title: Responding to simulated pandemic influenza in San Antonio, Texas.
abstract: OBJECTIVE
  To describe the results of a simulation study of the spread of pandemic influenza, the effects of public health measures on the simulated pandemic, and the resultant adequacy of the surge capacity of the hospital infrastructure and to investigate the adequacy of key elements of the national pandemic influenza plan to reduce the overall attack rate so that surge capacity would not be overwhelmed.
  
  
  METHODS
  We used 2 discrete-event simulation models: the first model simulates the contact and disease transmission process, as affected by public health interventions, to produce a stream of arriving patients, and the second model simulates the diagnosis and treatment process and determines patient outcomes.
  
  
  METHODS
  Hypothetical scenarios were based on the response plans, infrastructure, and demographic data of the population of San Antonio, Texas.
  
  
  RESULTS
  Use of a mix of strategies, including social distancing, antiviral medications, and targeted vaccination, may limit the overall attack rate so that demand for care would not exceed the capacity of the infrastructure. Additional simulations to assess social distancing as a sole mitigation strategy suggest that a reduction of infectious community contacts to half of normal levels would have to occur within approximately 7 days.
  
  
  CONCLUSIONS
  Under ideal conditions, the mix of strategies may limit demand, which can then be met by community surge capacity. Given inadequate supplies of vaccines and antiviral medications, aggressive social distancing alone might allow for the control of a local epidemic without reliance on outside support.
authors.affiliation: Altarum Institute, P.O. Box 134001, Ann Arbor, MI 48113-4001, USA. george.miller@altarum.org
authors.forename: George
authors.initials: G
authors.lastname: Miller
authors.forename: Stephen
authors.initials: S
authors.lastname: Randolph
authors.forename: Jan E
authors.initials: JE
authors.lastname: Patterson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003140:Communicable Disease Control / Q000379:methods; D003198:Computer Simulation; D004189:Disaster Planning / Q000379:methods*; D004196:Disease Outbreaks / Q000517:prevention & control*; D006801:Humans; D007251:Influenza, Human / Q000188:drug therapy / Q000453:epidemiology* / Q000517:prevention & control*; D008875:Middle Aged; D008954:Models, Biological; D011790:Quarantine; D013781:Texas / Q000453:epidemiology
chemical_list: D000998:Antiviral Agents