Raise the bar after flattening the curve

I am confident that you have heard the phrase “flatten the curve” when it comes to Covid-19 numbers. If you haven’t, read this article.

The point is that there is only so much hospital capacity that each city/country has and if we too many people want to use it at the same time, it won’t be possible. Hospitals and pretty much all emergency services are designed to cater to a small percentage of the population at the same time with a little bit of expansion possible during short term emergencies.

If a hospital can cater to 100 patients at once, it might be able to find a way to accommodate 110 through short term measures but it will not be able to manage 400 patients irrespective of what it does.

Hence if we had to choose between too many people getting sick for a short period of time vs more people getting sick over a longer period of time, we would choose the latter just because we would be able to provide better care for a higher percentage of patients that way.

The other option is to raise the capacity of our hospitals exponentially almost immediately which is not possible. Hence flatten the curve is more important than raising the bar in the short term. This was one of the reasons for the lockdowns and the subsequent phased opening up of the country during Covid-19.

The thing is, flatter the curve works in the short term but over a longer period of time, the aim of each system should be to raise the bar. When we think about hospital capacity, raising the bar would mean:

  • Increasing the number of beds in our current hospitals
  • Increasing the number of hospitals
  • Taking steps to increase average health of each citizen so that fewer people need hospitals

These would ensure that we are able to deal with pandemics and emergencies a lot better. It is simply increasing supply and reducing demand at the same time to create capacity in the system.

The first two points are important but they can only be executed incrementally and are also really capital intensive. The third point however is something that requires continuous focus rather than just one time action.

We have all heard prevention is better than cure. Vaccines are one way we put that phrase into practice. I believe that the government can do this with other major diseases that send people to hospitals.

Assuming that the major causes of death would give us an idea on what to focus on to decrease ‘demand’ for hospitals. To clarify, this is to say increase the number of people who don’t need to use the hospital because they are healthy.

All numbers are annua
All numbers are annual.

Is the situation in India very different? Not really.

Change in ranking for causes of death in India.

As you can see from the two images above, some of the biggest reasons for death in the country are heart diseases, diabetes, tuberculosis, road injuries, and self harm.

All of them have clear and scientifically proven ways to prevent them or reduce the chances of them occurring. We have a vaccine for tuberculosis and to an extent a cure for it. We know that heart disease and diabetes can be dramatically controlled/managed with better eating habits, exercise, and stress management. We know how to reduce road injuries. We know what is needed to reduce the number of people who resort to self harm.

Imagine a time when no one or an extremely small number of people who have these diseases or victims of these circumstances, show up at the hospital. It would open up the resources at hospitals to better focus on emergencies or deal with pandemics or care for people who suffer from diseases that don’t currently have cures.

What are steps that local/state/national governments can take to make this possible?

  • Increase access to early and/or affordable primary health care
  • Increase the number of public parks in and around residential spaces and encourage people to take care of their health
  • Improve the quality of food and air that’s accessible to each and every citizen
  • Build system of support for people who might be likely to resort to self harm or are people who want had resorted to self harm in the past
  • Build better roads and manage traffic better so as to ensure reduction in road injuries

The government doesn’t need to do this alone. They should involve citizens and citizen run organizations to do this together. It could turn out to be the best use of our time and resources.

State capacity is always in short supply in our country. Some would argue that it is growing at the best speed it can. Steps like these would reduce the pressure on it to have to grow incredibly fast and actually grow at a sustainable pace.

When we talk about raising the bar, it is not just in reference to state capacity. It is also in reference to what the state should aspire to do.

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