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Flattening the Curve Flattening the curve JUSTIN KWON, MARIA ROMAN, AND ANDREW THAI Motivation and context: health infrastructure and the curve What does it What we have heard mean to before: “flatten the Prevention from overwhelming the curve” ? healthcare system by using social distancing and “stay-at-home” measures Other things to consider: - Where the curve is flattened to is directly related to the capacity of the healthcare system - “protective measures” can have a wide variety of meanings Enough capital/equipment /production capability to Health maintain increased workers demand for health services/ products Availability How do you of tests, beds, measure Accessibility to ventilators, hospital care (language, transportation, PPE capacity and ability to pay Technology healthcare or take off time and from work, telehealth services to infrastructure? level of prevent in- comfort) person visits Where does the U.S stand when it comes to healthcare The answer to this infrastructure and question must hospital capacity? determine what the government regulations are in order to “flatten the curve” Percent of GDP that goes into health spending in the United States In 2018: 16. 9% of GDP for the U.S was related to healthcare spending. Most of this spending was either compulsory or by the U.S government. This is the most spending out of any OECD country!! But… what does this mean? OECD study Quality vs. health spending vs. infrastructure The U.S is an outlier when it comes to the relationship between health expenditure and life expectancy (a similar trend can be seen for other measures such as avoidable mortality) High health expenditure likely due to excessively high costs of healthcare, which grow at a much faster rate than the consumer price index (CPI). Possible reasons for high healthcare costs in the U.S include the complicated administrative structure of the U.S healthcare system (leading to redundancy and resource waste), and hospital monopolization and/or lack of competition. OECD study Capital expenditure on health The U.S spends a lower percentage of health expenditures on capital (such as machinery, equipment, technology, etc.) than the OECD average There’s a steady decline in availability of grants and other sources of funding - Debt is the most common way of financing capital investments in healthcare Side note: an example of low level of capital expenditure on health can be seen by the average Age of Plant (AoP) index of hospitals, which measures Disparities are present between different how updated a facility is when it comes to technology and infrastructure. types of hospitals, and by region, The median average AoP has increased in hospitals by three years since neighborhood, etc (more on this later) 1994, according to ASHE Other factors to consider: Slight shortage of Aging population = doctors, nurses, and increased demand Regional disparities other health in healthcare. This in healthcare professionals. is also important infrastructure both when thinking about COVID and at the local and There are many who is most likely to national levels need care. reasons for this. In rural counties, Broad premature deaths were geographical already more common. These are also now the disparities places most heavily impacted by COVID-19 People of ethnic/racial Note: some studies minority backgrounds have a show it is Racial disparities in higher chance of developing sometimes difficult conditions that make them Disparities “In some cities, for predisposing to separate more vulnerable to COVID. within example, life expectancy conditions and between Additionally, they are more cities can differ by as much as geographical and 25 years from one healthcare/hospital lkely to live in areas that racial disparities, neighborhood to the accessibility hare underserved and have as the two are next.” lower healthcare linked infrastructure Interactive map https://www.exlservice.com/covid-community-risk-health-disparities-map Relation to flattening the curve In addition to disparities Measures that must be taken Preventing the spread of directly related to health care, to “flatten the curve” will disease, and being able to certain populations may be depend on resources available treat a large volume of less able to follow stay-at- in the region, and the cases requires a strong home orders, have access to population’s ability to comply healthcare infrastructure care and testing to prevent with mandates/regulations. contact with other people The U.S faces a problem in that The next few sections will investment in capital and consider the calculations healthcare infrastructure of the that have been made so far, country has been on the decline. and what we have found Additionally, healthcare costs are when it comes to the high, and access is not equal effectiveness of current among all populations measures Mathematical Background Intro to “the curve” We introduced the motivation and context behind this Throughout the curve, and what pandemic, we’ve it means to been told about “flatten” it. this “curve” of the So what is the virus and that we curve from a need to flatten it to mathematical gain control of the perspective? situation Definition of “the curve” The “curve” refers to the general arc drawn over the columns when looking at a graph of Number of infected individuals vs time Maximum height determined by the maximum number of infected individuals It is what we are concerned about when it comes to hospital capacities and similar restraints Flattening the curve: two perspectives Two ways of flattening the curve The total volume of infected The total volume of infected individuals will remain the individuals can go down as same but with a lower max well as the max height height In both: most strategies and models ended up extending how long the pandemic lasted overall. • Ex: one model had an 8-time step with higher peak, that when they introduced social distancing made the pandemic last 13- time steps, but with a much lower peak Social distancing and the curve The current strategy used to flatten the curve is social distancing. • When represented using a graph where people are nodes, and are connected to the people they interact with, one can model how fast an epidemic occurs With less edges (interactions), the pandemic lasted longer but had a much lower peak Effects of Varying Social Distancing • One model that we researched looked at what different levels of social distancing would do to infection rates • As number of people contacted went from 10 to 6 per day, they saw the infection rates decrease, with further decreases being more helpful than earlier ones CDC Study •Analyzes the effectiveness of social distancing interventions. • Evaluating the Effectiveness of Social Distancing Interventions to Delay or Flatten the Epidemic Curve of Coronavirus Disease •Four scenarios of social distancing: 1) Protect vulnerable population: Only adults >60 years reduce contact by 95%. 2) Protect vulnerable population and close schools: Adults >60 years old reduce social contacts by 95% and children reduce contacts by 85%. 3) Protect vulnerable population and restrict young adults. School and essential business are still open: Adults >60 years old reduce contacts by 95% and adults <60 years of age reduce contacts by 25%, 75%, or 95%. 4) Real world scenario (at the time of the study, August ): Adults >60 years of age reduce contacts by 95%, children by 85%, and adults <60 years of age by 25%, 75%, or 95%. Andrew Timing of Social Distancing Effects of social distancing for 42 days (days 50-92) with a 75% reduction in contacts. Each graph assumes an increasing infectious period: 5, 6, 7, 8 days. One takeaway: early interventions only delayed the epidemic! Brief explanation of graphs A, C, E: early intervention. B, D, F: delayed intervention. A, B: 25% contact reduction. C, D: 75% contact reduction. E, F: 95% contact reduction. Our last model considered the timing of social distancing. Timing of Social • The paper simulated the effect of a 50 day strict social distancing period in different parts of the Distancing pandemic. • Early on: almost no effect • Middle of the pandemic: positive effects on flattening the curve, provided a majority of the public was reducing contact by 25% Strictness and timing of social distancing Surprisingly, when strictness of social distancing was increased significantly, with contact reduced by 75% and 95%, the resulting effects were not as significant in flattening the curve Stricter social distancing resulted in what looks like a shifting of the curve more than a flattening of the curve Implementation Stay-at-home orders State mandated stay-at-home orders and non-essential business closures. By the end of April: • 42 states had some form of stay-at-home order/recommendation. • 3 had partial orders for certain regions in the state. By now, most states have relaxed orders, but recent spikes have been reintroducing mandates. Mask mandates •Currently 34 states + DC require mask/face coverings in public. •Major resistance to implementation of mandatory masks in many states and cities. Contact tracing and quarantine Each state practices some form of contact tracing. • Typically involves calling a list of contacts that an infected person provides. Some states have quarantine requirements when traveling. • Some legal fine/repercussion for violations of mandatory quarantines. • ex: Alaska has fines up to $25,000. A recent negative test result can usually substitute for the quarantine. Note: some states have only quarantine suggestions while some have
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