Doctor behind ‘flatten the curve’ urges bipartisan response to outbreak

The doctor who helped coin the term “flatten the curve,” the public health mantra aimed at easing the impact of the coronavirus, says the outbreak will test the nation’s ability to transcend partisan politics. 

“The partisan stuff has to stop,” Dr. Howard Markel told The Hill. “This is not the time for games of ‘gotcha’ — it is time for our elected officials to govern and not to snipe at one another.”

Markel, a pediatrician and professor of medical history at the University of Michigan, said that Americans have regularly come through challenging crises, but only when the nation was united.

“In times of war, we used to say politics ends at the shoreline,” Markel said. “Now, politics has to end at the level of the microbe.”

Perhaps no single phrase better encompasses the nation’s public health fight against the coronavirus than the clarion call to “flatten the curve.”

The now-ubiquitous phrase refers to efforts to stop the rapid spread of a disease and prevent it from overwhelming hospitals and health care providers through social distancing, self-quarantines and closures of public events and gathering places.

The phrase often appears alongside a multicolored chart showing two curves, one that spikes and descends sharply, and another that shows a more gradual slope. The curves represent different projections of the number of people who will contract COVID–19 over a period of time. Public health officials fear that a sharply spiking epidemic curve of infections would overwhelm hospital resources and lead to more deaths, hence the need to flatten it.

To date, the pandemic has infected more than 14,000 and killed 205 in the U.S., according to data compiled by Johns Hopkins University, and every governor has now declared a state of emergency.

Markel said it’s both “gratifying and horrifying” that the phrase he helped coin has provided the conceptual model for responding to a global pandemic. A Google trends search shows a sharp uptick in searches for “flatten the curve” in March, as the number of cases grew rapidly. 

The phrase has served an important messaging role at a time when just 1 in 3 Americans — 37 percent — say they have a good or great deal of trust in the information they hear about the coronavirus from President Trump, according to a recent poll. In contrast, 84 percent of Americans said they trust public health experts.

Despite its importance, the precise origins of “flatten the curve” are a bit murky — largely because the public health officials who are most likely to have coined it refuse to take personal credit.

Markel said only that it was uttered over a meal of “bad Thai food” with his colleague Dr. Martin Cetron, sometime around 2006-07. That discussion came while they studied the relationship between epidemic curves and so-called nonpharmaceutical interventions (NPIs) like social distancing, self-quarantines, school closures and bans of large gatherings.

Public records show that Dr. Robin Robinson, a former top official at the Department of Health and Human Services, was one of the first to use “flatten the curve” in a public health context. But he declined to take credit for inventing it, noting that, “Howard [Markel] and Marty [Cetron] may have coined the term.” 

Cetron was the lead author of a 2007 report for the Centers for Disease Control and Prevention on community strategies for an influenza pandemic, which discussed how their findings suggested that “NPIs can delay and flatten the epidemic peak.” Yet Cetron too was reluctant to take personal credit for the term — saying the proper focus is on its message, not its sender.

“While I was the person on point to develop and lead the effort as well as to present and gain interagency approval, I cannot actually say who was the first to utter the phrase,” Cetron told The Hill. “Needless to say none of us actually envisioned it becoming part of the common lexicon.”

“Perhaps the most important thing is not with whom the credit is attributed, so much as the call to action it invokes that is necessary for it to succeed,” he said. “This is a ‘We Not Me’ moment.”

The collegial attitude among the health experts who have helped to frame the nation’s public health response is in stark contrast to the bitterly partisan debate over the government’s approach to the pandemic.

Democrats have criticized the Trump administration’s handling of the virus, accusing it of being slow to act. Trump and Republicans have fired back, accusing Democrats of seeking to politicize the response.

The emerging consensus among public health experts is that the Trump administration’s initial response to the outbreak was poor but has improved of late. However, experts caution that political scorekeeping should not distract the country from a unified public response. 

“As a nation, we blew it on the initial response to the outbreak in the U.S.,” said Michelle Mello, a professor of law and medicine at Stanford University. “There will be all the time in the world after the pandemic abates to do a postmortem, but right now we need to concentrate on making up for lost time.”

Markel said sidestepping political divisions would be crucial for combating the coronavirus.

“As sentient human beings we have the ability to make the right choice,” he said. “And for now, the obvious and healthy choice is to get together, all do our parts, follow the suggestions of our health officials and beat back the threat of COVID-19.”