A cyclist rides past a coronavirus graffiti by street artist 'Uzey' showing a nurse as Superwoman, the lettering reads "for the real heroes" on a wall in Hamm, Germany, on April 13, 2020. Image Credit: AP

Is it possible to flatten the curve? Yes, it's possble. Several countries and territories have done it. They have successfully contained the spread of the new coronavirus. China, where the SARS-Cov-2 virus originated, leads the list of countries that have flattened the curve.

South Korea, Singapore, Taiwan, Canada, Georgia, Austria and Iceland too have tamped down infections. In Europe, Germany is on course to flatten the curve, while Italy and Spain expect cases to drop after several weeks of dread and deaths when the number of cases overhauled China.

What’s flattening the curve?

During an epidemic, the curve represents the number of people who may get sick over a given period. A sharp rise means the disease is spreading quickly: too many people are infected at the same time, and the healthcare system is under strain.

A flatter curve indicates a slower rate of infection rate, which means people are infected over a longer period. There may not be an immediate fall in the number of cases, but newer cases will be fewer. The result is less impact on hospitals.

How do you flatten the curve?

Social distancing, self-isolation and quarantine will help reduce the spread of the disease. That’s why countries prefer lockdown, although it clobbers the economy. Widespread testing and tracing contacts are other measures that have been successfully employed.

South Korea and the southern Indian state of Kerala offer good examples of how to stop the contagion. Their steps were simple but proactive: aggressive testing, tracing contacts and providing support to the residents. They also imposed stringent controls that required all passengers arriving from foreign countries to quarantine in government facilities for 14 days.

In Europe, Germany’s success is worth emulating as it will soon be the first European country to flatten the curve. How did Germany do it? Emily Haber, German ambassador to the United States, has the answer that mirrors the actions of South Korea.

She attributed the success to widespread mass testing; a relatively young population that made up the bulk of the initial COVID-19 cases; and the benefit of time to expand intensive care facilities and stockpile medical equipment.

“We were able to prepare because we were not the first country in Europe affected, and we saw and could analyse developments elsewhere,” the Washington Post quoted Haber as saying.

How planning helps

Kerala Health Minister K.K. Shailaja, in an interview to Gulf News, said that the south Indian state had started planning much before the first case surfaced in her state. When Wuhan reported the epidemic, the state government began to draw up plans, she said, adding that a large number of Keralite students study in Wuhan. The lessons in fighting the Nipah virus last year helped, although the COVID-19 was on a much bigger scale.

South Korea too began early preparations. Being in China’s neighbourhood, it was well aware of the risks. The MERS outbreak had helped them develop the tools to fight an epidemic.

Why the South Korean model is different

South Korea is the second country after China to flatten the curve. And they did it without a lockdown, without harming their economy. Tedros Adhanom Ghebreyesus, chief of the World Health Organisation, praised South Korea and urged countries to “apply the lessons learned in Korea.”

So how did South Korea do it? A New York Times report throws more light into it. Here’s how they did it: Intervene fast before it’s a crisis; test early, often and safely; contact tracing, isolation and surveillance; and enlisting the public’s help.

The measures worked in the country of 50 million people. At the peak, 909 new cases were identified on February 29, but with less than a week new cases halved, and in four days it halved again. And the curve flattened.

South Korean President Moon Jae-in and his wife Kim Jung-sook cast their early ballots for the upcoming parliamentary elections at a polling station in Seoul, on April 10, 2020. Image Credit: AFP

How other Asian countries stopped the spread

Strict containment measures and tighter border controls helped Singapore and Taiwan keep the infections under control, despite their proximity to China. Some citizens who returned to Singapore recently were asked to share location data to prove their adherence to quarantines. Taiwan, which is only 160km from China, was quick to start checks on people arriving from Wuhan and introduced a system to track those in self-quarantine.

How lockdown helps in flattening the curve

When the coronavirus threatened to spiral out of control, China sealed Hubei province, where the virus originated. That was at the end of January. More areas were later locked down after more than 15,000 new cases were reported on February 12.

Lockdown seems like an extreme measure, but it worked in China. The restrictions in some areas have now been lifted. On April 8, Wuhan emerged from 76 days of quasi-quarantine — arguably the largest lockdown in human history.

How Europe is faring

Will lockdown work in a democracy, where human rights and freedom are paramount? Europe was to provide the answer soon. In February when Europe contracted COVID-19, Italy became the epicentre of the outbreak with an avalanche of cases.

Spurred by China’s success Italy enforced draconian measures, the strictest in a western democracy. On March 9, Prime Minister Giuseppe Conte imposed a national quarantine, restricting the movement of people except for emergencies and work. A month later, the strict measures seemed to have worked. The number of cases is levelling off.

Spain, which topped Italy in confirmed cases, too went into lockdown from March 15, and it is now looking at a flatter curve. So is the case with France. Both Italy and Spain reported more deaths than China.

Georgia, despite its small size and a struggling economy, reacted fast by closing schools and launching extensive tests. The result was fewer cases and a flatter curve. Iceland conducted tests on more people per capita and introduced quarantine measures, which helped contain the virus.

Germany, which has been under lockdown since March 22, plans to reopen soon. Despite becoming the fourth country to top 100,000 cases, Germany hopes to return to normal life next week as mandatory mask-wearing in public and limits on gatherings paid off.

Austrian Chancellor Sebastian Kurz says his country reacted faster and enforced a three-week shutdown that has enabled the country to recover quickly. Shops will open next week, but residents will have to wear masks.

In sharp contrast, Britain’s lax strategy is likely to make its mortality rate the highest in Europe.

The United States seemed slow of the blocks, while its neighbour Canada rolled out more extensive testing. That helped the Canadians to catch the cases early, and reduce the impact of the virus.

The US has more cases confirmed than any other country, but places like California seems to be flattening the curve.

Is there a risk of a second wave?

While several countries have shown that the spread of the virus can be curbed, the risk of a second wave looms. Citizens who were worried about outbreaks abroad are rushing home. The result is a surge in new infections in Hong Kong, Japan and China, mainly from imported cases.

The second wave has also been witnessed in places emerging from lockdowns. A small number of asymptomatic people will be among the residents who return to normal life. They will return to work, drop off children at school and go shopping, and that will give rise to another round of cases.

The WHO has already issued advisories. Countries in the northern hemisphere and countries with tropical climates have been asked to prepare for a second wave of pandemic spread.

So it’s still not yet time to lower the guard. We have to remain vigilant to flatten the curve.