With the number of confirmed COVID-19 cases rising by the day in the United States and around the world, and with “shelter-in-place” and “social lockdown” policies in effect around the world, it's difficult to not feel frightened and overwhelmed. Yet alongside the minute-by-minute news updates about the virus's spread, solutions journalists are on the ground reporting on what's working.

The stories in this collection (see below) are about efforts that have or are beginning to show signs that they are working to  “flatten the curve" of COVID-19 cases. Flattening the curve is rapidly becoming a household term; it refers to the epidemiological concept of slowing the rate of the spread of the coronavirus through social distancing and other measures. The goal of these measures is to keep the total number of cases at any given time below the threshold where a health care system would be overwhelmed. As the curve is flattened, the date when cases will peak in a given location is pushed further into the future.

In How the U.S. can defeat coronavirus: Heed Asia's lessons from past epidemics, we learn how early in the pandemic, several countries in Asia that had been hit hard by the SARS and MERS epidemics flattened their curves by acting swiftly to activate a sophisticated combination of mass testing, social distancing, border closures, and mandatory quarantines. We also hear of a small Italian town in the center of the epidemic that immediately instituted “drastic” social distancing measures at the outset that appear to have insulated it from the towns around it.

Closer to home, four other stories examine the cases of Seattle, San Francisco, and New Rochelle, NY. Each of these cities were at or near an epicenter of early US outbreaks, and each instituted early and substantial measures such as social distancing, the banning of large gatherings, and “stay-at-home” orders. New Rochelle established a “containment zone” that included drive-through testing and evaluation. All of these cities have seen infection rates below those originally modeled, although because the US response has come much later than those in Europe and Asia, the domestic results are somewhat preliminary. In particular, San Francisco’s efforts have appeared to push their predicted peak infection rate substantially forward.

Finally, an historical article compares the efforts of Philadelphia and San Francisco during the 1918 Spanish Flu, and how San Francisco’s banning of crowds dramatically flattened the curve during that pandemic.

Click here for more teaching collections on COVID-19.

1. What does it mean to "flatten the curve" of an epidemic’s spread and why is it important to do so? Be specific.
2. List the lessons learned from the 1918 Spanish flu. Compare and contrast what happened in St. Louis and Philadelphia in 1918 to produce such different public health results.  
3. Describe the strategies used in San Francisco, Seattle, and New Rochelle. Explain the connections between these strategies and fighting a pandemic. 
4. Would you be willing to submit to the “drastic” measures enacted in Codogno? Why or why not? What would be the hardest part about it, in your estimation? 
5. Describe three of the key strategies used by Asian countries to limit the spread of the COVID-19 virus. 
6. Many people have resisted—not just here, but also in other countries—the social distancing protocols and bans on gatherings. Consider where individual rights—the ability to move about with freedom, for example—clash with the norms of civil society and the collective good. Be specific in your argument.
7. Using the Institute for Health Metrics and Evaluation link at the bottom of the collection page, determine how many infections are in your home state. Then compare that to another state—a parent’s home state, roommate’s, friend’s, etc. How do they differ, and how do you account for it? 

1.  “Flattening the curve” refers to a strategy that doesn’t attempt to eradicate the virus, but to control its infection rates through time, preventing health care infrastructure from being overwhelmed. That, in turn, should lead to far fewer deaths. In the US, for example, models predict that a steep infection curve could lead to between 1-2 million US deaths. Flattening the curve could reduce that number to hundreds of thousands. In San Francisco, for example, this flattening of the curve could push their “peak” infection rate out by a matter weeks or months, allowing for both fewer deaths and a health care system that can actually tend everyone who is sick. 
2. There are several. Among them, that such viruses can spread with frightening speed and be highly contagious. From a public health standpoint, the differences between St. Louis and Philadelphia’s responses were textbook examples of the advantages of flattening the curve. St. Louis instituted stringent controls on gathering and events, encouraged people to stay indoors, and limited commerce. Philadelphia held a parade attended by 200,000 people and had lax enforcement of other social distancing measures. As one might expect, Philadelphia had a classic, steep, bell-shaped curve and St. Louis, a low, mounded curve. 
3. Each of these cities instituted rapid and relatively drastic measures, banning gatherings of more than a few people, asking citizens to shelter in place, closing public places of gathering, including sports and worship (often the same thing), and instituting broad testing protocols. In each of these cities, at least preliminarily, the curve has been flattened and lives have been saved. New Rochelle instituted the most dramatic measures, essentially a one-mile-radius quarantine that evaluated all inbound and outbound persons for signs of infection. Their tracking system was significantly enhanced by the fact that many of the infected had gathered at two events, and attendees were known. 
4. Answers will vary by student. However, Codogno is an example of a small group of people coming together, collectively participating in isolation, and having a drastically improved overall outcome than all those around them. The latest results indicate that COVID-19 has some ability to “aerosol,” which means it can be transmitted by droplets from breath or speaking that hang in the air. Students might be less stressed than expected on this question, given their connections on social media platforms. 
5. There are a number of potential answers to this question: political will in the wake of the MERS and SARS epidemics to protect the population; sophisticated tracking of potential carriers and victims; rapid and widespread testing; travel bans, both internal and external; rapid and multifaceted approach to infection organized by a central agency—such as Taiwan’s National Health Command Center—tasked with this single mission; transparent, rapid, and continuous public information campaigns; strong epidemiological surveillance and contact-tracing capacity, such as that exhibited by Singapore. 
6. This question is intended to elicit responses about the debate between individual rights and the common good. Such a discussion could move from Plato to Aristotle to Mill, Locke, Rousseau, Hegel, and Rawls. If you were to involve the economics involved, Adam Smith, Keynes, Freedman, even Alan Greenspan might shed light on the question. Of course, we now have myriad examples of groups of individuals “exercising their right to assembly” in the face of a public health crisis. What should those in authority do? What are the limits of that authority? Florida’s governor told spring-breakers—like many of our students—to “stop being asses.” In the wake of his announcement, 40 of 78 students who chartered a plane to Mexico from Texas returned positive for COVID-19; should such irresponsibility garner punishment? What is the university’s responsibility in such a situation? 
7. Student answers will vary. The intent of the question is to get students to compare their state with another, and then speculate about the social, economic, educational, and informational factors that contribute to adhering to CDC advice or ignoring it.