title: Can informal social distancing interventions minimize demand for antiviral treatment during a severe pandemic?
abstract: BACKGROUND
  In the case of a pandemic, individuals may alter their behaviour. A dynamic model incorporating social distancing can provide a mechanism to consider complex scenarios to support decisions regarding antiviral stockpile size while considering uncertainty around behavioural interventions. We have examined the impact of social distancing measures on the demand for limited healthcare resources such as antiviral drugs from a central stockpile during a severe pandemic.
  
  
  METHODS
  We used an existing age-structured model for pandemic influenza in Canada and biologically plausible scenarios for severe influenza transmission within the population. We incorporated data from published reports regarding stated intentions to change behaviour during a pandemic as well as the magnitude and duration of time that individuals expected to maintain the behavioural change. We ran simulations for all combinations of parameter values to identify the projected antiviral requirements in each scenario.
  
  
  RESULTS
  With 12 weeks of distancing, the effect is relatively small for the lowest R0 of 1.6 with a projected stockpile to treat 25.6% being required (IQR=21.7 - 28.7%) unless the proportion of people involved (81%) and magnitude of the behaviour change is large (69% reduction in contacts). If 24 weeks of distancing occurs, with only a low to moderate reduction in contacts (38% or less), it is not possible to bring treatment requirements below 20% regardless of what proportion of the population engages in distancing measures when transmissibility is high (R0=2.0; stockpile size=31%, IQR=29.2 - 33.5%).
  
  
  CONCLUSIONS
  Our results demonstrate that the magnitude and duration of social distancing behaviours during a severe pandemic have an impact on the need for antiviral drugs. However, significant investments over a long period of time (>16 weeks) are required to decrease the need for antiviral treatment to below 10% of the total population for a highly transmissible viral strain (R0>1.8). Encouraging individuals to adopt behaviours that decrease their daily contact rate can help to control the spread of the virus until a vaccine becomes available however; relying on these measures to justify stockpiling fewer courses of treatment will not be sufficient in the case of a severe pandemic.
authors.affiliation: Professional Guidelines and Public Health Practice Division, Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, ON, Canada. amy.greer@phac-aspc.gc.ca.
authors.forename: Amy L
authors.initials: AL
authors.lastname: Greer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use*; D002170:Canada / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D015438:Health Behavior; D006301:Health Services Needs and Demand; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007252:Influenza Vaccines; D007251:Influenza, Human / Q000188:drug therapy / Q000453:epidemiology* / Q000635:transmission; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D058873:Pandemics; D012929:Psychological Distance; D040242:Risk Reduction Behavior; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D007252:Influenza Vaccines