Public Health Responses to COVID-19: Whose Lives Do We Flatten Along With “The Curve?”

The Coronavirus 2019 (COVID-19) pandemic has received varying and evolving public health responses worldwide (1). Sweden remained largely open with health measures aimed most substantively at vulnerable groups, while South Korea implemented a large testing program, combined with extensive efforts to isolate infected people and trace/quarantine contacts. The United Kingdom (UK) considered various approaches before deciding on measures to isolate, quarantine, and promote social-distancing that were eased in mid-July (1); lockdown is now being re-implemented with a surging second wave (2). In contrast to early social-distancing measures in Canada to “flatten the curve,” American states adopted varying approaches, with many states having now relaxed their measures to differing extents (3). China adopted an aggressive approach of quarantining the affected Hubei province and isolating infected populations (4). India was under an ambitious 40-day lockdown, which was then extended until May-31 with districts designated as red/orange/green based on cumulative cases and doubling rate; red zones continued under full lockdown whereas orange/green zones had more relaxed measures (5). Gradual easing of restrictions (“unlock” 1.0 through 5.0) ensued, with lockdown measures nevertheless continuing in designated containment zones (6). Millions of people around the world still face public health measures of one form or another, raising the question: how stringent should government responses be in such pandemics (7), and how long can (or should) such measures continue?