Acute Care/Hospitalization

Reducing community contacts by half within 7 days may allow for local control of a flu pandemic

If hit by a flu pandemic, up to 35 percent of the U.S. population could develop the disease. Fifty percent of infected people will seek medical care and about 20 percent of them will be hospitalized. Up to 2 percent of those infected will die, according to the national plan to implement flu pandemic strategies. Clearly, the massive surge of sick patients would outstrip the surge capacity of local hospitals.

Using a mix of strategies, such as social distancing, antiviral medications, and targeted vaccination, may limit the infection rate so that demand for care would not exceed the surge capacity of local hospitals. However, it's not clear there would be enough supply of antiviral medications or vaccines or that they would be sufficiently effective in the event of a flu pandemic. In that worst-case scenario, reducing community contacts by half within 7 days may control a local epidemic without reliance on outside support, suggests a new study. This social distancing would include closing schools and churches, banning public gatherings, and encouraging people to work from home if possible.

George Miller, Ph.D., of the Altarum Institute in Ann Arbor, Michigan, and colleagues came to this conclusion based on two models to simulate disease contact and transmission based on public health interventions and to simulate diagnosis and treatment options. They used the models for hypothetical scenarios based on the response plans, infrastructure, and demographic data of the population of San Antonio, Texas, with a population of 1.4 million.

Delaying the decision to restrict contacts outside the household from 7 to 21 days would result in surges of demand that would exceed the supply of hospital beds. However, hospitals were able to meet the surge when social distancing was doubled by day 7 instead of by day 21. These results illustrate the importance of quick action to reduce community contacts in the face of a pandemic for which vaccine and antiviral medications are not available. The study was supported by the Agency for Healthcare Research and Quality (HS13683).

See "Responding to simulated pandemic influenza in San Antonio, Texas," by Dr. Miller, Stephen Randolph, M.B.A., and Jan E. Patterson, M.D., in the April 2008 Infection Control and Hospital Epidemiology 29(4), pp. 320-326.

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