Editor’s Note: Kent Sepkowitz is a CNN medical analyst and a physician and infection control expert at Memorial Sloan Kettering Cancer Center in New York City. The views expressed in this commentary are his own. View more opinion at CNN.
Thirty years ago, the tuberculosis (TB) expert Dr. Lee Reichman coined the term, “The U-shaped curve of concern” to describe the challenges of TB control. His notion was this: When a disease like TB is rampant, dollars, attention and expertise are brought to bear. Soon, cases decrease, creating the sinking left-hand side of the “U.”
But this success soon creates a new challenge. The once rampant TB problem appears to have been fixed, at least to those in charge of the budget, so the dollars, attention, and expertise are redirected to another pressing problem.
For a while – perhaps a week, a month, a year – this seems like a good move. But then WHAM, rampant TB returns and the rapid rise in cases forges the rising right-hand side of the “U” – reflecting the awful truth that the problem is back. And worst of all, this cycle is never-ending – a surge in cases brings panic, panic brings resources, resources bring control, control brings calm, calm brings inattention, inattention brings cases, cases bring panic – here we go again, ad infinitum.
This phenomenon is especially topical now as the world struggles to contain the Covid-19 pandemic. We currently are witnessing the life-saving benefits of social distancing in the Unites States and elsewhere. As hoped, the curve is being flattened. New cases are dropping, a little, or at least not rising as fast in many areas. This is great news.
However, despite this evidence that the monotonous, boring business of staying at home in sweatpants is actually effective, many (if not most) people in isolation may be starting to feel the pull of real life. Not in black-and-white anymore but in full living color. How about a little fun, maybe a walk outdoors without a mask. Or maybe – maybe – a chance to get together with a small select group of family or friends.
Plus, right on cue, the fact that social distancing has decreased the number of deaths is being called out by some as proof that the threat was wildly overblown. Another ploy by the media to hurt the economy or something. This sort of logic would consider any lives saved by delivery of food to a starving nation not as evidence that the food prevented deaths, but rather that the nation wasn’t really at risk for starvation at all and the act of humanity was pure showmanship.
So, for those tempted to dip their toe back into a January 2020-style American life, I have one word for you: Don’t. Please. Just don’t.
We are riding the early part of the dropping left-hand side of the “U” right now and things are looking better. But surely as May follows April, if we let up even a little, cut just one or two corners, we soon will find ourselves back in the terrifying surge that characterized March of 2020.
Plus, collective risk taking places an unfair strain on the people who work in public health. The entire pandemic has thrust these officials into a difficult role – not just the work of exploring epidemiology to make complex mitigation decisions as quickly as possible, but also to stand in as a sort of Miss Havisham for the public, a flock of pinch-faced killjoys, tsk tsk-ing at all of the naughtiness of exuberant youth. As a distant member of this group, may I implore you to give us a break and behave without pushing us to make constant threats and correctives. You’re not in junior high school anymore.
Rather, prepare yourselves for what’s ahead. Even though we have seen the power of social distancing, many enthusiasts failed to read the fine print on the policy. Social distancing only works if you do it – there is no after-effect, no extra credit to carry over. Indeed, if you are 100% good for a month but then sneak out for a fun time with friends, the virus will find you and your buddies and everyone else. And once that happens, the community doesn’t go back to where it was yesterday but rather all the way back to the terrifying beginning. The one-month clock starts at the start, not the middle.
Making the road ahead even tougher is the additional fine print accompanying the concept of flattening the curve. This approach to epidemic control is a last resort, that thing you do when you have failed to do everything else one does in an epidemic – test widely, isolate, trace contacts and forge a rational well-resourced path forward. But since the US and most other countries failed to take any of those steps executed so well by South Korea, Taiwan and Hong Kong, we were left with the hardest, slowest and least invigorating solution: Flattening the curve so that hospitals can handle the load of cases in an orderly, life-saving, healthcare worker-preserving manner.
This curve flattening was never designed to decrease the total number of cases; only to redistribute them over a longer period of time, so that hospitals could handle the work and save more lives. A flat curve is a wonderful thing but does not end the pandemic, it only allows us to manage it intelligently.
Which means that we and Covid-19 are going to be together for many, many more months of ducking and dodging. And during those months, we will have to tread lightly, avoid crowds and gatherings and yes, even baseball games. We will have to be on our best suppressed behavior, trying to enjoy ourselves within the confines of a scalding abstemiousness.
Because the rising side of the “U” is waiting for us to fail. It will throw us back into full-bore pandemic. We get no time off for good behavior. Or as a sober advocate of adult behavior once said of a different threat, “Only you can prevent forest fires.”
