How flattening the curve saves lives
While the recent heated exchange between Sen. Rand Paul and Dr. Anthony Fauci about pandemic response strategies received considerable attention, I’ve seen no scrutiny of Paul’s false claim that flattening the curve only saves lives if it prevents the health care system from being overwhelmed. This thinking assumes that the “area under the curve” (i.e., total deaths) will be the same regardless of the measures taken, so long as we don’t overburden the medical system. This belief has been stated often this year as if it were a fact, yet it’s patently false.
The claim rests on the absurd assumption that treatments for patients infected by this novel virus haven’t improved and will never improve. Expressed another way, Paul’s claim about flattening the curve only holds water if health care professionals are no better at treating infected patients today than they were in March.
Of course, months of research and clinical experience have improved our understanding of how to treat patients with COVID-19. For example, research on the use of corticosteroids to treat severe cases of COVID-19 has yielded promising results, including one study that found dexamethasone decreased mortality by approximately one-third among patients who were on ventilators. Additionally, a recent editorial from JAMA encourages placing some patients on ventilators in the prone position, a strategy rarely used at the start of the pandemic.
These advances in medical care mean that people who are infected today are more likely to survive than people who were infected at the beginning of the pandemic, and this trend will likely continue. Consequently, delaying the time at which a person is infected by flattening the curve increases their chances of surviving and having an easier course of illness.
Many critical questions about the virus remain unanswered, such as the optimal dose of dexamethasone for various patient demographics, and these gaps in knowledge further highlight the value of flattening curve. It takes time to research these issues and to discover more effective treatments, and flattening the curve allows these advances to help more people. Perhaps the most obvious example is the development and distribution of an effective vaccine. If an effective vaccine is distributed widely in the coming year, then the number of lives the vaccine saves will be directly related to how aggressively we’ve flattened the curve.
To be fair, Paul also claimed that public health interventions have no effect on the rate of transmission of the virus and therefore attempts to flatten the curve only cause economic and psychological damage rather than save lives. This claim is in stark opposition to the guidelines of the CDC and WHO and ignores the contradicting results of New Zealand’s approach. What’s more, while Paul cited the results of Sweden’s relatively lax approach to support his argument, Fauci noted that the country’s results may argue against his position: Sweden has death and case rates that are several-fold higher than those of other Scandinavian countries that more aggressively tried to curb transmission. While effectively flattening the curve may be more complicated than enforcing public health measures, it doesn’t mean that we’re better off disregarding such measures.
Though there may be compelling reasons to adjust pandemic response strategies, the falsely claiming that flattening the curve doesn’t save lives from COVID-19 infection isn’t one of them. If anything, promoting this falsehood likely endangers American lives. People need to stop repeating and spreading this lie. Sen. Paul, I hope you’re listening.