The Curve We Need To Flatten Nobody Talks About

COVID-19 is probably one of the most disruptive and exceptional phenomenas we've experienced in the last 100 years. This virus which started in China is now spread globally and taking the lives of thousands of people. There are many types of characters in this story: governments, businesses, individuals, schools and much more. All characters in the story are effected by one another. We see two types of characters in this story:

The Optimists - these are the institutions, businesses and individuals that carry on. They try to keep business as usual, try to think positive and convince themselves this would not be something major, and that it won't happen to them. Those organisations are calling to release the restrictions soon even though we have no clear evidence that the numbers of cases are getting better.

The Pessimistic - These are the institutions, businesses and individuals who are taking extreme measures to block and prevent the virus from spreading - for them it's not business as usual but it's war time. Slowly, you see more and more countries who become the pessimistic persona in this story. Britain started as an optimist and now is a pessimist persona, and many other countries went through the same transition.

I have been reading many articles about the strategy to flatten the curve. All those articles talk about our ability and need as a society to decrease the number of cases of COVID-19 by imposing harsh regulations and restrictions for social movement - Social distancing. To clarify, the curve mathematically talks about two axis: the vertical is the number of cases of COVID-19 (I also met some graphs that show the number of deaths due to the virus), and the horizontal axis is the timeline.

Another mathematical fact that I haven't seen in those article or all those random social network posts is what does the area beneath those graphs says. If you draw a vertical line at each point of time, you get the number of cases of that specific time. Then if you add all those line values you will get the total number of cases of COVID-19, or number of deaths in the time when we consider the pandemic to be live.

Before I would run and post these graphs on Facebook or Linkedin (which I did at first), I would zoom out and reflect about the mathematical facts that we do not consider in those diagram. The first question is which graph has the larger area? hence, in what scenario we will have a larger number of cases/death in total. You might flatten the curve, but for the long term could potentially have overall more deaths in a certain country.

* I am still researching for these numbers, and would love if people could comment if they have some more data around total number of cases in both scenarios.

The second mathematical fact is that the flattened curve does take longer for the number of cases to turn zero. This brings the psychological questions of social resilience, how long could a country or world population take such measures of social distancing financially and mentally. In addition, what are the consequences of prolonging this process.

The reasoning behind flattening this curve is not necessarily to reduce the number of cases or deaths of a pandemic, but to allow the health systems and organizations to deal with the number of cases at a given time. There is no healthcare system that I know that could handle the number of cases that we see now in Europe and in the US, and this is the reason why you see countries like Italy and Spain that are reaching so many death cases per day. Not flattening the curve, might mean that the regular cases that arrive for hospitals including women who need to give birth, heart problems and caner patients will not get the right attention and resources they need.

The World Health Organization declared COVID-19 as a pandemic and countries, business are taking extreme measures to keep their communities safe.

There are many different actions individuals and communities can do in order flatten the curve. Individuals can wash their hands more often, sneeze with a tissue paper, and just stay home and not participate in gathering of more than 2-3 people. For example, if you just came back from Italy, where the Corona virus is spreading very rapidly, you should voluntarily stay home and not risk anyone with getting infected.

One of the most common strategies to prevent infection of COVID-19 is called 'social distancing'. The requirements are to keep at least 2 meters distance from one another, and banning gathering of groups coming together. In some cases, which is becoming the trend today, countries declare a complete lockdown, that prevents people from reaching situations of contact and contamination. This is now a global trend that is was implemented in China and now applied in the UK, Spain, Italy and more countries.

Some countries applied a gradual social distancing act. For example, In Israel they went from restricting 5,000 people public gathering to 100 and then 10 in just four days - today you are only allowed to be in your close family, your households. The same happened in other countries as numbers of cases went up, the restrictions got tighter.

Another actions were taken by businesses, who transitioned to work remotely. We are living in an era, where many businesses are able to still run a large percentage of their operations digitally and remotely. Large businesses such as BP, Apple, Facebook and Microsoft moved their workable to work from home, leaning on video conferencing applications like Zoom and Microsoft Teams to communicate and manage tasks.

There are definitely some tradeoffs those countries and businesses made when they applied those new policies of social distancing - some of them financial and operational but others are mental and psychological as individuals but also as groups. 'Social distancing' is conceived a physical isolation and distancing. However, it is more than that - it's an emotional and mental distancing as well.

This approach took place in the US during the 1918 Flu pandemic. Researchers of that time, show how timely the intervention on activating social distancing mechanisms is. When they compare the curve of number of cases vs. time of Philadelphia and St. Louis, the curve looks the following.

As you can see in the graph above since the social distancing mechanism entered quite late in Philadelphia comparing to St. Louis, the virus was already spreading and acting at that stage could not stop the growth of the number of cases. Hospitals could not sustain the pressure, and then numbers boosted. However, we are not in 1918 any more, and there are really many parameters that could also impact this curve like the average age of the population in both places, or the number of hospitals/medical staff in each place.

Some compare what is happening in Italy these days to the one that happened in Philadelphia. However, there are many differences in those two cases. While I am a believer that social distancing is a good mechanism to deal with the Covid-19, I believe that there are additional aspects of flattening the curve that we are fortunate to be aware of today that the leaders in 1918 did not have any view or awarenesses - the most important one is mental health.

There is a huge gap in my view of how world leaders should approach 'social distancing' and our treatment in COVID-19, and how they do. I do not see any of the world leaders having psychology experts joining them to address their people. They are imposing physical restrictions and while some provide financial solutions, almost no one provides mental solutions or at least guidance.

According to the World Health organization (https://www.who.int/publications-detail/depression-global-health-estimates), Italy had in 2017 more than 3 million cases of depressive orders, and almost 3 million of anxiety disorders. Germany, had even more cases (see the table below). Both the World Health Organization and governments do not give enough thought to the implication of social distancing in a long period of time. Countries like Italy, Spain and Germany are now experiencing great financial restrictions. People lose their jobs, experience the lost of their loved ones, and are not able to go outside and feel free. If the starting point of the number of cases of depression were high, just imagine what they will be during and after COVID-19.

We see leaders delivering stressful messages to their people, imposing restrictions to go outside, closing all leisure and dining places immediately. While this is indeed necessary to prevent the spread of the virus, the way in which world leaders are delivering this message creates great anxiety and uncertainty. Like in managing a business the key for a successful business is clarity and alignment of your team to execute your vision. In many cases around the globe, country leaders are providing guidance which is vague, unclear and sometimes conflicting. These unclear statements create anxiety within the population which already is dealing with many changes in their lives including having their kids with them while working from home, have limited movement and in many cases changing their plans to travel.

Another thing that creates anxiety in this case is the speed in which countries went from one state to another. People that had clarity, routine, freedom of movement just lost everything instantly. In some countries, people were able to have some kind of transition period (even if short) to get used to the new situation. On the other hand, some people predicting what is about to come by looking at other countries even got stressed more and started buying food and groceries.

The combination of the already existing global depression pandemic, with the implications of the new reality in which we are all living, more and more people will become depressed and will have severe anxiety. As we keep this situation for a long time this number will go up and up, having people losing their freedom to move, become ill and see their loved ones, their dreams and their careers gone.

No matter if we flatten the curve of number of Covid-19 cases or not, the curve of depression will keep to go up exponentially. It will also keep growing after this ends due to the economical implications and consequences, the fear of something like this to erupt again, and in some cases even the relationship with your partners will change because the dynamics between partners. We already see an increase in number of people reaching our to seek mental and psychological help since the first week of a lock down in certain countries, and as lock down move on the number of people with anxiety will go up.

In a survey done in Israel, after the second week of lockdown, people had to rate what bothers them the most, and more than 50% were concerned about their financial situation vs. around 20% who were concerned about the virus itself.

What I am not here to say is that social distancing is unnecessary. On the contrary, I think it is crucial for us to get better. However, when country leaders, healthcare systems and businesses are imposing such restrictions, there should be a strategy and plan to cope with the mental health of our population including our kids. The first thing that could ease anxiety are leaders who communicate with empathy, and not putting extra pressure and uncertainty. If you communicate in an aggressive tone, you will create a war-like atmosphere which will increase anxiety. However, if leaders understand the mental implications of their communication style, this could immensely ease anxiety and depression.

There is only one world leader that I saw that is addressing the issue seriously and talking directly in order to flatten the mental health curve while flattening the COVID-19 and it is Canada's Prime Minister Justin Trudeau. In this video he addresses his people directly and says "It's Ok to be vulnerable. It's Ok to have tough days. I want you to know that you're not alone." This is the kind of world leader that we need these days. A leader with empathy that knows how to address not only the short term physical pandemics but the long term financial and mental pandemics his people will face as a consequence.

The second thing is to reduce uncertainty within the population. In order to do this, world leaders will have to first make sure they have solutions to the financial and healthcare consequences of Covid-19, and to communicate those clearly to their people. Those solutions should be delivered before any constraints are imposed and even if not, they should deliver those quickly after they took measures like a lockdown or putting people out of jobs.