32 | JULY 16 • 2020 

 Have We Truly
“Flattened
the Curve?”

We asked the term’
s founder.

CORRIE COLF STAFF WRITER

Health

T

hroughout the coronavi-
rus pandemic, the term 
“flatten the curve” has 
been used by health officials 
and federal and state leaders 
as a public health 
strategy to slow 
down the spread of 
the virus. The term 
was coined by Dr. 
Howard Markel, a 
local Jewish med-
ical expert and 
professor at the University of 
Michigan. 
Markel is the George E. 
Wantz, M.D. Distinguished 
Professor of the History of 
Medicine and director of 
the Center for the History of 
Medicine at the University 
of Michigan. He has writ-
ten multiple books about 
infectious diseases, including 
Quarantine! East European 
Jewish Immigrants and the 
New York City Epidemics of 
1892 and When Germs Travel: 
Six Epidemics That Invaded 
America since 1900 and the 
Fears They Unleashed. 
The term “flatten the curve” 
was coined by Markel while he 
was conducting research on the 
1918-1919 Spanish Flu pan-
demic, which he did following 
the SARS pandemic in 2004. 
“I was eating a very bad noo-
dle dish while we were working 
late at night,
” Markel said. “The 
noodles were in some kind of 
Styrofoam container, so they all 
formed one big flat noodle, and 

it was a joke that the flattened 
noodles were like the curve. 
And that’
s where ‘
flatten the 
curve’
 came from.
” 
After the SARS pandemic 
in 2002-2004, Markel was 
asked by the George W
. Bush 
administration to work with 
the Centers for Disease Control 
and Prevention (CDC) to help 
develop guidelines for a nation-
al response for future pandemic 
outbreaks. 
“The one thing we were 
concerned about back then 
was avian influenza, or ‘
bird 
flu,
’
 so that was the emergency 
or the thing that spurred this 
on,
” Markel said. “The bird flu 
became a big problem for birds, 
but not for humans.
” 

During the Obama adminis-
tration in 2009, there was also 
a flu pandemic, known as the 
H1N1 pandemic. According to 
Markel, that one was not much 
more lethal than seasonal flu 
and did not require the same 
extensive measures of quaran-
tining and lockdowns. But now 
the COVID-19 pandemic is 
different: a much more serious 
outbreak that has necessitated 
extreme measures. 
“Because these measures are 

so disruptive, economically and 
socially, you only use them for 
very deadly pandemics, such 
as the 1918-1919 flu pandemic 
and now with the coronavirus 
pandemic,
” Markel said. 
Markel’
s research focused 
mainly on response measures 
known as non-pharmaceutical 
interventions, which use isola-
tion, social distancing and lock-
downs to slow down the spread 
of the virus. 
During that time, cities 
throughout the U.S. had their 
communities quarantine, 
self-isolate, close schools 
and limit public gatherings. 
Throughout Markel’
s study, he 
found that cities that enacted 
these measures early on were 

much more effective than other 
cities that lifted their measures 
too early and saw another rise 
in the number of cases. 
His findings from his 
research on the 1918 pandemic 
are very similar to how the 
country is reacting today to the 
lockdown and social distancing 
guidelines. 
“The people got restless, 
just as they did in 1918, and 
they wanted the various things 
lifted back then and currently,
” 

Markel said. “So, even though 
we lifted all those regulations, 
the virus is still circulating and 
is still out there. We’
re now 
seeing bumps in several places, 
and so the curve is no longer 
flat. We have done all of these 
measures and we have endured 
a lot of economic problems, all 
for nothing because now we 
have a rise in cases.
” 
Markel’
s research is reproduc-
ible and has helped influence 
policies that remain in place 
today for the country’
s response 
to pandemics. Michigan Gov. 
Gretchen Whitmer has even 
used some of Markel’
s graphs 
during her press releases 
throughout the course of the 
coronavirus pandemic. 
As the country begins to 
open, Markel believes that we 
are going to see another rise in 
cases and that as a whole, “we 
are not out of the woods yet.
” 
Markel reminds people to 
continue to wash your hands, 
stay home if you’
re sick, wear a 
face mask and try to minimize 
your exposure to the public. 
“
All our research does is help 
you hide for a while from an 
infectious disease, but it doesn’
t 
cure it. The thing that ulti-
mately will cure it is a vaccine,
” 
Markel said. “The epidemic has 
certainly not gone away, and 
if we don’
t start doing these 
measures again, a lot of people 
are going to get sick and some 
of them are going to die. It is a 
very vicious virus.
” 

Dr. Howard 
Markel

U-M

 “The epidemic has
certainly not gone away.”

— DR. HOWARD MARKEL