Flattening the curve

Flattening the curve

1. As most know by now, the purpose behind "flattening the curve" is so that hospitals don't get overwhelmed with tons of patients at one time. So that it prevents a surge of sick people requiring medical services all at once.

The basic idea is if there are 100 sick people rushing into a hospital all at once, then it'd overwhelm the hospital. So it'd be better to have 10 people per day spread across 10 days (or whatever). That's the basic idea.

2. Otherwise, if too many people need a hospital at one time, and there's not enough personnel or equipment to help everyone at the same time, then physicians may need to make snap judgments. In worst case scenarios, they may need to make snap judgments about who to save and who to let die. That's what's happening in Italy. However, we're not Italy. Certainly not yet. Far from it so far.

Raising the capacity

Alongside flattening the curve, what about raising the capacity? What I mean is "flattening the curve" is from the perspective of the average American, whereas "raising the capacity" is from the perspective of the hospital or our health care system. Flattening the curve is more about "what can I do to ensure hospitals don't get overwhelmed", while raising the capacity is more about "what can hospitals do to ensure they don't get overwhelmed".

I think capacities can be subdivided into at least three categories: medical facilities, personnel, and medical equipment. I've briefly touched on some of this in the past (e.g. here), but let's elaborate:

1. Medical facilities.

a. We could build new hospitals. That's not super far-fetched. China built a new hospital in 10 days to respond to the coronavirus. We might take longer due to safety regulations and the like, but it's not impossible. It'd provide work for people too.

b. We could set up makeshift hospitals (tents) outside hospital and other parking lots.

c. We could turn community centers and other buildings into hospitals.

d. We could retrofit current hospitals with extensions or extra wings.

e. We could treat people from home using telemedicine. Health care providers could make home visits if needed.

f. Of course, much of this is normally happening anyway, but we could adapt it for the pandemic.

2. Personnel.

a. Med students. That's what med students are here for. To learn on the job. Med students might need supervision, someone to doublecheck their work, but med students are generally bright and capable, and have a lot to offer. However med schools might be shutting down rotations. (Residents are already working crazy hours.)

b. Primary care physicians (PCPs) tend to work in the community caring for patients with less severe diseases, chronic ailments, and the like. Many of these problems could be dealt with over the phone or remotely, at least temporarily until the pandemic is under control. If PCPs are willing, they could start working in hospitals again.

c. Specialists. The sickest patients end up in the intensive care unit (ICU). So the ICU is likely to have the most need. Hospitalists could help in the ICU. In fact, that already happens at many places. Likewise, if we're shutting down some ORs, then anesthesiologists could fit like a glove in the ICU.

d. Out-of-state doctors. Some places are more impacted than other places, so, if doctors are willing and able, they could travel to another state to help.

e. Of course, legal issues would have to be dealt with, but presumably normal restrictions could be waived in a pandemic.

3. Medical equipment.

a. We could start to rely more on homegrown companies rather than overseas ones and/or distribute it across multiple regions. Like how big tech companies have servers all over the world. Multiple disparate redundancies. For example, Michael Osterholm points out in his interview with Joe Rogan that Puerto Rico once (still?) manufactured 85% of the world's IV bags. Hence when Puerto Rico was hit with a hurricane, much of the world was in short supply of IV bags! Not a good idea to put all our eggs in one basket if our eggs are basic medical supplies.

b. Likewise we could Jack Bauer certain equipment. For example, here is a video that's just gone viral (forgive the pun). It's from an emergency physician who has been able to take one vent and turn it into multiple vents. The sickest patients need vents. Otherwise they could die. Of course, it'd normally be less than standard of care, but in an emergency it might be the only way to ventilate multiple patients if we don't have enough vents. At least temporarily; it's not a long-term solution.

c. Related to (b), perhaps engineers could partner with physicians to help figure out ways to alter existing medical equipment so that it can help multiple people. Like Gene Kranz's NASA team helping the Apollo 13 team using only what they had on board the command and lunar modules.