In the ruminations one falls into from a little fever and too much stale indoor air, I thought at length about “flatten the curve,” the old term that was the cri de guerre in the pandemic’s first months.
Those early days were frightening. We had no readily available rapid diagnostic test, poor understanding of how the virus that causes Covid-19 typically spreads, no appreciation of the virus’s ability to twist and turn to evade immune detection, no vaccines and no treatments. Then, the best way to prevent spread was to prevent human contact — thus the notion of flattening the (pandemic) curve to slow transmission of the virus so the health care system wasn’t overwhelmed.
Although the ensuing political theatrics added to the difficulty of the task, complete curve flattening for a protracted period was never realistic. That was the beauty of the idea: Curve flattening was not about extinguishing the outbreak but rather introducing a way to stall the widening catastrophe and buy time till scientists could get ahead of the problem.
For a moment, the idea caught on and dominated advice from public health experts, forward-looking politicians and TED Talk types with excellent graphics. Indeed, the before-and-after look of curve flattening made a great visual that, in its apparent simplicity, hid just how onerous the task would be. The work of flattening was sold as patriotic and even heroic, concepts that parts of the US quickly came to define quite differently.
The idea faded suddenly, both because it didn’t work that well in most places and because medical treatments for the disease emerged.
I never much liked the flatten the curve campaign: It seemed more about sloganeering — rah-rah, even corny words for their own sake to try to maintain a sense of control over what was not at all controllable (then or now). Plus, people were going to stay home, not out of civic duty but rather old-school fear, still the most potent motivator of any behavior.
As a guy who has lived a pretty dull life since I caught the infection, I am realizing that we actually carried out the original game plan: We flattened the curve.
Despite distractions, miscalculations, lies, bad studies and worse observations, we have pretty good tools in hand, a poorly controlled but no longer overwhelmingly lethal infection that continues to squirm out of our grip just when we think we have it, and rising rates of immunity, although not exactly enough protection to enter the fairy-tale land of herd immunity. Life has changed from a gripping daily fear of dying to an annoyance over the possibility of being uncomfortable for a week or two — assuming one is vaccinated.
So here we are in the post-flattened world, where variants will continue to flare, death rates will spike after each flare and people will always find someone else to blame.
Which raises the issue — now what? It is clear that vaccine-induced immunity from the current crop of vaccines has saved countless lives and with wider acceptance would save many more. But as built, this generation of vaccines is unable to control a pandemic characterized by a whack-a-mole supply of new variants.
It is also clear that the antivirals are pretty good but not so easy to take, with the preferred medication, Paxlovid, having complicated interactions with other drugs (a particular issue for those 65 and older who typically are on multiple medications). Also, drug resistance may eventually emerge, as we have seen from drugs to treat viral infections such as influenza, HIV and hepatitis B.
We also know that immunity triggered by infection is only good, not great. Indeed, my adult son has come down with a second Omicron illness only four months after his first. He is less sick but sick — despite youth, his previous recent infection, three messenger RNA vaccinations and a proper respect for how to avoid infection.
Surely, there will be more and better vaccines soon and more, better pills and more, better approaches. We will be awash with options. Necessity has once again come to be the mother of invention.
But until then, here’s the best plan forward. Until the new and improved products are here, let’s get vaccinated and wear a mask when we need to, take our medication if we are infected, keep funding the public health Covid-19 control framework and all work together for a simple, single goal. Let’s all flatten the curve! Because stalling and kicking the rock down the road a little longer turns out to be a pretty good approach to managing this monstrous pandemic.