
“Flattening the Curve” is a deadly delusion - yasp
https://medium.com/@joschabach/flattening-the-curve-is-a-deadly-delusion-eea324fe9727
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ColinWright
This article goes horribly wrong very quickly:

> _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.

~~~
etrabroline
[https://miro.medium.com/max/2400/1*FoIElQyKudIShpnBHckC5A.pn...](https://miro.medium.com/max/2400/1*FoIElQyKudIShpnBHckC5A.png)

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.

~~~
ColinWright
> _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.

That's my understanding.

~~~
etrabroline
The health services will be overwhelmed if all we do is tell people to wash
their hands. You are content with ~1,000,000 dead Americans, I am not.

~~~
ColinWright
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.

~~~
saurik
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.)

~~~
rumanator
> 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.

------
aawalton
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).

~~~
rumanator
> 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.

------
etrabroline
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.

~~~
gus_massa
The title should have been "Flattening the Curve is not enough!!!".

------
dangus
The author lists his own credentials, which do not include any medical field,
and certainly not not epidemiology.

Author: you are part of the problem. We don’t need more articles written by
non-experts.

------
babulus
Strawman arguments. JFC.

~~~
babulus
Like seriously some people think they fucking know everything b/c they know a
lot about one thing

------
cashsterling
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.)

