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(HealthNewsDigest.com) – STANFORD, Calif. — When H1N1 hits the suburbs, telecommuting and fewer office meetings are cost-effective, but not extended school closings, according to a study by investigators at the Stanford University School of Medicine.
Ideally, a vaccine would be available for all comers the minute a pandemic like the current H1N1 variety struck. But in the real world, as we have seen, it can take months from when a novel viral strain is identified to the time when a vaccine for it is available in bulk. Daniella Perlroth, MD, an infectious-disease specialist in the School of Medicine and research fellow at Stanford’s Center for Health Policy, and her colleagues wondered: If cases start to pop up in the interim, just what is a community supposed to do to minimize the consequences of the virus’s unwelcome intrusion?
Office workers may like the answer. Teenagers, not so much.
A study led by Perlroth and published online in Clinical Infectious Disease on Dec. 18 concludes that when an outbreak of a relatively mild influenza — so far, a good description of the new H1N1 strain — strikes suburbia, the most effective and cost-saving public-health measures are distribution of antiviral medications combined with moderate “social distancing” strategies: for example, telecommuting, cutting back on face-time-intensive group meetings in the office and keeping your kids away from the malls after school.
But closing schools isn’t worth it — unless the disease is substantially more virulent and transmissible than the current H1N1 seems to be so far.
Previous studies have compared the benefits of various public-health measures. However, this was the first to look at those measures’ cost-effectiveness, Perlroth said.
She and her co-investigators explored strategies that don’t require solving the vaccine-delay problem. “This is here and now,” Perlroth said. “Any community in the U.S. can do these things, in real time, based on a decision by a public health officer.”
Several combinations of these strategies, which vary with the strength of the viral onslaught, are cheaper overall than doing nothing at all. But it’s expensive for a community to engage in all of them at once. To find out which are worth the cost, Perlroth and her collaborators resorted to a mathematical model so complicated it has to be run on a large cluster of computers. This model, developed by co-author Robert Glass, PhD, of Sandia National Laboratories in Albuquerque, N.M., simulates likely patterns of person-to-person contact in a 10,000-person microcosm akin to a small town, suburb or neighborhood coalescent around an average-sized school. The microcosm’s demographics — typical household size, extent of interactions among neighbors, how often people leave home to go to the store — mirror those found in many non-urban areas in the United States.
“The Sandia model has a huge computing capacity,” said Perlroth. “But it doesn’t give any cost information.” She and her co-investigators factored in expenses of hospitalization, medication, lost work days and the additional infrastructure costs and extra salaries associated with leaving schools open into the following summer to compensate for extended closures. Then they plugged in up-to-date assessments of viral transmissibility and lethality, a set of potential public-policy prescriptions and educated guesses as to the likelihood of people complying with those policies.
In some cases, the burden of compliance was light or moderate: mere reductions in personal contacts on the job (reducing work-related contacts by telecommuting or eliminating unnecessary office meetings), getting antiviral treatment or staying home when you’re sick, discouraging teens from going to the mall or keeping younger children from congregating on playgrounds after school or on weekends. In other cases, it was more demanding: closing down schools, stores, theaters and workplaces. A wholesale shutdown of schools requires that at least one parent stay home to provide child care. Lost workdays are a major expense.
It does no good to close schools but then have kids clustering elsewhere, warned the paper’s senior author Douglas Owens, MD, senior research scientist at the Veterans Affairs Palo Alto Health Care System and professor of medicine. “If you close the schools but all the teens head to the mall, it doesn’t work,” he said.
Were transmission and virulence of the new viral strain to take a turn for the worse — or in the hypothetical case of a more severe pandemic caused, for example, by a different novel strain such as the one that brought about the notorious 1918 pandemic — that would be another story. Shutting down the schools for extended periods (weeks, not just one or two days as happened earlier this year when the H1N1 pandemic first raised its head) would then be cost-effective, the simulation revealed.
The researchers also found that regardless of the pandemic’s severity, using antiviral medications is a good line of defense. Antiviral agents not only mitigate disease but also prevent viral shedding and spreading. They are so relatively cheap and safe, and the economic as well as health consequences they stave off so expensive, that even when the computer model assumed them to be only weakly effective, their use was justified in virtually every scenario tested, Perlroth said.
Perlroth noted that the U.S. Centers for Disease Control and Prevention is not recommending using antivirals prophylactically for healthy people for the current H1N1 pandemic, in part because of a concern that their mass use might lead to influenza strains that are resistant to these drugs. That variable was not included in the computer analyses in this study, she added.
The other Stanford co-author of the study is Alan Garber, MD, PhD, professor of medicine and director of the Center for Health Policy. Perlroth, Owens and Garber were supported in part by the U.S. Department of Veterans Affairs. The study was funded in part by the National Institute on Drug Abuse and the U.S. Department of Energy.
The Stanford University School of Medicine consistently ranks among the nation’s top 10 medical schools, integrating research, medical education, patient care and community service. For more news about the school, please visit http://mednews.stanford.edu. The medical school is part of Stanford Medicine, which includes Stanford Hospital & Clinics and Lucile Packard Children’s Hospital. For information about all three, please visit http://stanfordmedicine.org/about/news.html.
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