Flattening the Curve of COVID-19 - Where Canada Stands

It has been 2 months since Canada documented its first case of coronavirus, and there have been thousands more confirmed cases since then. COVID-19 is all over the news and the internet, so chances are that you’ve heard the term flattening the curve by now.

But what does it really mean, and why is it important?

It all comes down to slowing the spread of the coronavirus to reduce stress on our healthcare system. Today we’ll discuss why this is so crucial right now, how Canada is faring compared to other countries, and what you can do to help flatten the coronavirus curve and be part of the solution.

Is Canada flattening the curve? How do we compare to other countries?

See how well Canadians are putting social distancing into practice by checking out Google’s COVID-19 Community Mobility Report for each province.

Below are the graphs of confirmed cases in Canada, the US, Italy and South Korea as of April 3, 2020. It is important to note that confirmed cases, while one of the best metrics that is publicly available, is not perfect and the following factors can affect its accuracy:

Not all countries have the capacity or the will to test for cases extensively or conduct effective contact tracing to find cases in the community. Countries that test a high number of people will ultimately detect more cases than countries that are not doing as much testing.
There may be a surge in the number of confirmed cases when a high number of tests are done in a short timeframe. if there is an outbreak at a given location.
There is a delay between actions taken to try and flatten the curve, when symptoms arise, when the test is completed and when the results are determined and reported.

Canada

See Map & Curves

United States

Italy

South Korea

Live Curves for Every Country

What does “flatten the curve” mean?

Flattening the curve means to slow the spread of a contagion during an epidemic or pandemic. The term flattening the curve is a reference to a graph that plots the exponential transmission of a virus during an epidemic as it spreads unchecked through a population.

As an increasing portion of the population becomes infected, the graph quickly skyrockets, peaks, and then shoots back down as people recover and the rate of infection decreases again.

When you flatten the curve, it means the community intervenes and takes protective measures to slow the spread of the virus. This prevents the drastic uptick in transmission rates and reduces the portion of the population that’s sick at the same time. The graph below will give you a better idea of what it means to flatten the curve:

The same number of people will probably still get sick even if we flatten the curve

Flattening the curve doesn’t necessarily mean reducing the overall number of people who will contract coronavirus throughout the course of the epidemic in Canada. Rather, it means the cases will be more spread out.

So the same number of people will still get sick and the epidemic will last longer, but flattening the curve will ensure that healthcare services are available for patients who need it, when they need it.

Why do we need to flatten the curve?

That all-important red line in the middle of the graph illustrates the number of people the healthcare system can care for at one time.

This is why flattening the curve is so important: if our communities don’t take steps to reduce transmission of the coronavirus, then too many people will get sick at once, and our healthcare system will be overwhelmed. In other words, there will be more sick people than our doctors, nurses, hospitals, and clinics can care for.

Coronavirus can take a terrible toll on the lungs, especially among vulnerable populations, who are people over 65, immuno-compromised people, and people with underlying medical conditions. These people are at an increased risk of developing pneumonia and other respiratory infections.

If too many people get sick at the same time, then there won’t be enough hospital beds, ventilators, protective equipment, and medical professionals to keep everyone alive and well.

And it’s not just patients that benefit from flattening the curve — it also protects healthcare workers who put their lives on the line to care for people who are infected.

What is a reproduction number (R₀)?

The rate at which an infection like coronavirus will spread through a population depends on a number of factors, such as the age and health of the population. One of the most important numbers is the R₀(R naught), which is the basic reproduction number, and this indicates how contagious an infection is.

When somebody is sick with an infectious disease, the R₀tells you how many other people that sick person is likely to infect. If a virus has an R0 of 4, then one infected person will infect an average of 4 more people.

The coronavirus is still very new and data is still being collected about it. However, current estimates suggest the R₀for coronavirus is between 2 and 2.5. That means one sick person could infect 2.5 healthy people, and those 2.5 healthy people could each infect another 2.5 people.

When you think about it that way, it’s easy to see how an infection can spread so quickly in a community when there are no intervention strategies in place to prevent transmission. That’s why it’s important for every Canadian to do their part to flatten the curve.

How do we flatten the curve in Canada?

The good news is that we already know how to flatten the curve of the coronavirus epidemic in Canada, and lots of people have already been taking steps to slow the transmission of the virus. Here’s a rundown of the most important steps you can take to stop the spread of COVID-19:

Social distancing

Social distancing could be called physical distancing because the philosophy behind it is to prevent the spread of a disease by keeping people physically separated from one another.

Coronavirus spreads from person-to-person, and that means you can get sick by touching or being too close to an infected person, or by touching an infected surface. Social distancing keeps us away from each other and keeps us healthy. The main points of social distancing are:

Stay home whenever possible
Leave home only for necessary trips like grocery shopping, going to the pharmacy, and going to work
Work from home if and when you can
Stay away from crowds and large groups of people
When you are around other people, maintain a 2-metre (6-foot) distance
Don’t go near hospitals, long-term care facilities, or other places where there are vulnerable people, unless it’s absolutely necessary

Self-isolation if you may have been exposed

Self-isolation is for people who feel fine and aren’t showing any symptoms, but who may have been exposed to COVID-19, or who have cared for or spent time with a person who has coronavirus.

Self-isolation means you stay home, don’t leave your house, keep your distance from other people, and monitor your symptoms for 14 days. The symptoms you’re monitoring for are the symptoms of COVID-19, including fever, a cough, and shortness of breath.

Mandatory travel quarantine for returning travellers

At the beginning of the pandemic, people who came back to Canada from international travel were asked to self-isolate for 14 days. However, on March 26, 2020, the Canadian government invoked the Quarantine Act, turning that voluntary self-isolation into a mandatory quarantine.

Under the Quarantine Act, travellers returning to Canada must go straight to their final destination, aren’t allowed to make stops along the way to their final destination, and aren’t allowed to take public transportation after disembarking from the plane. People who fail to quarantine themselves after travelling could face stiff fines or even jail time.

Isolation if you have COVID-19 symptoms

Isolation is for people who have symptoms of COVID-19, and who have either been diagnosed with the virus or have been tested and are awaiting results. Isolation means you stay home, you avoid others even in your house, and you wait for a public health authority to clear you before you can leave the house.

Avoiding travel

When coronavirus came to Canada, almost all of the original cases were related to travel outside the country. It wasn’t long before the government issued a warning against non-essential travel outside the country, and that is still in effect.

Travelling can increase your chances of contracting coronavirus, so avoid all travel if you can. If you do have to travel outside Canada, you will have to abide by the mandatory quarantine when you return.

Practicing good hygiene

Good hygiene also has a huge role to play in stopping the spread of coronavirus. Because the virus spreads from person-to-person, simple things like staying home when you’re sick and sneezing and coughing into a tissue or the bend of your arm can keep other people healthy. Here are some other hygiene tips to flatten the curve:

Wash your hands frequently with soap and water, and hand-washing should last at least 20 seconds
Use an alcohol-based hand sanitizer when soap and water aren’t available
Disinfect high-touch surfaces daily (this includes phones, door handles, and toilets, among other things around the house and workplace)
Avoid touching your face — nose, mouth, and eyes — if you haven’t washed your hands
Say hello to people with the Vulcan salute, waves, nods, hat tips, and other non-physical greetings (handshakes and hugs don’t respect the rules of social distancing)
Cook your food thoroughly

How prepared is Canada to flatten the curve?

Canada was fairly well prepared to fight an epidemic because we’ve dealt with one in the recent past. The SARS outbreak that hit Toronto in 2003 was eye-opening for our government 17 years ago the way COVID-19 has been for many other countries today. Because we went through that then, our government was somewhat better prepared to respond now.

For example, although the Quarantine Act predates the SARS epidemic, the Act was updated in 2005 to incorporate things we learned during that outbreak. Many provinces were quick to cancel schools, postpone events, and limit public gatherings. However, some provinces, communities, and people were slower to respond than others, and as of yet we have still not managed to flatten the curve.

Because the epidemic in Canada is still playing out, we might not know how well we’re doing to flatten the curve for another couple of weeks or even months, so we must continue practicing social distancing and other prevention measures. What we want to see is for cases to stop doubling, and that will indicate that we’re finally flattening the curve.

At the moment, Canada is faring better than some countries, but not as well as others. Here are some numbers, as of March 26, 2020, to give you perspective about infection rates in Canada versus other countries:

Japan: 1,399 confirmed cases, population of 126.86 million
Australia: 2,810 confirmed cases, population of 25.2 million
Canada: 3,412 confirmed cases, population of 37.59 million
South Korea: 9,241 confirmed cases, population of 51.47 million
Iran: 29,406 confirmed cases, population of 82.6 million
United States: 69,684 confirmed cases, population of 327.2 million
Italy: 74,386 confirmed cases, population of 60.48 million
China: 81,782 confirmed cases, population of 1.386 billion

When will coronavirus peak in Canada?

There’s no way to tell for sure when the coronavirus will reach its peak in Canada. When the virus does peak, it means there will be the highest number of infected people at one time, and after that the number will drop as transmission slows and people recover. It might seem counterintuitive, but the better we are at flattening the curve, the longer it will take for the virus to peak.

When you look at the population of Canada and the R₀ and incubation period of coronavirus, the virus could take a couple weeks to a couple months to peak, and that’s without health measures in place to prevent its spread. We have implemented intervention strategies, so the peak could be an additional couple months away.

Source: Imperial College COVID-19 Response Team

Again, because the virus hasn’t reached its peak and is still spreading rapidly through our communities, it’s more important than ever that we practice social distancing, self-isolation, and good hygiene, and respect travel advisories so that we can flatten the curve.

As long as someone in the world has the virus, breakouts can and will keep recurring without stringent controls to contain them. Researchers at Imperial College London proposed a way of doing this: impose more extreme social distancing measures every time admissions to intensive care units (ICUs) start to spike, and relax them each time admissions fall. Here’s how that looks in a graph:

A graph of weekly ICU cases over time. — Source: Imperial College COVID-19 Response Team

Conclusion

Flattening the curve is all about using preventative measures to slow the transmission of a disease throughout a population. When you hear that term today, people are talking about stopping coronavirus from blazing through our communities too quickly, because this would overtax our healthcare system, put patients at risk, and leave healthcare workers in dangerous and impossible positions.

Social distancing is one of the best tools we have against the spread of coronavirus right now, and will help us flatten the curve. You might be feeling a little lonely, bored, or even stir-crazy right now, but the effort we put in now to stop this disease from spreading too quickly will benefit all Canadians in the end, including you, your family, your friends, and the people you know and love.

References

Over to you

Have any suggestions for flattening the curve that weren’t mentioned? What are you doing to keep busy at home? Help other Canadians by sharing your advice in the comments.