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Title: Societal learning in epidemics: Intervention effectiveness during the 2003 SARS outbreak in Singapore
Authors: Drake J.M.
Chew S.K. 
Ma S. 
Keywords: article
clinical effectiveness
disease duration
early diagnosis
evidence based practice
health education
infection risk
information dissemination
public health
risk reduction
severe acute respiratory syndrome
social learning
stochastic model
communicable disease
psychological aspect
retrospective study
severe acute respiratory syndrome
social environment
theoretical model
Communicable Diseases, Emerging
Disease Outbreaks
Health Education
Models, Theoretical
Public Health
Retrospective Studies
Severe Acute Respiratory Syndrome
Social Environment
Time Factors
Issue Date: 2006
Publisher: Public Library of Science
Citation: Drake J.M., Chew S.K., Ma S. (2006). Societal learning in epidemics: Intervention effectiveness during the 2003 SARS outbreak in Singapore. PLoS ONE 1 (1) : e20. ScholarBank@NUS Repository.
Abstract: Background. Rapid response to outbreaks of emerging infectious diseases is impeded by uncertain diagnoses and delayed communication. Understanding the effect of inefficient response is a potentially important contribution of epidemic theory. To develop this understanding we studied societal learning during emerging outbreaks wherein patient removal accelerates as information is gathered and disseminated. Methods and Findings. We developed an extension of a standard outbreak model, the simple stochastic epidemic, which accounts for societal learning. We obtained expressions for the expected outbreak size and the distribution of epidemic duration. We found that rapid learning noticeably affects the final outbreak size even when learning exhibits diminishing returns (relaxation). As an example, we estimated the learning rate for the 2003 outbreak of severe acute respiratory syndrome (SARS) in Singapore. Evidence for relaxation during the first eight weeks of the outbreak was inconclusive. We estimated that if societal learning had occurred at half the actual rate, the expected final size of the outbreak would have reached nearly 800 cases, more than three times the observed number of infections. By contrast, the expected outbreak size for societal learning twice as effective was 116 cases. Conclusion. These results show that the rate of societal learning can greatly affect the final size of disease outbreaks, justifying investment in early warning systems and attentiveness to disease outbreak by both government authorities and the public. We submit that the burden of emerging infections, including the risk of a global pandemic, could be efficiently reduced by improving procedures for rapid detection of outbreaks, alerting public health officials, and aggressively educating the public at the start of an outbreak. © 2006 Drake et al.
Source Title: PLoS ONE
ISSN: 19326203
DOI: 10.1371/journal.pone.0000020
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