Why canceling events makes sense in the age of COVID-19

Governments, businesses and sports leagues are taking drastic steps to combat the spread of the novel coronavirus that has infected more than 1,300 people across the United States. 

The measures, virtually unprecedented in the century since the Spanish flu that killed more than 50 million people around the globe, are aimed at reducing the transmission of the potentially life-threatening virus between those already infected and those who are at risk. 

Public health experts say the steps are necessary, even critical, to stop the spread of the virus. The difference between fast action now and further delays, they said, will determine whether the outbreak in the United States looks more like the one in South Korea, where COVID-19 case counts are coming under control, or more like the one in Italy, where the outbreak is already swamping the health care system.

“We have to make those hard calls about canceling conferences, telling people to work from home, telling the elderly to stay home, don’t come out,” said Farzad Mostashari, the former national coordinator for health information technology at the Department of Health and Human Services who now runs Aledade, which serves 550 primary care practices in 27 states. “We have precious few days to prepare, in the worst case of this.”

New York has limited movement and closed community and religious institutions in the immediate vicinity of a New Rochelle synagogue that has been the epicenter of a cluster of COVID-19 cases. Governors in Washington and Oregon have banned gatherings of more than 250 people in key areas.

The NBA, Major League Soccer and NHL have suspended their seasons, and other sports leagues may soon follow. Seven major college conferences canceled basketball tournaments on Thursday. Major events, conferences and meetings have been canceled, from Austin’s South by Southwest festival to the American College of Cardiology’s annual meeting in Chicago, one of the largest gatherings of medical professionals in the country.

But similarly urgent measures are not happening at the federal level. President Trump on Wednesday announced travel restrictions for some in Europe, but he laid out no new plan to address the number of coronavirus cases spreading in communities across the United States.

Experts said the administration is running out of time to prevent a catastrophic outbreak.

Days after it became clear that the virus had spread from China’s Hubei province to South Korea, the government in Seoul moved quickly to track contacts, limit public events and, most crucially, test those who showed any symptoms, even at mobile drive-through testing sites. The country has tested more than 210,000 of its citizens for the virus, far more than any other nation outside of China. 

As a consequence, South Korea had confirmed 7,755 cases of COVID-19 through Wednesday, according to the World Health Organization. The number of new cases identified every day has slowed substantially. Sixty people have died, a mortality rate of a little under eight-tenths of a percent.

Italy, by contrast, was far slower to take the threat seriously once it became clear coronavirus had arrived on its shores. The country recorded its first two cases on January 31, and a cluster of new cases on February 21, three weeks later.  

The government waited until March 8, when more than 7,300 people were confirmed to have contracted the coronavirus, to impose a broad lockdown on Lombardy and 14 northern provinces. Two days later, Prime Minister Giuseppe Conte extended that lockdown to the entire country.

That slow approach to drastic action has led to an explosion of cases. The total number of cases in Italy has grown by more than 1,000 for each of the last five days; on Wednesday, Italy reported 2,300 new cases — and more than 200 new deaths in just a 24-hour period. Hospitals are so overwhelmed that doctors are making excruciating decisions about which patients in need of medical attention will get treatment. About 6 percent of those who have contracted the virus in Italy have died.

The critical factor that has made the difference between South Korea’s mortality rate, 0.8 percent, and Italy’s, 6 percent, is the capacity of the respective health systems to treat patients they see.

“Countries that act fast can reduce the number of deaths by [a factor of] ten. And that’s just counting the fatality rate. Acting fast also drastically reduces the cases, making this even more of a no-brainer,” wrote Tomas Puyeo, an author and tech expert who analyzed mortality rates between impacted countries in a Medium post.  

Epidemiologists say a virus that has spread as widely as this coronavirus has is likely to infect a huge portion of the population, whether fast action is taken or not. But the rate at which those infections take place matters a great deal: If infections happen all at once, as in Italy, the system’s capacity will become overwhelmed. If infections happen more slowly, as in South Korea, the system can treat the patients with the most dire symptoms.

The catchphrase that epidemiologists have embraced acknowledges those differences: Flatten the curve, a reference to the bell curve that defines the case counts in any given outbreak. 

A rapid pandemic will send case counts above the level at which health systems can support. A slower-burning one may still infect the same number of patients, but at a low-enough rate that the health system can handle capacity at any given moment.

“The goal is to slow down the spread and have it happen over a larger period of time so that hospitals aren’t overwhelmed and supply chains can keep up,” John Wiesman, the Washington state secretary of health, told The Hill days before the scope of the outbreak in his home state was evident. “It’s important for the public to understand what that goal is so that they’re not confused and say ‘hey, this isn’t working.’”

In the United States, the window for action is closing. Case counts are closely tracking Italy’s stratospheric rise, and the Trump administration has shown no signs of issuing the sort of emergency orders that Conte’s government did five days ago. 

“If you think about exponential growth, every day for the past couple of months the number of cases outside of China has grown by 15 percent day over day over day over day,” Mostashari said in an interview. “What that would imply for the U.S. is that 16 days from now we would have ten times the number of cases that we have today. And 16 days after that, we would have 100 times the number of cases we have today. That kind of puts it in perspective.”