Cure vs. Care: Flattening the Curve

The Issue:

One of the tactics emerging from global health scientists and national health care spokespersons is the importance of prophylactically addressing the virus pandemic. They speak of suppressing the rate of new infections – that is, control or fighting, rather than curing it—for two reasons:

(a) viruses cannot be cured with current medical technology and (b) many countries are at risk of persons who contract the virus over-running their hospital systems, emergency care personnel, and medical equipment including respirators, masks and COVID 19 tests .

Scientists call this “flattening the curves”. By this they mean decreasing the number of contracted cases without protective measures. This includes delaying and decreasing the outbreak peak, thus decreasing the need for protective measures, and decreasing the pressures on over-stressed health care systems. In many countries, pandemic strategies and response offices initiated to combat SARS in 2003, H1N1 in 2009, Ebola in 2013, and Zika in 2016 have atrophied or had the plug pulled.

Many jurisdictions are implementing one or more of various measures to help flatten the curve. They include quarantining, encouraging social distancing; encouraging working from home; closing schools and other institutions; restricting international travel and closing borders; and placing hard limits on the size of crowds at events. The mortality fraction of infected people appears to be higher by an order of magnitude when hospitals are overcrowded, so suppressing the rate of new infections serves the important purpose of allowing those in need to be treated.

Diagram:

Ethical and Moral Dilemmas:

From the point of view of saving lives, our own and others, the wisest policy at the moment may likely be to “flatten the curves”. This strategy could lengthen the doubling times as much as possible by suppressing social interactions. This means each of us acting as if we personally were infected. Everyone would be encouraged to stay at home until the infected recover. We would wash our hands before we go out to protect others; then wash our hands when we return home to protect ourselves.

The virus does not move on its own. It is transmitted by humans and survives a few days on contaminated surfaces. To flatten the curves, all nations must engage immediately in social distancing as well as in extensive testing and comprehensive isolation of patients with COVID-19 symptoms and people who had been in contact with such patients.


It is instructive to try and learn from the current situation in China, where the rate of COVID-19 infections was extinguished as a result of a lock-down, with drones warning people off the streets. Compared to Italy, where self-quarantining is voluntary, hospitals are full and doctors have to make life-death decisions about patients because there are not enough beds to treat everyone in need. One might say that actions in a totalitarian regime are not readily available in a democracy. However in response to the Spanish flu in 1919, the actions of civic officials about whether or not to allow parades to go ahead were different; Philadelphia had very different death rates than did St. Louis.

Overall, there is no doubt that many people will be exposed to COVID-19. As of now, delaying the growth is crucial for reducing the total number of deaths that the COVID-19 will amass. The situation is analogous to waiting after rush hour before driving our cars in order to minimize the death toll from collisions. The optimal strategy of policy makers must be to buy as much time as possible, so that hospitals will not be overcrowded. This is an opportunity for all of us to work together to flatten the growth curves shown above. By doing so, we could save many lives.

Legal and Values Dimensions:

As stated in the Talmud: “whoever saves a single life saves the whole world.”

Further Reading:

Visual Capitalist: https://www.visualcapitalist.com/infection-trajectory-flattening-the-covid19-curve/

Scientific American: https://blogs.scientificamerican.com/observations/flattening-the-covid-19-curves/

About the Author

David Nitkin, founder of EthicScan, is a full-time organizational ethicist. David’s original writing, teaching, consulting and research focuses upon ethical decision making; enhancing corporate accountability and reporting; and developing corporate ethics assurance programs, including transparency, risk management, integrity management, and safe partnering.

David has provided ethics training, advice and research for over 200 clients both internationally and in Canada who collectively employ over 750,000 employees. He consults and trains widely with a variety of clients, including corporations, industry associations, public service sector organizations (integrity commissions, human rights commissions, and anti-corruption tribunals social agencies, professional ethics certification organizations, not-for-profits; and civil society organizations.

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