# 1008
In a pandemic life would most certainly be different. People would behave differently in their attempts to try to avoid catching the virus. The ramifications of these behavior changes could have a huge impact on our society and our economy, not to mention on the spread of the disease.
In this month's Journal of Emerging Infectious Diseases, we have a study based on telephone surveys from around the world, on how people would react to a pandemic.
In (PDF file) Precautionary Behavior in Response to Perceived Threat of Pandemic Influenza by M. Zia Sadique,*† W. John Edmunds,* Richard D. Smith,‡ William Jan Meerding,§Onno de Zwart,§¶ Johannes Brug,§ and Philippe Beutels we learn, not surprisingly, that people will try to avoid contracting the virus.
(re-paragraphed for readability)
Faced with an epidemic of an infectious disease, persons may take precautionary actions to try to reduce their risk. Such actions include avoiding situations that persons perceive to be risky, which can have negative health and economic effects.
Therefore, we conducted a population-based survey of persons’ precautionary actions in response to a hypothetical influenza pandemic.
For the 5 European and 3 Asian regions that had been affected by severe acute respiratory syndrome, the pattern of reported precautionary action was broadly similar across the regions; ≈75% of respondents reported that they would avoid public transportation and 20%–30% would try to stay indoors.
Some regional differences were noted; Europeans were more likely than Asians to avoid places of entertainment, and Asians were more likely to avoid seeing physicians. This international survey provides insight into what might be expected during an influenza pandemic.
Utilizing a telephone survey, the authors of this study asked respondents from 5 countries to imagine two pandemic scenarios, one extremely mild, producing severe illness in 2.5% of the population and a 0.0025% fatality rate, and another more severe scenario where 10% become seriously ill, and .1% succumb. They were then asked about their perceptions of the relative risks of certain activities and exposures.
They were then asked if they would anticipate engaging in any of the following precautionary measures.
- Avoid public transportation (e.g., trains, buses, airplanes)
- Avoid going out for entertainment (e.g., bars, restaurants, theaters, cinema)
- Limit shopping to the essentials
- Take leave from work
- Keep children out of school, even if school remains open (only
adults with children were asked this question) - Limit physical contact with friends and family
- Avoid seeing doctors, even when sick from something unrelated to flu
- And stay indoors at all times.
The results (reformatted for readability):
Avoidance of public transportation was consistently reported across the region as the most likely precautionary behavior. From 65% (in Singapore) to 85% (in Great Britain) of respondents reported that they would avoid public transportation.
Similar proportions of European respondents reported that they would avoid places of entertainment, although a far smaller proportion of Asian respondents said that they would (Figure 2), despite Asians being more likely to report this setting as risky (Figure 1).
Approximately 60% of respondents said that they would shop for essentials only, and ≈50% said that they would take leave from work, prevent their children from attending school, or limit contact with friends and family.
Approximately 25% of European and 35% of Asian respondents said that they would try to stay indoors or avoid seeing physicians (Figure 2).
Univariate analysis results suggested a statistically significant difference between regions in terms of proportions of persons who would adopt precautionary actions in case of a hypothetical influenza outbreak .
Surprisingly, the risk scenarios presented didn't affect the responses much. People were nearly as adverse to exposing themselves in a mild pandemic as they were in a more severe one.
Obviously all of this will have a major impact on how society would function during a prolonged pandemic. Half of those responding indicated they would take leave from work to avoid the illness. If this number held true during a pandemic, the 40% absenteeism number we keep seeing would seem to be a major underestimation.
I'm always a little leery of surveys.
The answers provided are based on `first impressions' and `gut instincts', not careful thought and consideration. People may quickly answer they would avoid certain risk environments without considering how they will buy food, or pay their mortgage, if they go months without working.
Whether these respondents will find it possible to avoid these risky environments for a prolonged period of time is debatable, but it is pretty obvious that many will try. And that could have deep ripple effects on the economy.
Governments and economists who are promoting the idea of trying to maintain `business as much as usual' during a pandemic may need to revise their expectations.
