A tale of two COVID19 curves

The innovation side of “flattening the curve” of the Coronavirus outbreak



You have seen a version of this chart one or multiple times already:

The concept of “flattening the curve” has entered our lexicon and will probably define these early stages of the #COVID-19 response. The idea is easy to grasp: With appropriate use of “Non-Pharmaceutical Interventions” (that is the euphemistic name epidemiological policy gives to things like social distancing, curfews and the mandatory closing of businesses) it is possible to “delay the peak” of the pandemic, flattening the curve and keeping things under the available capacity of the healthcare system.

This is the first published example I have been able to find of the “flatten the curve” idea and chart:

Source: https://stacks.cdc.gov/view/cdc/11425

Sadly, this CDC report does not cite an author for the chart… but I think the Nobel Committee should consider giving its first Nobel prize of medicine to a meme!

You may have noticed that while newer reproductions of the chart often include a dotted line for “healthcare system capacity” parallel to the X-axis (and always drawn above the “flattened curve”), the original chart expressed that idea in a more complicated way, with an arrow pointing downwards as part to the 1, 2, 3 goals of Non-Pharmaceutical Interventions.

This is an improvement, as it makes it clearer what the objective of social distancing programs is, but it has one core problem that obscures the biggest reason why you should be strict about doing as much as you can to flatten the curve.

That “healthcare system capacity” dotted line makes it look like that capacity is a static value when it is not.

To understand why that line is not static, we have to introduce another curve.

Look at this chart:

Paul Wright’s Experience (or learning) curve.

This is one of the oldest learning curves. It was produced in 1936 by Paul Wright when he was studying how aircraft factories, with time, would get better at putting planes together, decreasing costs and increasing output capacity.

That is, through learning, capacity is increased. The same factory, with the same tools and the same employees, can produce more as the organization improves and optimization occurs.

This is why flattening the curve is so important to you personally. As we learn more about the disease, and more science and technology is developed, it is possible not only to avoid the nightmare scenario of a healthcare system overwhelmed by new cases, but also dramatically increase its carrying capacity through targeted policy interventions (ie. more beds, more ventilators, temporary hospitals deployed) and better biotechnology (ie. better treatments and, of course, the holy grail of epidemiology: a vaccine).

If we do things right, this is what the learning curve would look like, superimposed to the bell curve of an outbreak:

Learning curve and outbreak curve together

Here is the thing: for this to happen, we need cognitive space and brainpower. If our doctors and epidemiologists are barely “keeping their heads above the water” (or, like in Italy, under the water) it will be a lot harder for those same minds to establish patterns of learning.

Flattening the curve by staying home means more opportunities for medical researchers to come up with new processes, new medical practices and perform research…. and, for you, it means that if you ever get COVID-19, you will get it as late as possible, when learning has happened… during outbreaks, you do not want to be an early adopter!! let others debug the system!

Handbook of Covid-19 Prevention and Treatment

For example, from China, we now have a version 1.0 of a handbook of best practices by those with clinical experience, but this information is still percolating among the medical community of practice and may still be full of errors… We. Need. Time.

This is an innovation war. It is not enough to preserve the current capacity of the healthcare system, but we need to rapidly innovate at a pace that moves faster than the spread of the virus. If you are not a medical professional, this means that you have one important job: don’t be a vector!

Each dollar spent on response is a dollar that cannot be spent on research and development. Each hour spent saving the life of a patient is an hour that a medical professional cannot use to reflect on what s/he just learned.

The more the outbreak remains under the carrying capacity of the healthcare system, the more we can innovate our way out of coronavirus hell. We need to help humanity flatten the outbreak curve and entrepreneurship and innovation accelerate the capacity one.

Here is a structure I propose we need to follow to get out of this by following good innovation practices: