcare leaders across the U.S. are implementing more stringent social distancing guidelines and policies daily, all in an effort to ‘flatten the curve.’ But social distancing and flattening the curve were two concepts rarely discussed in previous U.S. media, culture, or literature. This has caused confusion, distrust, and disbelief.

Confusion:

Distrust:

Disbelief:

Just like me, I’m sure you’ve been asked by family members, friends, and patients, ‘are we going too far,’ ‘is all of this really necessary’ or ‘are we going to be ok?’

These are difficult questions to answer that take time to research and reflect to confidently answer. I’d like to help by sharing some scientific rationale behind social distancing, current measures for virus containment, and what we may expect over the next 6-8 weeks.

We know our goal is flattening the curve but why and what does that mean?

It means we want to reduce the rate of transmission and protect our hospitals from patient surges that would overwhelm them and risk higher than expected mortality rates. Italy is currently an example of a country where the surge is overwhelming the healthcare system and has led to higher mortality rates than those seen in China.

A study released by the CDC on March 18th shows the mortality rate of COVID-19 in the U.S. from February 12 – March 15 is between 1.8% and 3.4%. As of March 23rd the global mortality rates range between 0.33% and 11.43%. We anticipate that both globally and domestically low-income areas and areas unable to cope with a surge capacity will see higher mortality rates.

In a webinar on March 17th,  Professor of Epidemiology Dr. Terri Rebbman reported that on an individual basis mortality rates for those with co-morbidities is around 5% and for those without co-morbidities it is around 0.9%. She went on to explain that the attack rate for COVID-19, or the risk of infection to the population, is between 40-60%. Part of the reason this is so high is because of the high reproductive rate (R0) – a mathematical way to gauge how contagious an infection could be. The R0 for COVID-19 is between 2.2-3.1, meaning for each person diagnosed with COVID-19, they will infect between 2.2 and 3.1 other people. Any R0 over 1.5 is considered at risk to cause a pandemic.

Based on the above referenced analyses, our best information is that this virus has the potential to infect somewhere close to half of the population and that each person who is infected will likely infect at least infect 2 others, so our only responsible course of action is containment and slowing the transmission. This has been the driving force behind social distancing, working to slow the attack rate and decrease the possible surges on our health system.

Some U.S. hospitals are already starting to experience patient surges, and those that aren’t are preparing for them. As of March 20, some New York hospitals had run out of ICU beds.  We have seen  announcements of soccer fields being transformed into a makeshift hospital. This is the first but will not be the last. We may start seeing fever tents and parking area triage sights for patients with suspected COVID-19 or fever presentation. It is possible we will see temporary care sites set up for COVID-19 patients.

We will also continue to see conservation measures for our PPE, instructions on how to reuse PPE, and potentially even calls for communities to make their own PPE and masks. For more detail on these measure check this CDC link.

In this message I have hinted that this situation is going to get worse before it gets better. It is a reality that we face, but I hope this information has provided you some facts that provide reason behind the trends and the measures being taken today. We will continue to keep you informed and follow Infectious Disease Specialist, Dr. Abdu Sharkawy’s recommendation of “Facts not fear. Clean hands. Open hearts.”

Melissa Lacy, MSN, FNP-BC
SVP, Clinical Operations