Diplomatic Notes

Flattening the curve

On Sunday, the Prime Minister of The Bahamas Hubert Minnis spoke of the possibility of the most extreme measures ever witnessed in The Bahamas for the sake of the public good in the face of the impending crisis associated with the COVID-19 virus. I must admit that, up to a week ago, I was under the impression that some of the global reactions were disproportionate and that we could not possibly be looking at a global lockdown that would include The Bahamas. My thoughts were that we only had zero known cases, our economy is tourism-based, so it would be best to just observe best practices, but continue with life as normal as we could have it until the crisis subsides and then we could return to normal.

Everything changed when I did two things – speak with local medical and environmental personnel in high positions and engage in detailed research on pandemics of the past. I had heard the term “flattening the curve” before but did not get a real appreciation for it until I did a study on the last pandemic of the magnitude of what we are facing today.

My perspective changed as I began to study the Spanish Flu pandemic of 1918. I studied the most recent pandemic also, which, somehow, I had previously overlooked; the swine flu H1N1 pandemic of 2010. The swine flu pandemic was massive, but the mortality rate was very low, so, it somehow went under the radar. The swine flu infected 700 million people worldwide, resulting in an estimated 575,000 deaths over a period of one year. It did not result in mass lockdowns and within 14 months, a vaccine was produced and the swine flu, although still with us, became just a normal part of our flu season, nothing of major concern.

The Spanish flu pandemic was another story. The Spanish flu, which is attributed to the same H1N1 virus, infected 500 million people and resulted in as many as 100 million deaths according to the American Journal of Epidemiology and the World Health Organization in reassessing the death rate, which was earlier estimated to be around 50 million. What was startling about the Spanish flu pandemic was the difference in approach and outcomes in two American cities. When word of the pandemic reached the United States of America (USA), the city of St. Louis, then the third largest city in the USA, ordered an immediate lockdown of all public facilities and gatherings. The mayor, at the time, was criticized for taking draconian measures and there was a massive push back, but the mayor’s order was enforced. In the city of Philadelphia, the mayor stated that the city could not afford to close and ordered schools and restaurants and all public facilities to remain open. He allowed a massive “War Bonds” parade to continue, as it was seen as a needed fundraiser at the end of World War 1.

With the action of the St. Louis mayor, St. Louis “flattened the curve” and was spared the brunt of the pandemic with minimal loss of life despite the initial inconvenience. Philadelphia was devastated. By not locking down, there was a run on health services, hospitals were overwhelmed to the point where there were people in hallways and even in the parking lot unable to receive attention who subsequentially died. Doctors and medical personnel were overwhelmed and many of them died because the curved peaked. Too many people needed medical attention at the same time because of the rapid spread associated with community transmission, which was enabled by the public interactions associated with continued gatherings and close interactions in restaurants, bars, schools and other public gathering places. By the time they realized what was happening, it was too late. St. Louis, on the other hand, by limiting public contact and community transmission through the lockdown, was able to recover, and a year later, the Spanish flu was history for almost 100 years, until it’s re-emergence in 2010.

I guess the point is: either we learn from history or we repeat it.

Today, Italy is facing an unprecedented death rate because they did not flatten the curve. Before Northern Italy realized it, the health systems were already overwhelmed, not enough respirators, medical personnel overwhelmed causing mass panic, fear and death. A few days ago, 368 persons died in Italy because they failed to flatten the curve.

United States President Donald Trump initially saw no need to take dramatic action and opined that things would be fine soon. As news and information spread about what was happening in Europe, his tone changed, and he ordered the most draconian measures ever witnessed in this generation. No travel to or from Europe, the United Kingdom, China and several other countries. Why the change? Why the drastic action? He was told about the curve and he realized the possible calamity ahead if the curve was not flattened. The estimate of ventilators and ICU hospital beds needed was only about 10 percent of capacity if the curve was not flattened. This means only 10 percent of patients could receive the emergency care they needed if no action was taken. The president heeded the medical professionals and epidemiologists and is hoping to avoid the catastrophe that is Northern Italy and some parts of Europe today.

I was asked some very important questions about my position since it would involve closing of churches or shifting services to online platforms. My response was influenced by what has happened in both South Korea and New York in the past few weeks. In both cases, the spread of the virus was linked to a typical mass gathering, in one case, the pastor in Korea unwittingly infected multiple congregants leading to the South Korea outbreak, and in the other, New York city, which has the largest outbreak in the USA and the epicenter, was a mass gathering at a synagogue. I then realized the inherent danger and my position was influenced by both past and current history. When we see a hurricane coming, we pray but we also prepare. I pray because we are instructed by our spiritual guidebook and constitution to do so. I also prepare. When a hurricane is coming, I do not say I will remain outside. I batten up like everyone else and ride out the storm.

Our prime minister, being a medical practitioner himself, knows about the curve and took decisive action. I am not here to either praise or dismiss the prime minister, but to simply look at history and say on this one, despite the hardship ahead, he made the right call. Life is more important than money. When the crisis is over, we will return to normal, resources will be redistributed, commerce will return, and things will eventually get back to normal. If we do not flatten the curve, lives could be lost that we cannot get back. We can always recover things, but we cannot recover lost lives. If at all possible, let’s remember the lesson of St. Louis and Philadelphia and err on the side of caution by flattening the curve.

• Pastor Dave Burrows is senior pastor at Bahamas Faith Ministries International. Feel free to email comments, whether you agree or disagree, to pastordaveburrows@hotmail.com. I appreciate your input and dialogue. We become better when we discuss, examine and exchange.

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