![](media/image1.png){width="1.5in" height="1.0138888888888888in"}

**Local Mitigation Strategies for Pandemic Influenza**

Robert J. Glass\*, Laura M. Glass, and Walter E. Beyeler

National Infrastructure Simulation and Analysis Center

Sandia National Laboratories

Albuquerque, New Mexico, USA

December 21, 2005

**\* rjglass@sandia.gov**

![](media/image3.jpeg){width="3.7375in" height="2.5409722222222224in"}

**SAND Number: 2005-7955J**

[]{#refheading___toc125417458 .anchor}**Executive Summary**

Local, open-outbreak mitigation strategies for pandemic influenza that
target zones of high infectious contact within a community's social
network may be very effective. A networked agent-based model was used to
instantiate the contact network within a stylized small town and vary
the behavior of targeted groups. Simulations show that until sufficient
vaccine becomes available, influenza could be halted solely through
social distancing whereby children and teenagers stay home while the
rest of the population continues normal day-to-day activities.
Subsequent vaccinations that start with children and teenagers return
the community to normalcy most rapidly, with the least illness, death,
and vaccine.

[]{#__RefHeading___Toc125417459 .anchor}Acknowledgements

This research was supported by the National Infrastructure Simulation
and Analysis Center (NISAC), a program of the Department of Homeland
Security\'s Infrastructure Protection/Risk Management Division and
comprised of a core partnership of Sandia National Laboratories and Los
Alamos National Laboratory. We thank Louise Maffitt, Paul Kaplan, Nancy
Brodsky, Theresa Brown, George Barr, and Jason Min of the NISAC team for
their suggestions and constructive review. Sandia is a multiprogram
laboratory operated by Sandia Corporation, a Lockheed Martin Company for
the United States Department of Energy's National Nuclear Security
Administration under contract DE-AC04-94AL85000.

**Table of Contents**

[Executive Summary ii](#refheading___toc125417458)

[Acknowledgements ii](#__RefHeading___Toc125417459)

[1 Introduction 1](#introduction)

[2 Networked Agent-Based Model 2](#networked-agent-based-model)

[2.1 Contact network: 2](#contact-network)

[2.2 Behavioral rules for influenza: 4](#behavioral-rules-for-influenza)

[3 Base Case Pandemic Influenza Simulations
5](#base-case-pandemic-influenza-simulations)

[4 Targeting zones of high infectious contact
9](#targeting-zones-of-high-infectious-contact)

[5 Discussion 12](#discussion)

[References 14](#__RefHeading___Toc125417467)

[Appendix: Supporting Online Material 16](#__RefHeading___Toc125417468)

**Local Mitigation Strategies for Pandemic Influenza**

# Introduction

The rapid spread of highly pathogenic, H5N1 avian influenza within and
among multiple species, both domesticated and wild *(1,* 2), is of great
concern (3). Because humans have no natural immunity to this strain, if
H5N1 evolves the ability to pass from human to human, its infectivity
and mortality characteristics may create a pandemic (4). Influenza
pandemics have occurred many times in the past, the most noted example
being the Spanish Influenza of 1918 that killed on the order of 50
million people worldwide (3). Recently, RNA sequencing of the deadly
1918 flu virus showed that it was also avian and jumped to humans after
only a small number of critical mutations (5).

Since the mid 20^th^ century, vaccines have been used to effectively
suppress most varieties of influenza. However, at the beginning of a
pandemic, an effective vaccine is not expected to be available in
sufficient supply (6). Anti-viral drugs, while not conferring immunity,
may be used to decrease symptom severity and transmission.
Unfortunately, antiviral drugs are not fully effective (7) and worldwide
stores are currently very low (8). Behavioral modifications, such as
wearing masks, washing hands, disinfecting surfaces, and avoiding close
contact with others, can be successful at suppressing influenza in
controlled settings (9). But, to be effective, such behaviors must be
widely adhered to throughout the population, a challenge that is
especially difficult for the young. Often thought of as a last resort,
quarantine may be enforced to prohibit infectious people within hot
zones from carrying the disease to uninfected populations. Widespread
quarantine has logistical, economic, and social costs, potentially
including civil unrest *(*10).

Computational simulation can be of great use in identifying, evaluating,
prioritizing, and coordinating mitigation strategies for pandemic
influenza. Recent simulation efforts have focused on containment at the
source using vaccines, anti-viral drugs, and quarantine *(11,* 12).
Here, we consider the pandemic after the virus has moved beyond the
source to threaten communities worldwide. Assuming that vaccines and
anti-viral drugs are initially unavailable for the general population,
we focus on developing open-outbreak mitigation strategies that target
zones of high infectious contact within a community's social network.
Towards this end, we develop a simulation model that both instantiates
the rich contact network within a structured community, and allows the
behavior of specific groups of people targeted by a mitigation strategy
to be varied. Simulations for a stylized small town in the United States
indicate that until sufficient vaccine becomes available, influenza
could be effectively halted solely by implementing a social distancing
strategy whereby children and teenagers are kept home while the rest of
the population continues to carry on their day-to-day activities.
Subsequent vaccinations that start with children and teenagers would
return the community to normalcy most rapidly, with the least illness
and death, and the least amount of vaccine.

# Networked Agent-Based Model

Agent-based models treat entities (individuals, groups) explicitly as
*agents*. Individual agents are endowed with behavioral rules for
internal states and interaction with other agents or the external
environment. Such models have been developed and applied in a wide range
of fields including economics *(*13), sociology *(*14), and more
recently epidemiology *(*15). A number of theoretical studies also show
the critical importance of the underlying contact network along which an
infectious disease spreads *(16,* 17). Our simulation approach combines
both agents and explicit networks *(*18). For the spread of an
infectious disease, agents represent individual people and are linked to
each other within and among groups to form a contact network reflective
of a multiply-overlapping, structured community. Behavioral rules for
agents, their interaction, and the performance of network links, are
specified to model the spread of influenza.

## Contact network: 

We constructed our contact network to represent a stylized small town
within the United States. The population of 10,000 consists of children
(0-11 years of age, 17.7%), teenagers (12-18 years of age, 11.3%),
adults (19-64 years of age, 58.5%) and seniors (65+ years of age,
12.5%). All individuals belong to multiple groups, each associated with
a sub-network of links reflecting their lives within the community; an
example of a typical teenager's groups and contact network is shown in
**Figure 1**. Households are composed of families (adults with
children/teenagers) or adults and/or seniors without children/teenagers.
The makeup of the population and households conforms to the statistics
of the 2000 Census *(*19). All individuals within each household are
linked to each other (fully connected sub-network topology) with mean
link contact frequencies of 6 contacts/day. Every individual also
belongs to one multi-age extended family (or neighborhood) group that
has a mean membership of 12.5 and is fully connected with mean link
contact frequencies of 1 contact/day.

All children and teenagers go to a pre-school or school; children attend
a single class per day while teenagers attend six (all classes of size
20-35). All adults go to work daily where they interact with other
adults (size 10 to 50), and all seniors attend senior gatherings (size 5
to 20). For contacts within school classes, work, and senior gatherings,
we assume the simplest sub-network topology that imposes local
clustering: a ring lattice in which an individual is linked to two (for
children/teenager classes and senior gatherings) or three (adult work)
neighboring agents on each side along the ring (see **Figure 1**). Mean
link contact frequencies for children in a single class are 6
contacts/day while teen classes, adult work, and senior gatherings have
mean link contact frequencies of 1 contact/day.

![](media/image5.wmf){width="5.659722222222222in" height="4.41875in"}

**Figure 1**: Typical groups and individual-to-individual links for an
example teenager. A teen belongs to a household (fully connected
network, mean link contact frequency 6/day), an extended family or
neighborhood (fully connected network, mean link contact frequency
1/day), and 6 school classes (ring network with connections to 2 other
teenagers on each side as shown in black, purple links denote those of
other teenagers within the class, mean link contact frequency 1/day).
Two random networks are also imposed, one within the age group (teenager
random, average of 3 links per teenager, mean link contact frequency of
1/day), and one across all age groups (over-all random, average of 25
links per person (not all shown), mean link contact frequency of
0.04/day).

To represent additional within-age-class interactions such as
extracurricular activities, playgrounds, bowling leagues, or friends,
individuals are linked at random to an average of three other
individuals of the same age class (mean link contact frequency of 1
contact/day). Finally, to emulate a somewhat patterned set of random
contacts that come from commercial transactions and other ventures into
public spaces, we impose a random over-all network across all age
classes with a mean of 25 links per person to yield one contact per
person per day (mean link contact frequency of 0.04/day). The
combination of the ring and random networks add a "small-world"
character to the inherently clustered social network. While similar to
the idealization of a single ring blended with a single random network
introduced by Watts and Strogatz *(*20), our network exhibits the
multiply-overlapping quality of a structured community *(21,* 22).
Complete group specifications are reported in **SOM** **Table 1** in the
Appendix.

## Behavioral rules for influenza: 

We model the spread of influenza within the contact network as a series
of events. There are two classes of events: the transition of an
individual between disease states, and individual-to-individual
influenza transmissions. Individual state transitions follow the natural
history of influenza (**Figure 2**) proceeding from a *latent* state, to
a *pre-symptomatic infectious* state during which the flu can be
transmitted before symptoms influence the behavior of the agent. An
infected person's state then transitions to either *symptomatic* or to
*non-symptomatic* with probability *pS,* or *1- pS,* respectively. Those
who develop symptoms either *stay-at-home* with probability *pH*, thus
influencing their contacts, or continue to *circulate* with probability
*1-pH*. Infected agents who are non-symptomatic continue interacting
without behavioral changes. Agents who are symptomatic transition to
*dead* or *immune* with probability *pM* or *1- pM*, respectively, while
non-symptomatic agents simply transition to immune.

Individual-to-individual transmission events are evaluated at the
beginning of each period during which an agent is infectious. Assuming
contact events are statistically independent, a transmission time for
each of an infectious agent's links within the contact network is chosen
from an exponential distribution with the mean of the link's contact
frequency scaled by (*I~D~\*I~A~\*S~P~\*S~A~*) where *I~D~* is the
infectivity of the disease, *S~P~* is the susceptibility of people to
the disease (here taken as 1.0), *I~A~* is the relative infectivity of
the agent who is transmitting, and *S~A~* is the relative susceptibility
of the agent receiving. If the transmission time is less than the period
of time that the agent will be in a particular infectious state, then
transmission is scheduled at the chosen time, otherwise transmission
along that link does not occur during that particular period. All
transmission parameters and contact frequencies may be modified in each
of the various states as well as varied among age classes through the
use of relative scaling factors.

We have chosen influenza-specific mean state periods (1 day latent, 1
day infectious pre-symptomatic, 4 days infectious symptomatic or
non-symptomatic) and transition probabilities for *pS* (0.5) and *pH*
(0.5) that are representative of those used in recent pandemic strain
simulation studies reported in the literature *(11, 12,* 23). As in the
recent study of Ferguson et al. *(*12), we reflect viral shedding data
*(*24) by reducing *I~D~* (here by 50%) after the pre-symptomatic period
for all states (i.e., symptomatic circulating, symptomatic stay-at-home,
or non-symptomatic). We assume that children and teenagers are more
infective, as they have closer contact with others (hugging, wrestling,
etc.), and are more susceptible, as their immune systems are less
developed *(*25). These assumptions are reflected in the values chosen
for relative infectivity and relative susceptibility: *I~A~* and *S~A~*
are both 1.5 for children, 1.25 for teenagers, 1.0 for adults and 1.0
for seniors. As for normal influenza, we presume seniors are at greatest
risk of death after becoming symptomatic, and accordingly increase their
probability of dying (*pM)* by a factor of five. We double the frequency
of contacts within the family when an individual is in the symptomatic
stay-at-home state to reflect an assumed greater contact

![](media/image6.wmf){width="5.996527777777778in"
height="2.7194444444444446in"}

**Figure 2:** Natural history of influenza as encapsulated within our
model. The duration of each state for a given agent is chosen from an
exponential distribution with means as noted. Transition probabilities
between pre and post symptomatic states are also noted. After the
pre-symptomatic infectious stage, we reduce the infectivity of all
infected individuals by half. For those that develop symptoms and stay
at home, the link frequency within the household is doubled while all
other link frequencies are reduced by 99%.

for care-giving. We choose the remaining two parameters, *I~D~* = 0.01
and *pM* = 0.15, to yield total *infected attack rates* of \~50% and
*death rates* of \~5%, as might be representative of a highly pathogenic
influenza pandemic. Unless otherwise noted, these rates are defined as a
percent of the total population. The often reported *illness attack
rate* is roughly half of the infected attack rate (the latter we refer
to from here on as simply the *attack rate*) and reflects our choice of
*pS* (0.5).

# Base Case Pandemic Influenza Simulations 

With the assumption that adults are first to be infected via business
travel or interaction with visitors from outside the community, we begin
a simulation by infecting 10 adults at random. In context of our contact
network, the influence of increasing disease and agent realism is shown
in **Figure 3**. The initial case (with only state periods, *I~D~*, and
*pM* specified) is extremely virulent. Differentiating the symptomatic
state into three components (see **Figure 2)** and reducing the
infectivity in these states by half, dramatically decreases influenza's
virulence (blue line). Further differentiating agents by age class
(relative values for infectivity, susceptibility, and mortality)
reinvigorates influenza (red line). We refer to the final case with full
realism as our *base case* for pandemic influenza that yields attack
rates of \~50% and death rates of \~5% in our model community. Analysis
of the early stage of the base case yields a reproductive number,
*R~o~*, defined as the average number of others an infected person will
infect, of \~1.6, and a generation time, defined as the average time
between becoming infected and infecting others, of \~3.5 days.

![](media/image7.wmf){width="5.9944444444444445in"
height="2.9916666666666667in"}

**Figure 3:** Example simulations. a) Influence of influenza parameter
realism on the number infected (in some stage of the disease) as a
function of time. Typical results for a single realization of the
community structure and with the identical set of 10 initially infected
adults. The initial case (black line) begins with an *I~D~* of 0.01,
*pM* of 0.15, and mean state periods. Disease realism is added with a
reduction in infectivity after the pre-symptomatic stage to 0.5 and
differentiation between symptomatic and non-symptomatic states (*pS* =
0.5), and between circulating and staying at home when symptomatic (*pH*
= 0.5) (blue line). We then distinguish each of the four age classes by
adding agent specific parameter values for relative infectivity and
susceptibility (*I~A~* and *S~A~* 1.5 for children, 1.25 for teenagers,
1.0 for adults and 1.0 for seniors) (red line). This final case with all
pandemic influenza parameters forms our *base case* with infectious
attack rates of \~50% and death rates of \~5%. b) Breakout of infected
by age class (children, red; teenagers, blue; adults, black; seniors,
green) for the base case simulation shown in (a. Statistics for peak
infected, attack rate, death rate, time to peak, and total time for
epidemic from multiple simulations are given in **SOM Tables** in the
Appendix; averages for the base case are given in **Table 1**.

The results in **Figure 3** reflect a single realization of the contact
network with the same set of 10 initially infected adults. Results vary
across multiple realizations and not every realization leads to an
epidemic, here defined when the total number infected rises above 1% of
the population (**Table 1,** **SOM Table 2** in the Appendix). The
effect of stochastic variability is most clearly observed by increasing
the number of initially infected adults, beginning with a single
instigator, and counting the number of epidemics that occur. In 100
realizations, a single instigator produced only 35 epidemics, 2
instigators yielded 56, 4 yielded 82, 8 yielded 97, and 10 yielded 98
(as used for our base case). For 16 instigators and above, all
simulations yielded epidemics. While timescales for epidemics expectedly
shorten as the number of instigators increase (the time to peak
infections fell by more than 50%), attack and death rates are remarkably
similar (**SOM Table 3** in the Appendix).

![](media/image8.wmf){width="8.991666666666667in"
height="5.225in"}**Table 1:** Summary Results, Averages for Base case
and Mitigation Strategies^\*^

^\*^Note: negative % reductions reflect % increases

Analysis of the infectious contact progression shows that influenza must
be passed to a child or teenager for an epidemic to occur. Once the
virus is within the schools, it affects roughly the same cross-section
of the community. On average, 79% of children and 73% of teenagers
become infected. Adults, whose attack rate is 42%, receive influenza
mainly from children, teenagers, and other adults within the nuclear
family. Seniors, who contact children and teenagers only through the
extended family/neighborhoods and random over-all network, are
relatively isolated with an attack rate of 22%.

The importance of children and teenagers to the spread of influenza is
most clearly seen in the infectious contact fractions (given as a
percent of the total infectious contacts, **Table 2**). Children and
teenagers are responsible for 65% of infectious contacts, while adults
are responsible for 32% and seniors for only 3%. Adults receive
influenza from children/teenagers with greater frequency (26%) than from
other adults (23%), and seniors are equally likely to receive influenza
from children/teenagers (2%) as from adults/seniors (2%). Notably,
transmissions to children/teenagers are low with only 8% instigated by
adults and nearly none by seniors. These transmission results are
supported by recent field studies that show children who go to
pre-school and school are more likely to contact the flu, and their
family members are also more likely to become ill *(26,* 27). In
addition, it has been found that an individual is more likely to be
infected when exposed to children or teenagers as compared with adults
*(*26).

**Table 2:** Infectious contact fractions between age classes given as a
percentages of the total number of infectious contacts.

  ---------------- ------------ ------------- ---------- ----------- ----------
                   **To         **To          **To       **To        **Total
                   Children**   Teenagers**   Adults**   Seniors**   From**

  **From           21.4         3.0           17.4       1.6         43.4
  Children**                                                         

  **From           2.4          10.4          8.5        0.7         21.9
  Teenagers**                                                        

  **From Adults**  4.6          3.1           22.4       1.8         31.8

  **From Seniors** 0.2          0.1           0.8        1.7         2.8

  **Total To**     28.6         16.6          49.0       5.7         
  ---------------- ------------ ------------- ---------- ----------- ----------

Given that children and teenagers together are roughly half as abundant
as adults, their importance is striking. This importance comes from
three characteristics. First, on average, children and teenagers each
have 52 contacts per day while adults have 34 and seniors only 24.
Secondly, children and teenagers are both more infectious and more
susceptible than adults (*I~A~* and *S~A~* are both 1.5 for children,
and both 1.25 for teenagers). And thirdly, most of the contacts for
children and teenagers are like-to-like with nearly half taking place in
school classes. The combination of these factors leads to very different
rates of disease spread within age class specific groups. For an *I~D~*
of 0.01, transmission from an infectious adult or senior to a
susceptible adult or senior occurs an average of once in every 100
contacts (*I~A~* and *S~A~* are both 1.0 for these age classes). If we
consider two adults in a work environment, where the average number of
contacts is 6 per day, then during the course of one day, an infectious
adult will infect another adult at work with a frequency of about 1 in
17. Now consider two children. Because *I~A~* and *S~A~* for children
are both 1.5, transmission rates are increased from an average of 1 in
100 contacts to about 1 in 44. In our contact network, a child has an
average of 24 contacts per day within the classroom environment, and
thus, the frequency per day of transmission from an infectious child to
a susceptible child at school is a bit over 1 in 2.

# Targeting zones of high infectious contact 

In the absence of vaccine or anti-viral treatment, what mitigation
strategies afford protection from pandemic influenza carriers arriving
from outside? Analysis of the base case presented above shows the
critical role of children and teenagers in spreading influenza. The
combination of high infectiousness and a high number of contacts, many
of which are like-to-like, creates a zone of high infectious contact
centered on children and teenagers within the community's social
network. Mitigation strategies that target this zone could effectively
protect the population at large by lowering the overall infectious
contact rate below the epidemic threshold.

As a first strategy, we examine the often implemented social distancing
measure of closing schools. We note that, while contacts in classes will
be removed, those in all other groups may increase in frequency as
children and teenagers now spend more time at home, in their
neighborhoods, with their friends, and in public spaces within the
community. At a minimum, we assume that school closure doubles household
contacts. Closing the schools after 10 symptomatic individuals are
detected within the community (by reducing the original contact
frequency within classes by 99%), we find a reduction of attack and
death rates of 45% as compared with the base case (**Table 1, SOM Table
4** in the Appendix). However, as a possible worst case, if we assume
that school closure doubles all the link contact frequencies for
children/teenagers within their non-class groups, attack and death rates
are actually increased relative to the base case by 14% and 19%,
respectively (**Table 1,** **SOM Table 4**).

In search of a more effective strategy, we send all children and
teenagers home on school closure to remain for the duration of the
pandemic. Contact frequencies are reduced by 99% for all groups that
contain only children or teenagers (classes and their random networks),
and doubled, as before, for children/teenagers in households. In the
extended family/neighborhood and the random over-all networks,
children/teenager contact frequencies are also reduced by 99%. Thus,
while children and teenagers are restricted to the home, adults and
seniors go about their day-to-day routines as usual except that they
avoid children/teenagers who are not family members. Imposition of this
strategy after 10 symptomatic individuals are detected reduces attack
and death rates by 98% as compared with the base case (**Figure 4a,
Table 1, SOM Table 5** in the Appendix). Waiting until 80 individuals
are detected (a possible worse case) still reduces attack and death
rates by 87% (**Figure 4a, Table 1, SOM Table 5** in the Appendix).

To evaluate the trade-off between effectiveness and public compliance,
we reduce the percent of the contacts that are reset with this children
and teenager stay-at-home policy. At 80% compliance, attack and death
rates can be reduced by 95% (**Figure 4b, Table 1, SOM Table 6** in the
Appendix). Further relaxation to 70% compliance still reduces influenza
severity within the community by above 86% (**Figure 4b, Table 1, SOM
Table 6**). We note that reduction in compliance also increases the time
scales for the epidemic. Below \~75% compliance, epidemics are
lengthened above the base case and reach nearly a factor of two at 60%
compliance (**Figure 4b**).

![](media/image9.wmf){width="5.9944444444444445in"
height="2.770138888888889in"}

**Figure 4:** Percent reduction from base case due to social distancing
of children and teenagers, as a function of a) implementation policy
threshold given by the number of symptomatic detected, and b) compliance
with the policy. Solid squares are for attack and death rates, open
squares for peak infected, long dashed for time to peak infected, and
short dashed for total time of epidemic. Results for attack and death
rates are also given in b) for two more virulent cases with 25% (open
circles) and 50% (open triangles) increases in disease infectivity, each
weighted against comparable no social distancing cases. Each point
plotted represents the average of 100 simulations. Summary statistics
are given in **SOM Tables 5 and 6**.

Other social distancing strategies can be considered. For instance,
since there are more children than teenagers, what if only children were
distanced while teenagers attended school? While not as effective,
simulation results indicate that this strategy still reduces the attack
and death rates by 72% at 99% compliance as compared with the base case
(**Table 1, SOM Table 7** in the Appendix). Many adults may also wish to
be distanced from work; however, distancing all adults has a small
effect, whether it is in addition to distancing children/teenagers (92%
at 70% compliance) or independently (only 6% decrease at 99% compliance)
(**Table 1, SOM Tables 8 and 9** in the Appendix). Finally, as is often
suggested, the simplest social distancing policy of all is to require
sick individuals to remain at home. Such a policy yields only a 21%
reduction in attack rate relative to the base case because just 25% of
the infectious are influenced (i.e., *pS\*pH* = 0.25) (**Table 1, SOM
Table 9**).

While it appears that social distancing strategies can be quite
effectively designed, implementation is challenging. The strategies must
be imposed for the duration of the local epidemic and possibly for the
entire period of the global pandemic if infected individuals continue to
enter the community. To return to normalcy, vaccination is required. As
vaccine becomes available, who should be vaccinated first? Knowledge of
the heterogeneous structure of infectious contact within social networks
enables us to define a vaccination strategy that can most quickly and
effectively protect the community. Vaccinating children and teenagers
first shows that at 60% coverage and above (assuming 100% vaccine
effectiveness), attack and death rates are decreased by 98% or greater
(**Figure 5**, **Table 1,** **SOM Table 10** in the Appendix). Similar
to that found for compliance (**Figure 4b**), epidemic time scales
lengthen as vaccination coverage is decreased.

![](media/image10.wmf){width="3.009027777777778in"
height="2.466666666666667in"}

**Figure 5:** Average percent reduction from base case due to priority
vaccination of children and teenagers, as a function of the percentage
vaccinated. Solid squares are for attack and death rates, open squares
for peak infected, long dashed for time to peak infected, and short
dashed for total time of epidemic. Results for attack and death rates
are also given for two more virulent cases with 25% (open circles) and
50% (open triangles) increases in disease infectivity, each weighted
against comparable no vaccination cases. Each point plotted represents
the average of 100 simulations. Summary statistics are given in **SOM
Table 10**.

A vaccination strategy that targets seniors first (based on their higher
mortality) is less effective, cutting the death rate by only 23% and the
attack rate by a mere 6% (**Table 1, SOM Table 11** in the Appendix).
Implementing a typical influenza vaccination demographic (26%
vaccination in children and teenagers, 30% in adults, and 59% in
seniors) not only requires a large supply of vaccine, it is also less
effective than a children and teenagers first policy, with an 83%
decrease in attack and 85% decrease in death rates (**Table 1, SOM Table
11**). The effectiveness of vaccinating children and teenagers has also
been advocated by Longini and coworkers *(*28) with support from both
mathematical modeling using a non-network approach *(29,* 30) and from
field data *(31-*33).

We probed the robustness of our targeted mitigation strategies in three
ways. First, the disease infectivity, *I~D~*, was increased by 25% and
50% to reflect more virulent strains (note that increasing infectivity
to 50% yields an average *R~o~* \~ 2.4). Increasing influenza
infectivity decreases the effectiveness of both the children and
teenagers targeted social distancing and vaccination strategies, thus
requiring higher compliance or vaccination rates to achieve the same
benefit (**Figures 4b and 5, SOM Tables 12 through 15** in the
Appendix). Second, we removed the increased infectivity and
susceptibility of children and teenagers as this may not be the case for
the influenza strain that erupts. Third, we considered a single
perturbation to the given contact networks by increasing the frequency
of random connections by a factor of 10 within the population at large
(from one random contact to 10 per day). Taken independently or together
these last two perturbations did not significantly change results, thus
emphasizing the critical controlling influence of the underlying
structured contact network.

# Discussion

Results for our stylized small town suggest significant value in
targeting zones of high infectious contact within a community, to both
stop the progression of pandemic influenza when no vaccine or antiviral
drugs are available, and to immunize the community most effectively once
vaccine arrives. Effective strategies can be designed at the community
level, but they must draw on insights that do not currently inform
public policies *(*34). For social distancing, we must not just close
the schools, we must maintain reduced contact among children and
teenagers to be most effective. When vaccine becomes available, a focus
on children and teens rather than on individuals with presumed highest
mortality would return the community to normalcy most rapidly, with the
least illness, death, and vaccine.

While our results are dependent on the underlying social contact network
and influenza strain characteristics, we have chosen both such as to
give a reasonable "worst case" for the design and testing of mitigation
strategies during the open-outbreak phase of an influenza pandemic.
Results for both targeted social distancing and vaccination of children
and teenagers are robust both to reasonable increases in random contacts
(e.g., shopping malls) and to the removal of age-class specific
differences in infectivity and susceptibility for children and
teenagers. Increases in disease infectivity require higher compliance
and vaccination coverage for the same benefit; the virulence of a
pandemic virus will not be known until it erupts.

As has been pointed out by a number of researchers *(35-*37), results
from epidemiological models must be interpreted with their assumptions
in mind. The classical modeling approach considers a population as
continuous and shows that the reproductive number, *R~o~* (the average
number of people an infected person will infect), critically controls
whether or not an outbreak develops into an epidemic *(*38). If *R~o~*
is above 1, an epidemic forms; if below, it does not. While conceptually
powerful, *R~o~* is an effective parameter at the population scale that
must be estimated empirically, post hoc. It subsumes both the properties
of the disease-host interaction and the contact network along which the
disease has spread. It therefore depends on the initial conditions
within the population (susceptibility), and the operable mixing
processes within the local culture (contact network), both of which vary
from place to place and will change during the worldwide progression of
a pandemic. More importantly, as demonstrated in our analyses, averaging
over a highly heterogeneous contact network can hide critical features
that could be exploited to design effective mitigation strategies.

Our networked agent-based model is a bottom-up, discrete process
approach that explicitly implements both the disease-host interaction
and the contact network. The full system behavior is built from
appropriate "unit" processes. In principle, experiments can be defined
to estimate parameters for both the contact network and the
viral-spreading rules between individuals. Measuring contact networks
within communities for the spread of infectious diseases requires
focused research that combines sociology and epidemiology. Such networks
will likely differ between urban and rural communities, and possibly
vary with community size. In our current study the contact network has
been created to represent a stylized small town in the United States.
With the aid of detailed demographic data, expert elicitation,
behavioral surveys, and experiments, it can be expanded or adjusted for
communities of interest and for other parts of the world. Configurations
that explicitly consider college campuses might be of great importance
in light of the fact that the highest death rate of any group in the
1918 Spanish Influenza pandemic were young adults *(*39).

The spread of infectious diseases is a critical problem in the densely
populated and well-connected world of the 21^st^ century. Fears of a
massive pandemic akin to that of the 1918 Spanish Influenza have
heightened with the H5N1strain of avian influenza as a potential
candidate. When such a pandemic begins, will we be prepared? We believe
our results, based on networked agent-based simulations, compel
exploration of the "how to" of effective social distancing strategies.
For such strategies to be used effectively in a time of crisis, their
value must be understood, and their implementation must be clear, well
prepared for, and supported by all of society.

[]{#__RefHeading___Toc125417467 .anchor}References

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[]{#__RefHeading___Toc125417468 .anchor}Appendix: Supporting Online
Material

**Base Case:**

SOM Table 1: Community structure

SOM Table 2: Increasing Influenza realism. Results for 100 simulations
each.

SOM Table 3: Summary statistics for influence of number of instigators.
Results for 100 simulations each.

**Social Distancing Strategies:**

SOM Table 4: Social Distancing: Closing Schools, Threshold 10
symptomatic, Compliance 99%, with contact displacement. Results for 100
simulations each.

SOM Table 5: Social Distancing: Closing Schools and Children-Teenagers
stay at home, Threshold variation, Compliance 99%. Results for 100
simulations each.

SOM Table 6: Social Distancing: Closing Schools and Children-Teenagers
stay at home, Threshold 10 symptomatic, Compliance variation. Results
for 100 simulations each.

SOM Table 7: Social Distancing: Only Children's Schools are Closed and
stay at home, Threshold 10 symptomatic, Compliance variation. Results
for 100 simulations each.

SOM Table 8: Social Distancing: Closing Schools and Work, only
Children-Teenagers stay at home, Threshold 10 symptomatic, Compliance
variation. Results for 100 simulations each.

SOM Table 9: Adults only avoid work, Threshold 10 symptomatic, 99%
compliance; and All who become symptomatic always Stay At Home when
sick. Results for 100 simulations each.

**Vaccination Strategies:**

SOM Table 10: Vaccination Strategy: Percent Coverage of Children and
Teens. Results for 100 simulations each.

SOM Table 11: Vaccination Strategies: Seniors Only and Current
Vaccination Practice. Results for 100 simulations each.

**Robustness:**

SOM Table 12: *I~D~* increased by 25%, Social Distancing: Closing
Schools and Children-Teenagers stay at home, Threshold 10 symptomatic,
Compliance variation. Results for 100 simulations each.

SOM Table 13: *I~D~* increased by 50%, Social Distancing: Closing
Schools and Children-Teenagers stay at home, Threshold 10 symptomatic,
Compliance variation. Results for 100 simulations each.

SOM Table 14: *I~D~* increased by 25%, Vaccination Strategy: Percent
Coverage of Children and Teens. Results for 100 simulations each.

SOM Table 15: *I~D~* increased by 50%, Vaccination Strategy: Percent
Coverage of Children and Teens. Results for 100 simulations each.

**SOM Table 1: Community structure**

+--------------------+----------+----------+----------+--------------+
| **Group (and       | **Memb   | *        | *        | **Average    |
| number of groups   | ership** | *Average | *Network | Frequency of |
| in Community)**    |          | \# of    | type and | contact per  |
|                    |          | links    | para     | link**       |
|                    |          | per      | meters** |              |
|                    |          | member** |          |              |
+--------------------+----------+----------+----------+--------------+
| **Non-Senior       | 1-2      | 2.13     | Fully    | 6 times a    |
| Households**       | adults   |          | c        | day          |
|                    |          |          | onnected |              |
| **(2730)**         | 0-4      |          |          |              |
|                    | children |          |          |              |
|                    |          |          |          |              |
|                    | 0-4      |          |          |              |
|                    | teens    |          |          |              |
|                    |          |          |          |              |
|                    | Mean     |          |          |              |
|                    | size     |          |          |              |
|                    | 3.13     |          |          |              |
+--------------------+----------+----------+----------+--------------+
| **Senior           | 1-2      | 0.75     | Fully    | 6 times a    |
| Households**       | seniors  |          | c        | day          |
|                    |          |          | onnected |              |
| **(742)**          | Mean     |          |          |              |
|                    | size     |          |          |              |
|                    | 1.75     |          |          |              |
+--------------------+----------+----------+----------+--------------+
| **Extended         | 0-2      | 11.5     | Fully    | once a day   |
| families or        | seniors  |          | c        |              |
| Neighborhoods**    |          |          | onnected |              |
|                    | 0-8      |          |          |              |
| **(800)**          | adults   |          |          |              |
|                    |          |          |          |              |
|                    | 0-8      |          |          |              |
|                    | teens    |          |          |              |
|                    |          |          |          |              |
|                    | 0-8      |          |          |              |
|                    | children |          |          |              |
|                    |          |          |          |              |
|                    | Mean     |          |          |              |
|                    | size     |          |          |              |
|                    | 12.5     |          |          |              |
+--------------------+----------+----------+----------+--------------+
| **Child classes**  | 1 class  | 4        | Ring     | 6 times a    |
|                    | per      |          | network  | day          |
| **(69)**           | child,   |          | with     |              |
|                    |          |          | radius 2 |              |
|                    | 20-35    |          |          |              |
|                    | children |          |          |              |
|                    | in each  |          |          |              |
|                    | class    |          |          |              |
+--------------------+----------+----------+----------+--------------+
| **Child random**   | All      | 3        | Random   | once a day   |
|                    | children |          | network  |              |
| **(1)**            |          |          | link     |              |
|                    |          |          | density  |              |
|                    |          |          | 3/1769   |              |
+--------------------+----------+----------+----------+--------------+
| **Teen classes**   | six      | 4        | Ring     | once a day   |
|                    | classes  |          | network  |              |
| **(264)**          | per      |          | with     |              |
|                    | teen,    |          | radius 2 |              |
|                    |          |          |          |              |
|                    | 20-35    |          |          |              |
|                    | teens in |          |          |              |
|                    | each     |          |          |              |
|                    | class    |          |          |              |
+--------------------+----------+----------+----------+--------------+
| **Teen random**    | All      | 3        | Random   | once a day   |
|                    | teens    |          | network  |              |
| **(1)**            |          |          | link     |              |
|                    |          |          | density  |              |
|                    |          |          | of       |              |
|                    |          |          | 3/1129   |              |
+--------------------+----------+----------+----------+--------------+
| **Adult work**     | 1 work   | 6        | Ring     | once a day   |
|                    | group    |          | network  |              |
| **(351)**          | per      |          | with     |              |
|                    | adult,   |          | radius 3 |              |
|                    | 10-50    |          |          |              |
|                    | adults   |          |          |              |
|                    | in each  |          |          |              |
+--------------------+----------+----------+----------+--------------+
| **Adult random**   | All      | 3        | Random   | once a day   |
|                    | adults   |          | network  |              |
| **(1)**            |          |          | link     |              |
|                    |          |          | density  |              |
|                    |          |          | of       |              |
|                    |          |          | 3/5849   |              |
+--------------------+----------+----------+----------+--------------+
| **Senior           | 1        | 4        | Ring     | once a day   |
| gathering**        | g        |          | network  |              |
|                    | athering |          | with     |              |
| **(156)**          | per      |          | radius 2 |              |
|                    | senior,  |          |          |              |
|                    | 5-20     |          |          |              |
|                    | seniors  |          |          |              |
|                    | in each  |          |          |              |
+--------------------+----------+----------+----------+--------------+
| **Senior random**  | All      | 3        | Random   | once a day   |
|                    | seniors  |          | network  |              |
| **(1)**            |          |          | link     |              |
|                    |          |          | density  |              |
|                    |          |          | of       |              |
|                    |          |          | 3/1249   |              |
+--------------------+----------+----------+----------+--------------+
| **Over-all         | All age  | 25       | Random   | 1/25 a day   |
| random**           | classes  |          | network  |              |
|                    |          |          | link     |              |
| **(1)**            |          |          | density  |              |
|                    |          |          | of       |              |
|                    |          |          | 25/9999  |              |
+--------------------+----------+----------+----------+--------------+

**SOM Table 2: Increasing Influenza realism. Results for 100 simulations
each.**

  ----------------- ------------- ---------- --------- -------- -------- ----------- ------------- ---------- --------- --------- --------
                    Statistics                                                       Statistics                                   
                    for all 100                                                      for                                          
                    simulations                                                      simulations                                  
                    including                                                        with                                         
                    those without                                                    epidemics                                    
                    epidemics                                                        (total                                       
                                                                                     infected \>                                  
                                                                                     100)                                         

                    Peak Infected Total      Dead      Time to  Total    Number of   Peak Infected Total      Dead      Time to   Total
                                  Infected             Peak     Time     Epidemics                 Infected             Peak      Time
                                                       (days)   (days)                                                  (days)    (days)

  Initial                                                                100                                                      

  Average           1527.2        7207.2     1082.6    43.1     111.1                1527.2        7207.2     1082.6    43.1      111.1

  Max               1703          7404       1171      56.0     141.5                1703          7404       1171      56.0      141.5

  Min               1368          6911       954       33.8     88.9                 1368          6911       954       33.8      88.9

  STD               74.7          93.0       37.8      4.4      10.7                 74.7          93.0       37.8      4.4       10.7

  Reduction from    -51.7%        -42.8%     -134.0%   3.2%     2.3%                 -48.5%        -39.8%     -129.1%   5.2%      4.0%
  *base case*                                                                                                                     

  ID reduced by 50%                                                      83                                                       
  after                                                                                                                           
  pre-symptomatic                                                                                                                 
  period                                                                                                                          

  Average           184.4         2253.3     338.6     81.1     194.5                219.4         2705.3     406.7     95.8      225.9

  Max               391           3626       549       201.9    403.6                391           3626       549       201.9     403.6

  Min               10            18         0         0.1      13.4                 20            101        10        12.6      51.2

  STD               101.1         1164.9     176.3     44.6     90.1                 71.1          649.3      99.5      32.9      61.8

  Reduction from    81.7%         55.3%      26.8%     -82.1%   -71.1%               78.7%         47.5%      13.9%     -110.7%   -95.3%
  *base case*                                                                                                                     

  Probability of                                                         87                                                       
  Symptomatic (*pS*                                                                                                               
  = 0.5)                                                                                                                          

  Average           193.6         2366.2     179.0     86.9     199.0                220.4         2714.8     205.4     99.5      224.5

  Max               376           3353       282       235.7    430.6                376           3353       282       235.7     430.6

  Min               11            14         1         1.1      11.7                 25            122        5         4.5       49.7

  STD               92.3          1053.5     80.4      47.6     83.8                 64.7          576.1      44.9      37.3      55.1

  Reduction from    80.8%         53.1%      61.3%     -95.3%   -75.1%               78.6%         47.3%      56.5%     -118.8%   -94.1%
  *base case*                                                                                                                     

  Probability of                                                         71                                                       
  Stay At Home                                                                                                                    
  (*pS* = 0.5)                                                                                                                    

  Average           78.2          1055.3     78.7      71.0     164.5                103.5         1468.0     109.5     97.2      217.1

  Max               222           2496       202       232.9    436.7                222           2496       202       232.9     436.7

  Min               10            20         0         0.1      15.6                 18            106        5         3.2       71.2

  STD               54.9          841.1      64.0      56.4     99.8                 44.7          636.2      49.9      45.4      66.1

  Reduction from    92.2%         79.1%      83.0%     -59.3%   -44.8%               89.9%         71.5%      76.8%     -113.9%   -87.7%
  *base case*                                                                                                                     

  Relative                                                               91                                                       
  Infectivity of                                                                                                                  
  Children (1.5)                                                                                                                  
  and Teenagers                                                                                                                   
  (1.25)                                                                                                                          

  Average           428.9         3581.8     271.0     66.9     157.2                470.1         3933.2     297.6     73.3      170.1

  Max               650           4373       367       149.9    273.7                650           4373       367       149.9     273.7

  Min               10            15         0         0.1      13.5                 314           3422       248       49.2      129.9

  STD               149.5         1139.8     88.4      25.8     48.0                 74.4          203.7      26.0      16.3      25.4

  Reduction from    57.4%         29.0%      41.4%     -50.2%   -38.3%               54.3%         23.7%      37.0%     -61.3%    -47.1%
  *base case*                                                                                                                     

  Relative                                                               99                                                       
  Susceptibility of                                                                                                               
  Children (1.5)                                                                                                                  
  and Teenagers                                                                                                                   
  (1.25)                                                                                                                          

  Average           1012.5        5103.7     384.3     45.6     116.6                1022.6        5155.1     388.2     46.1      117.6

  Max               1210          5477       440       68.6     182.7                1210          5477       440       68.6      182.7

  Min               12            18         1         1.9      22.6                 833           4759       338       34.3      86.7

  STD               124.6         529.6      44.3      7.8      19.1                 73.3          129.4      21.6      6.4       16.7

  Reduction from    -0.6%         -1.1%      16.9%     -2.4%    -2.6%                0.5%          0.0%       17.9%     -1.3%     -1.6%
  *base case*                                                                                                                     

  Relative                                                               97                                                       
  mortality of                                                                                                                    
  Seniors increased                                                                                                               
  by factor of 5                                                                                                                  
  (base case)                                                                                                                     

  Average           994.0         4974.6     452.5     43.0     111.2                1024.4        5127.8     466.5     44.3      114.1

  Max               1185          5432       554       62.0     144.3                1185          5432       554       62.0      144.3

  Min               10            12         0         0.1      8.5                  813           4709       400       33.5      90.0

  STD               186.9         885.9      84.1      9.3      21.0                 70.3          137.4      27.1      5.6       12.8

  Reduction from    1.3%          1.4%       2.2%      3.4%     2.2%                 0.4%          0.5%       1.3%      2.5%      1.4%
  *base case*                                                                                                                     

  Base case, 1000                                                        979                                                      
  simulations                                                                                                                     

  Average           1006.7        5046.3     462.7     44.5     113.7                1028.1        5154.2     472.6     45.5      115.7

  Max               1295          5592       552       99.4     195.5                1295          5592       552       99.4      195.5

  Min               10            11         0         0.1      9.6                  796           4780       386       32.2      85.3

  STD               163.8         746.4      71.5      9.8      19.3                 75.5          122.9      23.7      7.6       13.7
  ----------------- ------------- ---------- --------- -------- -------- ----------- ------------- ---------- --------- --------- --------

**SOM Table 3: Summary statistics for influence of number of
instigators. Results for 100 simulations each.**

  ------------- ------------- ---------- ------- -------- -------- ----------- ------------- ---------- ------- -------- --------
                Statistics                                                     Statistics                                
                for all 100                                                    for                                       
                simulations                                                    simulations                               
                including                                                      with                                      
                those without                                                  epidemics                                 
                epidemics                                                      (total                                    
                                                                               infected \>                               
                                                                               100)                                      

                Peak Infected Total      Dead    Time to  Total    Number of   Peak Infected Total      Dead    Time to  Total
                              Infected           Peak     Time     Epidemics                 Infected           Peak     Time
                                                 (days)   (days)                                                (days)   (days)

  1 Instigator                                                     35                                                    

  Average       357.0         1792.1     166.5   21.4     50.3                 1016.7        5115.3     475.2   57.4     130.0

  Max           1208          5573       522     86.5     158.0                1208          5573       522     86.5     158.0

  Min           1             1          0       0.1      0.8                  793           4724       415     37.2     101.0

  STD           489.4         2453.1     228.2   27.6     59.6                 90.91         177.2      25.3    11.6     13.7

  Reduction     64.5%         64.5%      64.0%   51.9%    55.7%                1.1%          0.8%       -0.6%   -26.4%   -12.4%
  from *base                                                                                                             
  case*                                                                                                                  

  2 Instigators                                                    56                                                    

  Average       564.8         2869.4     264.7   31.2     74.3                 1006.2        5120.3     472.5   53.4     123.5

  Max           1190          5401       523     83.1     190.2                1190          5401       523     83.1     190.2

  Min           2             2          0       0.1      2.5                  852           4700       421     35.3     100.8

  STD           503.9         2554.1     236.4   26.4     57.9                 79.7          134.6      26.2    10.1     19.2

  Reduction     43.9%         43.1%      42.8%   30.0%    34.6%                2.1%          0.7%       0.0%    -17.4%   -6.8%
  from *base                                                                                                             
  case*                                                                                                                  

  4 Instigators                                                    82                                                    

  Average       847.2         4231.7     388.3   43.3     102.5                1031.8        5158.3     473.3   51.8     121.4

  Max           1184          5518       531     91.6     174.4                1184          5518       531     91.6     174.4

  Min           4             4          0       0.1      3.5                  891           4811       422     36.3     96.5

  STD           400.2         1990.9     183.7   20.5     42.8                 63.9          123.1      23.8    10.0     14.1

  Reduction     15.8%         16.1%      16.1%   2.7%     9.8%                 -0.4%         -0.1%      -0.2%   -14.0%   -5.0%
  from *base                                                                                                             
  case*                                                                                                                  

  8 Instigators                                                    97                                                    

  Average       991.3         4996.3     456.5   46.7     116.4                1021.6        5150.3     470.6   48.1     119.4

  Max           1219          5408       517     83.1     154.3                1219          5408       517     83.1     154.3

  Min           8             11         0       0.1      10.9                 816           4693       419     33.9     93.2

  STD           192.6         888.8      82.8    11.8     21.9                 85.4          124.9      19.7    8.9      13.5

  Reduction     1.5%          1.0%       1.4%    -4.9%    -2.4%                0.6%          0.1%       0.4%    -5.8%    -3.2%
  from *base                                                                                                             
  case*                                                                                                                  

  16                                                               100                                                   
  Instigators                                                                                                            

  Average       1031.5        5158.5     474.6   41.9     113.5                1031.5        5158.5     474.6   41.9     113.5

  Max           1188          5463       527     65.7     150.7                1188          5463       527     65.7     150.7

  Min           835           4846       418     31.3     85.0                 835           4846       418     31.3     85.0

  STD           67.3          120.8      22.2    5.9      14.0                 67.3          120.8      22.2    5.9      14.0

  Reduction     -2.5%         -2.2%      -2.6%   6.0%     0.1%                 -0.3%         -0.1%      -0.4%   7.9%     1.9%
  from *base                                                                                                             
  case*                                                                                                                  

  32                                                               100                                                   
  Instigators                                                                                                            

  Average       1057.0        5196.6     476.2   35.1     105.3                1057.0        5196.6     476.2   35.1     105.3

  Max           1301          5528       544     45.4     146.8                1301          5528       544     45.4     146.8

  Min           865           4915       398     26.1     82.1                 865           4915       398     26.1     82.1

  STD           80.4          117.8      24.2    3.6      12.5                 80.4          117.8      24.2    3.6      12.5

  Reduction     -5.0%         -3.0%      -2.9%   21.1%    7.3%                 -2.8%         -0.8%      -0.7%   22.7%    8.9%
  from *base                                                                                                             
  case*                                                                                                                  

  62                                                               100                                                   
  Instigators                                                                                                            

  Average       1068.8        5227.2     479.5   30.7     99.7                 1068.8        5227.2     479.5   30.7     99.7

  Max           1307          5560       532     38.0     140.5                1307          5560       532     38.0     140.5

  Min           923           4989       403     24.9     76.9                 923           4989       403     24.9     76.9

  STD           70.3          123.2      24.5    2.6      12.3                 70.3          123.2      24.5    2.6      12.3

  Reduction     -6.2%         -3.6%      -3.6%   31.0%    12.2%                -4.0%         -1.4%      -1.5%   32.5%    13.8%
  from *base                                                                                                             
  case*                                                                                                                  

  128                                                              100                                                   
  Instigators                                                                                                            

  Average       1102.4        5287.3     485.5   25.5     96.0                 1102.4        5287.3     485.5   25.5     96.0

  Max           1259          5636       532     30.4     131.9                1259          5636       532     30.4     131.9

  Min           917           4946       441     21.6     76.7                 917           4946       441     21.6     76.7

  STD           74.7          120.2      22.0    2.1      10.8                 74.7          120.2      22.0    2.1      10.8

  Reduction     -9.5%         -4.8%      -4.9%   42.6%    15.5%                -7.2%         -2.6%      -2.7%   43.8%    17.0%
  from *base                                                                                                             
  case*                                                                                                                  

  256                                                              100                                                   
  Instigators                                                                                                            

  Average       1183.7        5432.4     495.0   20.6     87.8                 1183.7        5432.4     495.0   20.6     87.8

  Max           1379          5735       548     25.5     130.8                1379          5735       548     25.5     130.8

  Min           985           5146       442     17.3     68.8                 985           5146       442     17.3     68.8

  STD           75.7          134.1      25.1    1.7      9.4                  75.7          134.1      25.1    1.7      9.4

  Reduction     -17.6%        -7.7%      -7.0%   53.7%    22.8%                -15.1%        -5.4%      -4.7%   54.6%    24.1%
  from *base                                                                                                             
  case*                                                                                                                  

  Base case,                                                       979                                                   
  1000                                                                                                                   
  simulations                                                                                                            

  Average       1006.7        5046.3     462.7   44.5     113.7                1028.1        5154.2     472.6   45.5     115.7

  Max           1295          5592       552     99.4     195.5                1295          5592       552     99.4     195.5

  Min           10            11         0       0.1      9.6                  796           4780       386     32.2     85.3

  STD           163.8         746.4      71.5    9.8      19.3                 75.5          122.9      23.7    7.6      13.7
  ------------- ------------- ---------- ------- -------- -------- ----------- ------------- ---------- ------- -------- --------

**SOM Table 4: Social Distancing: Closing Schools, Threshold 10
symptomatic, Compliance 99%, with contact displacement. Results for 100
simulations each.**

  ------------- ------------- ---------- -------- -------- -------- ----------- ------------- ---------- -------- -------- --------
                Statistics                                                      Statistics                                 
                for all 100                                                     for                                        
                simulations                                                     simulations                                
                including                                                       with                                       
                those without                                                   epidemics                                  
                epidemics                                                       (total                                     
                                                                                infected \>                                
                                                                                100)                                       

                Peak Infected Total      Dead     Time to  Total    Number of   Peak Infected Total      Dead     Time to  Total
                              Infected            Peak     Time     Epidemics                 Infected            Peak     Time
                                                  (days)   (days)                                                 (days)   (days)

  just                                                              95                                                     
  schools +                                                                                                                
  double in                                                                                                                
  Houshold                                                                                                                 

  Average       217.6         2759.7     253.5    82.2     207.5                228.3         2903.0     266.6    86.1     217.0

  Max           440           3546       341      208.7    402.6                440           3546       341      208.7    402.6

  Min           12            17         2        1.3      11.4                 37            269        23       15.2     94.0

  STD           81.4          795.9      74.1     37.3     65.6                 68.3          501.9      48.1     34.0     52.0

  Reduction     78.4%         45.3%      45.2%    -84.7%   -82.5%               77.8%         43.7%      43.6%    -89.4%   -87.6%
  from *base                                                                                                               
  case*                                                                                                                    

  just                                                              98                                                     
  schools +                                                                                                                
  double in all                                                                                                            
  groups                                                                                                                   

  Average       1063.5        5746.1     552.0    46.4     117.8                1085.0        5862.8     563.2    47.3     119.7

  Max           1339          6184       625      64.3     162.2                1339          6184       625      64.3     162.2

  Min           10            19         1        0.1      20.2                 946           5545       512      36.4     94.1

  STD           169.9         831.3      82.2     9.0      19.1                 78.5          132.8      23.7     6.5      13.6

  Reduction     -5.6%         -13.9%     -19.3%   -4.3%    -3.6%                -5.5%         -13.7%     -19.2%   -4.1%    -3.5%
  from *base                                                                                                               
  case*                                                                                                                    

  Base case,                                      979                                                                      
  1000                                                                                                                     
  simulations                                                                                                              

  Average       1006.7        5046.3     462.7    44.5     113.7                1028.1        5154.2     472.6    45.5     115.7

  Max           1295          5592       552      99.4     195.5                1295          5592       552      99.4     195.5

  Min           10            11         0        0.1      9.6                  796           4780       386      32.2     85.3

  STD           163.8         746.4      71.5     9.8      19.3                 75.5          122.9      23.7     7.6      13.7

                                                                                                                           
  ------------- ------------- ---------- -------- -------- -------- ----------- ------------- ---------- -------- -------- --------

**SOM Table 5: Social Distancing: Closing Schools and Children-Teenagers
stay at home, Threshold variation, Compliance 99%. Results for 100
simulations each.**

  ------------- ------------- ---------- ------- -------- -------- ----------- ------------- ---------- ------- -------- --------
                Statistics                                                     Statistics                                
                for all 100                                                    for                                       
                simulations                                                    simulations                               
                including                                                      with                                      
                those without                                                  epidemics                                 
                epidemics                                                      (total                                    
                                                                               infected \>                               
                                                                               100)                                      

                Peak Infected Total      Dead    Time to  Total    Number of   Peak Infected Total      Dead    Time to  Total
                              Infected           Peak     Time     Epidemics                 Infected           Peak     Time
                                                 (days)   (days)                                                (days)   (days)

  Threshold 10                                                     54                                                    
  symptomatic                                                                                                            
  detected                                                                                                               

  Average       30.4          105.0      9.7     11.5     51.4                 36.9          135.9      13.0    12.6     60.9

  Max           64            208        23      24.3     106.6                64            208        23      23.1     106.6

  Min           11            18         1       1.0      18.5                 20            101        5       5.9      32.8

  STD           10.6          42.9       5.1     4.8      17.4                 9.09          29.7       4.3     4.3      13.6

  Reduction     97.0%         97.9%      97.9%   74.1%    54.8%                96.4%         97.4%      97.2%   72.2%    47.3%
  from *base                                                                                                             
  case*                                                                                                                  

  Threshold 20                                                     81                                                    
  symptomatic                                                                                                            
  detected                                                                                                               

  Average       47.9          178.4      15.7    15.1     59.0                 53.6          203.9      17.8    16.2     64.4

  Max           104           398        42      64.4     130.5                104           398        42      64.4     130.5

  Min           13            15         0       1.8      7.4                  24            103        8       8.8      31.4

  STD           20.5          79.1       7.7     6.9      20.5                 18.3          64.5       7.0     6.6      18.4

  Reduction     95.2%         96.5%      96.6%   66.0%    48.1%                94.8%         96.0%      96.2%   64.3%    44.3%
  from *base                                                                                                             
  case*                                                                                                                  

  Threshold 40                                                     100                                                   
  symptomatic                                                                                                            
  detected                                                                                                               

  Average       93.7          361.2      32.2    21.6     73.5                 93.7          361.2      32.2    21.6     73.5

  Max           173           680        66      38.6     136.2                173           680        66      38.6     136.2

  Min           34            185        11      12.8     44.1                 34            185        11      12.8     44.1

  STD           25.9          91.4       10.6    5.5      19.9                 25.9          91.4       10.6    5.5      19.9

  Reduction     90.7%         92.8%      93.0%   51.5%    35.3%                90.9%         93.0%      93.2%   52.5%    36.5%
  from *base                                                                                                             
  case*                                                                                                                  

  Threshold 80                                                     99                                                    
  symptomatic                                                                                                            
  detected                                                                                                               

  Average       159.5         636.5      55.2    27.3     82.5                 161.0         642.7      55.8    27.6     82.9

  Max           268           923        89      58.9     115.6                268           923        89      58.9     115.6

  Min           10            24         1       0.1      36.1                 75            329        26      16.0     54.4

  STD           44.8          151.1      14.6    8.3      14.4                 42.4          138.6      13.6    7.8      13.7

  Reduction     84.2%         87.4%      88.1%   38.7%    27.4%                84.3%         87.5%      88.2%   39.3%    28.3%
  from *base                                                                                                             
  case*                                                                                                                  

  Threshold 160                                                    99                                                    
  symptomatic                                                                                                            
  detected                                                                                                               

  Average       297.9         1163.3     103.4   30.3     93.7                 300.7         1174.5     104.4   30.6     94.2

  Max           409           1593       148     54.0     160.3                409           1593       148     54.0     160.3

  Min           21            48         4       6.9      46.1                 174           720        70      18.8     62.6

  STD           57.9          201.7      19.4    7.0      17.3                 50.9          168.1      16.7    6.6      16.7

  Reduction     70.4%         76.9%      77.6%   31.9%    17.6%                70.7%         77.2%      77.9%   32.7%    18.6%
  from *base                                                                                                             
  case*                                                                                                                  

  Threshold 320                                                    99                                                    
  symptomatic                                                                                                            
  detected                                                                                                               

  Average       525.6         1994.2     176.7   33.7     97.4                 530.7         2014.0     178.5   34.0     98.1

  Max           663           2456       229     57.9     156.1                663           2456       229     57.9     156.1

  Min           14            30         2       2.3      24.6                 347           1491       122     22.6     70.0

  STD           85.2          273.9      27.0    7.1      16.7                 68.0          189.8      20.5    6.4      15.0

  Reduction     47.8%         60.5%      61.8%   24.4%    14.3%                48.4%         60.9%      62.2%   25.2%    15.1%
  from *base                                                                                                             
  case*                                                                                                                  

  Threshold 640                                                    98                                                    
  symptomatic                                                                                                            
  detected                                                                                                               

  Average       799.3         3012.3     267.8   38.6     96.0                 815.4         3073.2     273.2   39.3     97.6

  Max           985           3550       337     55.8     126.1                985           3550       337     55.8     126.1

  Min           13            16         2       3.1      10.9                 619           2699       223     29.0     76.2

  STD           137.3         460.1      44.4    7.3      15.5                 79.1          168.4      23.0    5.5      10.6

  Reduction     20.6%         40.3%      42.1%   13.3%    15.5%                20.7%         40.4%      42.2%   13.6%    15.6%
  from *base                                                                                                             
  case*                                                                                                                  

  Threshold                                                        99                                                    
  1280                                                                                                                   
  symptomatic                                                                                                            
  detected                                                                                                               

  Average       1003.2        4166.0     380.4   44.4     100.0                1013.2        4207.7     384.2   44.9     100.7

  Max           1175          4414       442     65.2     138.3                1175          4414       442     65.2     138.3

  Min           10            33         4       0.1      30.6                 874           3981       343     34.8     81.4

  STD           122.3         430.9      44.1    7.9      13.1                 70.3          107.1      22.4    6.5      11.1

  Reduction     0.4%          17.4%      17.8%   0.2%     12.0%                1.4%          18.4%      18.7%   1.2%     13.0%
  from *base                                                                                                             
  case*                                                                                                                  

  Threshold                                                        96                                                    
  10000                                                                                                                  
  symptomatic                                                                                                            
  detected                                                                                                               

  Average       986.2         4944.6     456.1   43.5     111.5                1026.8        5149.7     475.0   45.2     115.2

  Max           1167          5474       526     65.8     159.8                1167          5474       526     65.8     159.8

  Min           10            16         1       0.1      16.3                 864           4891       420     32.9     92.5

  STD           210.2         1018.5     95.8    10.8     23.4                 66.5          137.3      23.1    6.9      14.6

  Reduction     2.0%          2.0%       1.4%    2.2%     1.9%                 0.1%          0.1%       -0.5%   0.5%     0.4%
  from *base                                                                                                             
  case*                                                                                                                  

  Base case,                                                       979                                                   
  1000                                                                                                                   
  simulations                                                                                                            

  Average       1006.7        5046.3     462.7   44.5     113.7                1028.1        5154.2     472.6   45.5     115.7

  Max           1295          5592       552     99.4     195.5                1295          5592       552     99.4     195.5

  Min           10            11         0       0.1      9.6                  796           4780       386     32.2     85.3

  STD           163.8         746.4      71.5    9.8      19.3                 75.5          122.9      23.7    7.6      13.7
  ------------- ------------- ---------- ------- -------- -------- ----------- ------------- ---------- ------- -------- --------

**SOM Table 6: Social Distancing: Closing Schools and Children-Teenagers
stay at home, Threshold 10 symptomatic, Compliance variation. Results
for 100 simulations each.**

  ------------- ------------- ---------- -------- -------- -------- ----------- ------------- ---------- -------- -------- --------
                Statistics                                                      Statistics                                 
                for all 100                                                     for                                        
                simulations                                                     simulations                                
                including                                                       with                                       
                those without                                                   epidemics                                  
                epidemics                                                       (total                                     
                                                                                infected \>                                
                                                                                100)                                       

                Peak Infected Total      Dead     Time to  Total    Number of   Peak Infected Total      Dead     Time to  Total
                              Infected            Peak     Time     Epidemics                 Infected            Peak     Time
                                                  (days)   (days)                                                 (days)   (days)

  99%                                                               51                                                     
  Compliance                                                                                                               

  Average       32.9          112.4      9.2      11.7     49.8                 41.6          152.8      12.3     14.2     59.9

  Max           67            300        22       33.2     97.1                 67            300        22       33.2     97.1

  Min           11            26         1        1.7      17.4                 23            101        3        5.5      31.2

  STD           13.1          55.4       4.9      5.8      17.0                 11.9          47.6       4.5      5.5      15.5

  Reduction     96.7%         97.8%      98.0%    73.7%    56.2%                96.0%         97.0%      97.4%    68.8%    48.2%
  from *base                                                                                                               
  case*                                                                                                                    

  90%                                                               61                                                     
  Compliance                                                                                                               

  Average       36.1          146.4      12.9     15.0     58.7                 45.6          194.9      16.8     16.7     67.7

  Max           76            476        43       54.2     125.0                76            476        43       54.2     125.0

  Min           10            22         1        0.1      20.0                 18            103        5        8.1      28.8

  STD           16.8          89.8       8.5      8.4      21.6                 14.4          83.1       8.6      8.8      22.1

  Reduction     96.4%         97.1%      97.2%    66.3%    48.3%                95.6%         96.2%      96.4%    63.2%    41.5%
  from *base                                                                                                               
  case*                                                                                                                    

  80%                                                               76                                                     
  Compliance                                                                                                               

  Average       39.5          243.0      22.0     23.0     86.5                 45.6          298.4      27.0     27.1     100.1

  Max           88            938        91       136.3    270.4                88            938        91       136.3    270.4

  Min           11            15         1        0.7      10.4                 22            104        8        5.3      38.6

  STD           17.8          177.1      17.0     21.6     45.6                 15.9          167.9      16.4     23.0     43.5

  Reduction     96.1%         95.2%      95.2%    48.4%    23.9%                95.6%         94.2%      94.3%    40.3%    13.5%
  from *base                                                                                                               
  case*                                                                                                                    

  70%                                                               85                                                     
  Compliance                                                                                                               

  Average       63.8          718.6      64.2     45.5     146.9                71.8          834.9      74.5     52.1     165.7

  Max           152           1902       191      196.2    390.5                152           1902       191      196.2    390.5

  Min           10            21         1        0.1      13.6                 16            101        8        1.9      51.2

  STD           35.6          538.9      48.3     37.7     74.9                 32.5          500.9      45.0     37.1     64.7

  Reduction     93.7%         85.8%      86.1%    -2.2%    -29.2%               93.0%         83.8%      84.2%    -14.5%   -43.3%
  from *base                                                                                                               
  case*                                                                                                                    

  60%                                                               94                                                     
  Compliance                                                                                                               

  Average       140.2         1825.6     161.4    74.9     201.6                148.0         1938.5     171.4    79.3     212.1

  Max           299           3069       276      206.5    344.2                299           3069       276      206.5    344.2

  Min           10            17         1        0.1      19.3                 24            128        11       10.2     50.0

  STD           65.6          807.0      72.4     41.3     74.4                 59.6          691.6      62.5     38.6     63.5

  Reduction     86.1%         63.8%      65.1%    -68.2%   -77.4%               85.6%         62.4%      63.7%    -74.4%   -83.4%
  from *base                                                                                                               
  case*                                                                                                                    

  50%                                                               97                                                     
  Compliance                                                                                                               

  Average       291.3         3091.5     273.3    77.8     188.3                299.8         3185.5     281.6    79.8     193.0

  Max           499           3681       360      208.1    336.9                499           3681       360      208.1    336.9

  Min           13            22         2        2.2      18.7                 138           2608       206      34.9     134.5

  STD           79.8          591.9      54.3     31.8     46.5                 64.5          252.3      26.7     30.1     38.0

  Reduction     71.1%         38.7%      40.9%    -74.8%   -65.6%               70.8%         38.2%      40.4%    -75.5%   -66.9%
  from *base                                                                                                               
  case*                                                                                                                    

  40%                                                               95                                                     
  Compliance                                                                                                               

  Average       436.8         3640.0     325.7    60.7     152.7                459.0         3829.7     342.6    63.6     159.4

  Max           650           4293       411      112.0    221.8                650           4293       411      112.0    221.8

  Min           11            17         1        0.4      17.0                 23            106        13       12.1     46.2

  STD           127.0         938.6      84.5     18.3     38.5                 83.6          447.9      41.4     13.2     25.3

  Reduction     56.6%         27.9%      29.6%    -36.2%   -34.3%               55.3%         25.7%      27.5%    -40.0%   -37.8%
  from *base                                                                                                               
  case*                                                                                                                    

  30%                                                               97                                                     
  Compliance                                                                                                               

  Average       606.4         4219.5     383.6    55.9     140.2                624.8         4349.0     395.4    57.6     143.8

  Max           800           4766       462      103.1    199.2                800           4766       462      103.1    199.2

  Min           11            25         0        0.4      15.2                 472           3708       322      36.7     107.6

  STD           125.8         762.9      73.1     16.0     27.5                 70.4          189.4      28.9     13.0     18.7

  Reduction     39.8%         16.4%      17.1%    -25.6%   -23.4%               39.2%         15.6%      16.3%    -26.7%   -24.3%
  from *base                                                                                                               
  case*                                                                                                                    

  20%                                                               100                                                    
  Compliance                                                                                                               

  Average       765.5         4667.7     424.9    52.0     132.6                765.5         4667.7     424.9    52.0     132.6

  Max           917           5220       493      78.1     186.5                917           5220       493      78.1     186.5

  Min           580           4320       368      36.3     102.0                580           4320       368      36.3     102.0

  STD           70.6          155.4      25.5     8.2      16.7                 70.6          155.4      25.5     8.2      16.7

  Reduction     24.0%         7.5%       8.2%     -16.7%   -16.7%               25.5%         9.4%       10.1%    -14.3%   -14.6%
  from *base                                                                                                               
  case*                                                                                                                    

  10%                                                               100                                                    
  Compliance                                                                                                               

  Average       919.8         4961.6     458.8    48.0     122.4                919.8         4961.6     458.8    48.0     122.4

  Max           1107          5336       513      66.6     166.1                1107          5336       513      66.6     166.1

  Min           775           4709       386      33.2     95.1                 775           4709       386      33.2     95.1

  STD           69.8          124.1      24.0     7.3      14.2                 69.8          124.1      24.0     7.3      14.2

  Reduction     8.6%          1.7%       0.9%     -7.8%    -7.7%                10.5%         3.7%       2.9%     -5.6%    -5.8%
  from *base                                                                                                               
  case*                                                                                                                    

  0% Compliance                                                     96                                                     

  Average       986.2         4944.6     456.1    43.5     111.5                1026.8        5149.7     475.0    45.2     115.2

  Max           1167          5474       526      65.8     159.8                1167          5474       526      65.8     159.8

  Min           10            16         1        0.1      16.3                 864           4891       420      32.9     92.5

  STD           210.2         1018.5     95.8     10.8     23.4                 66.5          137.3      23.1     6.9      14.6

  Reduction     2.0%          2.0%       1.4%     2.2%     1.9%                 0.1%          0.1%       -0.5%    0.5%     0.4%
  from *base                                                                                                               
  case*                                                                                                                    

  Base case,                                                        979.00                                                 
  1000                                                                                                                     
  simulations                                                                                                              

  Average       1006.7        5046.3     462.7    44.5     113.7                1028.1        5154.2     472.6    45.5     115.7

  Max           1295.00       5592.00    552.00   99.4     195.5                1295.00       5592.00    552.00   99.4     195.5

  Min           10.00         11.00      0.00     0.1      9.6                  796.00        4780.00    386.00   32.2     85.3

  STD           163.8         746.4      71.5     9.8      19.3                 75.5          122.9      23.7     7.6      13.7
  ------------- ------------- ---------- -------- -------- -------- ----------- ------------- ---------- -------- -------- --------

**SOM Table 7: Social Distancing: Only Children's Schools are Closed and
stay at home, Threshold 10 symptomatic, Compliance variation. Results
for 100 simulations each.**

  ------------- ------------- ---------- -------- -------- -------- ----------- ------------- ---------- -------- -------- --------
                Statistics                                                      Statistics                                 
                for all 100                                                     for                                        
                simulations                                                     simulations                                
                including                                                       with                                       
                those without                                                   epidemics                                  
                epidemics                                                       (total                                     
                                                                                infected \>                                
                                                                                100)                                       

                Peak Infected Total      Dead     Time to  Total    Number of   Peak Infected Total      Dead     Time to  Total
                              Infected            Peak     Time     Epidemics                 Infected            Peak     Time
                                                  (days)   (days)                                                 (days)   (days)

  99%                                                               87                                                     
  Compliance                                                                                                               

  Average       148.1         1389.5     116.8    58.4     144.3                167.7         1589.6     133.6    65.8     160.9

  Max           300           2233       202      176.9    262.1                300           2233       202      176.9    262.1

  Min           11            11         1        0.9      12.2                 22            123        12       7.0      40.1

  STD           79.3          703.2      58.8     33.4     59.0                 65.2          507.5      42.3     29.2     42.9

  Reduction     85.3%         72.5%      74.8%    -31.1%   -27.0%               83.7%         69.2%      71.7%    -44.7%   -39.1%
  from *base                                                                                                               
  case*                                                                                                                    

  90%                                                               88                                                     
  Compliance                                                                                                               

  Average       179.0         1718.5     147.3    64.7     152.6                201.4         1947.0     166.8    72.6     168.7

  Max           371           2581       227      200.7    267.6                371           2581       227      200.7    267.6

  Min           10            18         0        0.1      16.4                 28            111        7        9.3      44.0

  STD           92.9          833.0      72.8     38.7     59.9                 74.7          590.9      53.0     34.3     43.2

  Reduction     82.2%         65.9%      68.2%    -45.4%   -34.3%               80.4%         62.2%      64.7%    -59.7%   -45.9%
  from *base                                                                                                               
  case*                                                                                                                    

  80%                                                               94                                                     
  Compliance                                                                                                               

  Average       257.9         2349.5     202.7    62.6     160.2                273.4         2496.6     215.4    66.2     168.1

  Max           442           3135       284      140.0    281.2                442           3135       284      140.0    281.2

  Min           12            21         1        1.1      16.4                 20            106        3        20.7     48.7

  STD           97.1          757.5      66.6     23.8     51.0                 77.4          496.2      44.6     19.6     41.3

  Reduction     74.4%         53.4%      56.2%    -40.6%   -41.0%               73.4%         51.6%      54.4%    -45.6%   -45.3%
  from *base                                                                                                               
  case*                                                                                                                    

  70%                                                               91                                                     
  Compliance                                                                                                               

  Average       324.7         2782.8     244.5    60.7     155.3                355.4         3053.8     268.3    65.9     167.0

  Max           590           3643       335      116.4    237.1                590           3643       335      116.4    237.1

  Min           10            19         1        0.1      17.4                 194           2395       192      38.1     116.9

  STD           117.3         902.5      80.6     23.2     44.7                 67.5          266.6      27.6     16.9     25.2

  Reduction     67.7%         44.9%      47.2%    -36.4%   -36.6%               65.4%         40.8%      43.2%    -44.9%   -44.4%
  from *base                                                                                                               
  case*                                                                                                                    

  60%                                                               96                                                     
  Compliance                                                                                                               

  Average       446.9         3455.0     305.0    59.4     149.6                465.0         3597.7     317.6    61.7     154.4

  Max           658           4125       380      109.4    216.0                658           4125       380      109.4    216.0

  Min           10            15         1        0.1      13.3                 30            153        15       30.4     50.1

  STD           125.1         814.8      73.3     17.6     34.6                 89.6          421.1      39.7     13.6     25.6

  Reduction     55.6%         31.5%      34.1%    -33.3%   -31.6%               54.8%         30.2%      32.8%    -35.8%   -33.5%
  from *base                                                                                                               
  case*                                                                                                                    

  0% Compliance                                                     98                                                     

  Average       1008.7        5044.2     462.0    44.2     112.4                1029.1        5146.6     471.4    45.0     114.3

  Max           1180          5509       526      60.3     148.6                1180          5509       526      60.3     148.6

  Min           10            21         1        0.1      16.5                 867           4813       418      33.2     88.7

  STD           161.1         734.2      71.1     8.8      18.1                 74.4          141.0      26.6     6.5      12.1

  Reduction     -0.2%         0.0%       0.1%     0.7%     1.1%                 -0.1%         0.1%       0.3%     0.9%     1.1%
  from *base                                                                                                               
  case*                                                                                                                    

  Base case,                                                        979.00                                                 
  1000                                                                                                                     
  simulations                                                                                                              

  Average       1006.7        5046.3     462.7    44.5     113.7                1028.1        5154.2     472.6    45.5     115.7

  Max           1295.00       5592.00    552.00   99.4     195.5                1295.00       5592.00    552.00   99.4     195.5

  Min           10.00         11.00      0.00     0.1      9.6                  796.00        4780.00    386.00   32.2     85.3

  STD           163.8         746.4      71.5     9.8      19.3                 75.5          122.9      23.7     7.6      13.7
  ------------- ------------- ---------- -------- -------- -------- ----------- ------------- ---------- -------- -------- --------

**SOM Table 8: Social Distancing: Closing Schools and Work, only
Children-Teenagers stay at home, Threshold 10 symptomatic, Compliance
variation. Results for 100 simulations each.**

  ------------- ------------- ---------- -------- -------- -------- ----------- ------------- ---------- -------- -------- --------
                Statistics                                                      Statistics                                 
                for all 100                                                     for                                        
                simulations                                                     simulations                                
                including                                                       with                                       
                those without                                                   epidemics                                  
                epidemics                                                       (total                                     
                                                                                infected \>                                
                                                                                100)                                       

                Peak Infected Total      Dead     Time to  Total    Number of   Peak Infected Total      Dead     Time to  Total
                              Infected            Peak     Time     Epidemics                 Infected            Peak     Time
                                                  (days)   (days)                                                 (days)   (days)

  99%                                                               36                                                     
  Compliance                                                                                                               

  Average       32.4          89.4       8.1      10.2     40.4                 46.6          133.5      11.4     11.7     48.0

  Max           78            228        23       19.7     76.9                 78            228        23       19.2     76.9

  Min           12            20         0        1.3      13.0                 30            102        4        6.0      33.6

  STD           13.6          41.0       4.2      3.8      11.8                 10.8          28.7       4.0      2.9      9.5

  Reduction     96.8%         98.2%      98.3%    77.1%    64.5%                95.5%         97.4%      97.6%    74.3%    58.5%
  from *base                                                                                                               
  case*                                                                                                                    

  90%                                                               55                                                     
  Compliance                                                                                                               

  Average       32.7          113.2      10.0     12.1     49.8                 41.6          153.4      13.5     13.5     60.7

  Max           95            417        42       31.1     99.3                 95            417        42       23.0     99.3

  Min           11            21         0        0.5      16.9                 20            101        3        5.9      30.1

  STD           15.4          63.8       6.3      4.9      17.2                 14.8          58.8       6.2      4.1      14.5

  Reduction     96.8%         97.8%      97.8%    72.9%    56.2%                96.0%         97.0%      97.1%    70.3%    47.5%
  from *base                                                                                                               
  case*                                                                                                                    

  80%                                                               79                                                     
  Compliance                                                                                                               

  Average       38.7          174.2      15.0     15.3     65.4                 43.6          204.2      17.6     17.3     72.1

  Max           96            488        39       56.6     142.2                96            488        39       56.6     142.2

  Min           10            14         0        0.1      22.4                 16            101        6        5.3      33.3

  STD           17.5          101.0      8.9      8.7      24.2                 16.3          92.3       8.3      8.6      22.0

  Reduction     96.2%         96.5%      96.8%    65.6%    42.5%                95.8%         96.0%      96.3%    62.0%    37.6%
  from *base                                                                                                               
  case*                                                                                                                    

  70%                                                               84                                                     
  Compliance                                                                                                               

  Average       50.1          413.2      36.1     31.5     110.0                56.0          480.6      41.9     35.6     123.7

  Max           152           1471       129      133.5    262.9                152           1471       129      133.5    262.9

  Min           12            17         2        1.2      13.6                 20            101        6        5.2      32.9

  STD           28.1          336.3      29.4     24.3     57.8                 26.7          325.6      28.6     24.3     52.6

  Reduction     95.0%         91.8%      92.2%    29.2%    3.2%                 94.6%         90.7%      91.1%    21.7%    -7.0%
  from *base                                                                                                               
  case*                                                                                                                    

  60%                                                               90                                                     
  Compliance                                                                                                               

  Average       97.6          1199.9     104.1    67.5     180.6                106.5         1328.0     115.3    74.3     197.1

  Max           216           2514       238      185.0    390.7                216           2514       238      185.0    390.7

  Min           10            12         1        0.1      11.9                 17            150        11       8.6      50.8

  STD           51.2          677.2      59.5     43.1     80.6                 45.9          586.6      51.8     40.1     66.6

  Reduction     90.3%         76.2%      77.5%    -51.6%   -58.9%               89.6%         74.2%      75.6%    -63.4%   -70.4%
  from *base                                                                                                               
  case*                                                                                                                    

  0% Compliance                                                     98                                                     

  Average       1010.6        5044.4     466.6    43.6     114.3                1031.1        5147.1     476.1    44.5     116.4

  Max           1208          5518       536      79.6     178.1                1208          5518       536      79.6     178.1

  Min           10            11         0        0.1      11.2                 846           4815       401      33.8     91.6

  STD           161.5         735.8      71.2     9.7      20.9                 74.6          140.7      24.9     7.4      15.0

  Reduction     -0.4%         0.0%       -0.8%    2.1%     -0.6%                -0.3%         0.1%       -0.7%    2.1%     -0.7%
  from *base                                                                                                               
  case*                                                                                                                    

  Base case,                                                        979.00                                                 
  1000                                                                                                                     
  simulations                                                                                                              

  Average       1006.7        5046.3     462.7    44.5     113.7                1028.1        5154.2     472.6    45.5     115.7

  Max           1295.00       5592.00    552.00   99.4     195.5                1295.00       5592.00    552.00   99.4     195.5

  Min           10.00         11.00      0.00     0.1      9.6                  796.00        4780.00    386.00   32.2     85.3

  STD           163.8         746.4      71.5     9.8      19.3                 75.5          122.9      23.7     7.6      13.7
  ------------- ------------- ---------- -------- -------- -------- ----------- ------------- ---------- -------- -------- --------

**SOM Table 9: Adults only avoid work, Threshold 10 symptomatic, 99%
compliance; and All who become symptomatic always Stay At Home when
sick. Results for 100 simulations each.**

  ------------- ------------- ---------- -------- -------- -------- ----------- ------------- ---------- -------- -------- --------
                Statistics                                                      Statistics                                 
                for all 100                                                     for                                        
                simulations                                                     simulations                                
                including                                                       with                                       
                those without                                                   epidemics                                  
                epidemics                                                       (total                                     
                                                                                infected \>                                
                                                                                100)                                       

                Peak Infected Total      Dead     Time to  Total    Number of   Peak Infected Total      Dead     Time to  Total
                              Infected            Peak     Time     Epidemics                 Infected            Peak     Time
                                                  (days)   (days)                                                 (days)   (days)

  99% of adults                                                     100                                                    
  avoid work                                                                                                               

  Average       915.6         4727.8     435.7    46.4     117.2                915.6         4727.8     435.7    46.4     117.2

  Max           1116          5034       477      81.9     186.2                1116          5034       477      81.9     186.2

  Min           690           4399       393      33.4     93.8                 690           4399       393      33.4     93.8

  STD           80.7          126.9      20.8     8.3      15.3                 80.7          126.9      20.8     8.3      15.3

  Reduction     9.1%          6.3%       5.8%     -4.2%    -3.1%                10.9%         8.3%       7.8%     -2.1%    -1.3%
  from base                                                                                                                
  case                                                                                                                     

  All who                                                           92                                                     
  become                                                                                                                   
  symptomatic                                                                                                              
  stay at home                                                                                                             

  Average       657.9         3985.0     356.9    47.6     120.7                713.9         4328.5     387.6    51.4     128.7

  Max           889.00        4690.00    449.00   94.6     187.3                889.00        4690.00    449.00   94.6     187.3

  Min           10.00         14.00      1.00     0.1      15.7                 542.00        3953.00    335.00   37.1     96.3

  STD           205.7         1180.1     106.8    15.7     31.6                 80.2          153.5      22.3     9.1      16.1

  Reduction     0.35          0.21       0.23     -0.07    -0.06                0.31          0.16       0.18     -0.13    -0.11
  from base                                                                                                                
  case                                                                                                                     

  Base case,                                                        979                                                    
  1000                                                                                                                     
  simulations                                                                                                              

  Average       1006.7        5046.3     462.7    44.5     113.7                1028.1        5154.2     472.6    45.5     115.7

  Max           1295          5592       552      99.4     195.5                1295          5592       552      99.4     195.5

  Min           10            11         0        0.1      9.6                  796           4780       386      32.2     85.3

  STD           163.8         746.4      71.5     9.8      19.3                 75.5          122.9      23.7     7.6      13.7
  ------------- ------------- ---------- -------- -------- -------- ----------- ------------- ---------- -------- -------- --------

**SOM Table 10: Vaccination Strategy: Percent Coverage of Children and
Teens. Results for 100 simulations each.**

  ------------- ------------- ---------- -------- -------- -------- ----------- ------------- ---------- -------- -------- --------
                Statistics                                                      Statistics                                 
                for all 100                                                     for                                        
                simulations                                                     simulations                                
                including                                                       with                                       
                those without                                                   epidemics                                  
                epidemics                                                       (total                                     
                                                                                infected \>                                
                                                                                100)                                       

                Peak Infected Total      Dead     Time to  Total    Number of   Peak Infected Total      Dead     Time to  Total
                              Infected            Peak     Time     Epidemics                 Infected            Peak     Time
                                                  (days)   (days)                                                 (days)   (days)

  100% Coverage                                                     0                                                      

  Average       12.8          25.5       2.2      2.7      26.6                 NA            NA         NA       NA       NA

  Max           22            59         8        13.4     100.6                NA            NA         NA       NA       NA

  Min           10            10         0        0.1      6.9                  NA            NA         NA       NA       NA

  STD           2.2           10.2       1.9      2.5      13.5                 NA            NA         NA       NA       NA

  Reduction     98.7%         99.5%      99.5%    94.0%    76.6%                NA            NA         NA       NA       NA
  from *base                                                                                                               
  case*                                                                                                                    

  90% Coverage                                                      0                                                      

  Average       13.5          28.4       2.6      2.9      28.3                 NA            NA         NA       NA       NA

  Max           25            80         10       19.8     64.5                 NA            NA         NA       NA       NA

  Min           10            12         0        0.1      10.2                 NA            NA         NA       NA       NA

  STD           3.0           12.2       2.1      2.9      11.2                 NA            NA         NA       NA       NA

  Reduction     98.7%         99.4%      99.4%    93.4%    75.1%                NA            NA         NA       NA       NA
  from *base                                                                                                               
  case*                                                                                                                    

  80% Coverage                                                      2                                                      

  Average       14.4          37.6       3.7      4.3      35.6                 29.0          133.0      8.5      31.1     102.3

  Max           36            142        14       49.3     121.7                36            142        10       49.3     121.7

  Min           10            12         0        0.1      7.6                  22            124        7        12.9     82.9

  STD           4.3           22.9       2.6      6.3      18.6                 9.9           12.7       2.1      25.7     27.4

  Reduction     98.6%         99.3%      99.2%    90.2%    68.7%                97.2%         97.4%      98.2%    31.6%    11.6%
  from *base                                                                                                               
  case*                                                                                                                    

  70% Coverage                                                      12                                                     

  Average       15.7          51.2       5.2      8.0      41.4                 22.3          123.1      12.3     24.1     79.4

  Max           33            186        22       69.2     115.0                33            186        22       69.2     115.0

  Min           10            11         0        0.1      10.4                 16            102        8        4.9      41.4

  STD           4.7           35.1       4.1      11.1     24.2                 5.9           25.4       4.6      18.7     24.4

  Reduction     98.4%         99.0%      98.9%    82.1%    63.6%                97.8%         97.6%      97.4%    47.0%    31.4%
  from *base                                                                                                               
  case*                                                                                                                    

  60% Coverage                                                      23                                                     

  Average       18.4          75.8       7.3      12.7     52.5                 28.7          178.4      17.4     33.3     100.6

  Max           48            332        45       121.7    176.3                48            332        45       121.7    176.3

  Min           10            12         0        0.1      11.1                 18            102        6        5.9      43.2

  STD           7.6           68.7       7.4      18.9     34.9                 7.7           70.5       8.9      28.5     33.7

  Reduction     98.2%         98.5%      98.4%    71.5%    53.8%                97.2%         96.5%      96.3%    26.7%    13.0%
  from *base                                                                                                               
  case*                                                                                                                    

  50% Coverage                                                      47                                                     

  Average       29.2          205.1      18.9     26.3     75.1                 44.9          382.7      35.2     46.8     116.9

  Max           110           1115       117      138.4    203.6                110           1115       117      138.4    203.6

  Min           10            10         0        0.1      7.8                  14            104        6        7.7      43.3

  STD           22.1          251.7      24.3     31.3     51.8                 23.6          273.6      27.3     34.9     46.5

  Reduction     97.1%         95.9%      95.9%    41.0%    33.9%                95.6%         92.6%      92.6%    -2.9%    -1.1%
  from *base                                                                                                               
  case*                                                                                                                    

  40% Coverage                                                      75                                                     

  Average       86.7          1022.7     96.6     65.2     158.2                110.4         1348.0     127.4    84.5     198.1

  Max           217           2309       238      259.1    352.0                217           2309       238      259.1    352.0

  Min           10            10         0        0.1      12.9                 18            101        10       3.1      56.4

  STD           58.2          768.9      73.9     52.2     90.8                 47.3          601.6      58.8     46.0     66.7

  Reduction     91.4%         79.7%      79.1%    -46.4%   -39.2%               89.3%         73.8%      73.1%    -85.8%   -71.2%
  from *base                                                                                                               
  case*                                                                                                                    

  30% Coverage                                                      87                                                     

  Average       237.7         2294.9     212.8    71.6     165.6                271.3         2632.3     244.1    81.5     184.9

  Max           414           3301       321      156.3    297.7                414           3301       321      156.3    297.7

  Min           11            18         1        0.3      14.1                 30            106        11       14.6     47.2

  STD           106.7         938.5      88.4     34.4     59.5                 66.1          357.6      36.8     24.1     33.3

  Reduction     76.4%         54.5%      54.0%    -60.7%   -45.7%               73.6%         48.9%      48.4%    -79.4%   -59.9%
  from *base                                                                                                               
  case*                                                                                                                    

  20% Coverage                                                      95                                                     

  Average       461.1         3383.5     312.3    62.1     145.4                484.7         3559.7     328.6    64.8     151.5

  Max           623           3968       375      109.3    231.9                623           3968       375      109.3    231.9

  Min           10            13         1        0.1      14.1                 331           3068       274      36.7     117.1

  STD           122.7         795.4      74.7     18.8     34.6                 67.8          195.6      23.2     14.6     22.2

  Reduction     54.2%         33.0%      32.5%    -39.5%   -27.9%               52.9%         30.9%      30.5%    -42.6%   -31.0%
  from *base                                                                                                               
  case*                                                                                                                    

  10% Coverage                                                      98                                                     

  Average       723.3         4300.7     400.9    52.0     126.7                737.8         4387.8     409.0    53.0     128.7

  Max           933           4673       461      88.6     187.2                933           4673       461      88.6     187.2

  Min           11            23         2        0.6      14.6                 571           4013       347      35.7     102.7

  STD           125.9         627.7      61.8     12.1     21.3                 74.3          137.5      23.6     9.9      16.3

  Reduction     28.2%         14.8%      13.4%    -16.8%   -11.5%               28.2%         14.9%      13.5%    -16.7%   -11.2%
  from *base                                                                                                               
  case*                                                                                                                    

  0% Coverage                                                       98                                                     

  Average       1015.3        5063.7     465.4    43.6     112.9                1035.8        5166.6     474.8    44.5     114.8

  Max           1211          5464       540      73.6     147.0                1211          5464       540      73.6     147.0

  Min           10            16         1        0.1      17.8                 854           4880       397      32.8     87.7

  STD           162.8         734.4      72.4     9.5      17.9                 76.2          122.2      28.6     7.3      12.0

  Reduction     -0.8%         -0.3%      -0.6%    2.0%     0.7%                 -0.7%         -0.2%      -0.5%    2.1%     0.8%
  from *base                                                                                                               
  case*                                                                                                                    

  Base case,                                                        979.00                                                 
  1000                                                                                                                     
  simulations                                                                                                              

  Average       1006.7        5046.3     462.7    44.5     113.7                1028.1        5154.2     472.6    45.5     115.7

  Max           1295.00       5592.00    552.00   99.4     195.5                1295.00       5592.00    552.00   99.4     195.5

  Min           10.00         11.00      0.00     0.1      9.6                  796.00        4780.00    386.00   32.2     85.3

  STD           163.8         746.4      71.5     9.8      19.3                 75.5          122.9      23.7     7.6      13.7
  ------------- ------------- ---------- -------- -------- -------- ----------- ------------- ---------- -------- -------- --------

**SOM Table 11: Vaccination Strategies: Seniors Only and Current
Vaccination Practice. Results for 100 simulations each.**

  -------------- ------------- ---------- ------- -------- -------- ----------- ------------- ---------- ------- -------- --------
                 Statistics                                                     Statistics                                
                 for all 100                                                    for                                       
                 simulations                                                    simulations                               
                 including                                                      with                                      
                 those without                                                  epidemics                                 
                 epidemics                                                      (total                                    
                                                                                infected \>                               
                                                                                100)                                      

                 Peak Infected Total      Dead    Time to  Total    Number of   Peak Infected Total      Dead    Time to  Total
                               Infected           Peak     Time     Epidemics                 Infected           Peak     Time
                                                  (days)   (days)                                                (days)   (days)

  Vaccination of                                                    99                                                    
  all seniors                                                                                                             

  Average        934.4         4722.5     355.5   45.2     114.8                943.7         4770.0     359.1   45.7     115.7

  Max            1135          5043       409     71.3     152.3                1135          5043       409     71.3     152.3

  Min            11            19         2       0.7      18.5                 757           4461       309     33.0     85.4

  STD            118.3         487.4      41.3    8.2      15.8                 73.2          109.5      20.9    6.9      12.5

  Reduction from 7.2%          6.4%       23.2%   -1.5%    -1.0%                8.2%          7.5%       24.0%   -0.5%    -0.1%
  base case                                                                                                               

  Current Policy                                                    55                                                    
  (26% children                                                                                                           
  and teenagers,                                                                                                          
  30% adults,                                                                                                             
  59% seniors)                                                                                                            

  Average        88.4          872.3      69.1    48.2     110.6                153.1         1568.3     124.4   84.1     181.4

  Max            303           2040       174     154.5    323.6                303           2040       174     154.5    323.6

  Min            4             4          0       0.1      5.4                  30            125        12      22.0     61.5

  STD            81.0          806.0      64.1    45.4     86.1                 50.6          306.9      25.2    28.6     45.8

  Reduction from 91.2%         82.7%      85.1%   -8.2%    2.7%                 85.1%         69.6%      73.7%   -85.1%   -56.8%
  base case                                                                                                               

  No Vaccination                                                    98                                                    
  (100                                                                                                                    
  simulations)                                                                                                            

  Average        1015.3        5063.7     465.4   43.6     112.9                1035.8        5166.6     474.8   44.5     114.8

  Max            1211          5464       540     73.6     147.0                1211          5464       540     73.6     147.0

  Min            10            16         1       0.1      17.8                 854           4880       397     32.8     87.7

  STD            162.8         734.4      72.4    9.5      17.9                 76.2          122.2      28.6    7.3      12.0

  Reduction from -0.8%         -0.3%      -0.6%   2.0%     0.7%                 -0.7%         -0.2%      -0.5%   2.1%     0.8%
  base case                                                                                                               

  Base case,                                                        979                                                   
  1000                                                                                                                    
  simulations                                                                                                             

  Average        1006.7        5046.3     462.7   44.5     113.7                1028.1        5154.2     472.6   45.5     115.7

  Max            1295          5592       552     99.4     195.5                1295          5592       552     99.4     195.5

  Min            10            11         0       0.1      9.6                  796           4780       386     32.2     85.3

  STD            163.8         746.4      71.5    9.8      19.3                 75.5          122.9      23.7    7.6      13.7
  -------------- ------------- ---------- ------- -------- -------- ----------- ------------- ---------- ------- -------- --------

**SOM Table 12: *I~D~* increased by 25%, Social Distancing: Closing
Schools and Children-Teenagers stay at home, Threshold 10 symptomatic,
Compliance variation. Results for 100 simulations each.**

  ------------ ------------- ---------- ------- --------- --------- ----------- ------------- ---------- ------- --------- ---------
               Statistics                                                       Statistics                                 
               for all 100                                                      for                                        
               simulations                                                      simulations                                
               including                                                        with                                       
               those without                                                    epidemics                                  
               epidemics                                                        (total                                     
                                                                                infected \>                                
                                                                                100)                                       

               Peak Infected Total      Dead    Time to   Total     Number of   Peak Infected Total      Dead    Time to   Total
                             Infected           Peak      Time      Epidemics                 Infected           Peak      Time
                                                (days)    (days)                                                 (days)    (days)

  99%                                                               91                                                     
  Compliance                                                                                                               

  Average      49.8          245.5      22.1    16.1      75.1                  52.8          264.2      23.8    16.9      78.9

  Max          113           662        59      86.2      199.6                 113           662        59      86.2      199.6

  Min          10            16         0       0.1       14.7                  22            101        5       6.9       37.1

  STD          21.7          137.5      13.1    10.9      32.3                  20.3          129.6      12.4    11.0      30.9

  Reduction    97.1%         96.2%      96.4%   51.6%     20.8%                 96.9%         95.9%      96.1%   49.1%     16.7%
  from 0%                                                                                                                  
  Compliance                                                                                                               

  90%                                                               91                                                     
  Compliance                                                                                                               

  Average      66.2          540.9      48.9    28.1      116.5                 70.5          586.9      53.1    30.1      123.5

  Max          163           1462       157     330.5     421.7                 163           1462       157     330.5     421.7

  Min          12            20         1       2.6       23.1                  28            108        11      8.2       27.4

  STD          30.8          352.6      33.7    35.1      55.9                  28.9          336.2      32.3    36.2      53.6

  Reduction    96.2%         91.6%      92.0%   15.4%     -22.9%                95.9%         90.9%      91.4%   9.5%      -30.3%
  from 0%                                                                                                                  
  Compliance                                                                                                               

  80%                                                               96                                                     
  Compliance                                                                                                               

  Average      143.9         1990.6     182.8   75.0      214.9                 149.0         2070.5     190.1   77.6      222.4

  Max          302           3038       279     258.7     491.3                 302           3038       279     258.7     491.3

  Min          17            52         4       10.4      20.3                  34            167        17      10.7      56.3

  STD          57.9          705.2      64.4    47.6      72.1                  53.3          597.5      54.5    46.8      63.4

  Reduction    91.7%         69.1%      70.3%   -125.5%   -126.8%               91.4%         67.9%      69.1%   -133.3%   -134.6%
  from 0%                                                                                                                  
  Compliance                                                                                                               

  70%                                                               99                                                     
  Compliance                                                                                                               

  Average      351.6         3646.6     330.5   68.1      181.6                 355.0         3683.2     333.8   68.7      183.2

  Max          528           4264       421     124.7     284.1                 528           4264       421     124.7     284.1

  Min          10            19         0       0.1       19.4                  224           2474       204     39.0      124.2

  STD          74.8          482.0      49.3    18.8      35.6                  66.7          314.7      36.5    17.6      31.8

  Reduction    79.6%         43.4%      46.2%   -104.7%   -91.6%                79.4%         42.8%      45.7%   -106.8%   -93.3%
  from 0%                                                                                                                  
  Compliance                                                                                                               

  60%                                                               99                                                     
  Compliance                                                                                                               

  Average      593.7         4575.9     419.2   55.2      146.3                 599.5         4621.9     423.4   55.7      147.6

  Max          775           4927       480     89.1      210.3                 775           4927       480     89.1      210.3

  Min          12            16         1       0.5       9.5                   425           4104       359     39.5      108.8

  STD          88.5          488.7      48.5    11.9      24.9                  66.5          164.3      24.0    10.6      20.9

  Reduction    65.6%         29.0%      31.8%   -65.9%    -54.3%                65.3%         28.3%      31.1%   -67.6%    -55.8%
  from 0%                                                                                                                  
  Compliance                                                                                                               

  0%                                                                100                                                    
  Compliance                                                                                                               

  Average      1726.7        6443.0     614.6   33.2      94.8                  1726.7        6443.0     614.6   33.2      94.8

  Max          1951          6705       682     48.3      161.2                 1951          6705       682     48.3      161.2

  Min          1488          6172       558     27.1      74.7                  1488          6172       558     27.1      74.7

  STD          79.0          103.4      27.0    3.8       11.8                  79.0          103.4      27.0    3.8       11.8
  ------------ ------------- ---------- ------- --------- --------- ----------- ------------- ---------- ------- --------- ---------

**SOM Table 13: *I~D~* increased by 50%, Social Distancing: Closing
Schools and Children-Teenagers stay at home, Threshold 10 symptomatic,
Compliance variation. Results for 100 simulations each.**

  ------------ ------------- ---------- ------- --------- --------- ----------- ------------- ---------- ------- --------- ---------
               Statistics                                                       Statistics                                 
               for all 100                                                      for                                        
               simulations                                                      simulations                                
               including                                                        with                                       
               those without                                                    epidemics                                  
               epidemics                                                        (total                                     
                                                                                infected \>                                
                                                                                100)                                       

               Peak Infected Total      Dead    Time to   Total     Number of   Peak Infected Total      Dead    Time to   Total
                             Infected           Peak      Time      Epidemics                 Infected           Peak      Time
                                                (days)    (days)                                                 (days)    (days)

  99%                                                               97                                                     
  Compliance                                                                                                               

  Average      89.8          821.1      79.0    33.7      142.5                 91.9          844.0      81.2    34.4      145.1

  Max          211           2009       177     257.4     384.0                 211           2009       177     257.4     384.0

  Min          12            52         6       1.0       35.0                  36            138        10      8.3       35.0

  STD          37.2          436.1      43.1    38.5      62.2                  35.7          422.4      41.8    38.9      61.2

  Reduction    96.2%         88.8%      88.9%   -24.2%    -68.2%                96.1%         88.4%      88.6%   -27.1%    -71.4%
  from 0%                                                                                                                  
  Compliance                                                                                                               

  90%                                                               100                                                    
  Compliance                                                                                                               

  Average      191.7         2596.7     243.7   68.8      217.1                 191.7         2596.7     243.7   68.8      217.1

  Max          381           3634       363     161.2     372.9                 381           3634       363     161.2     372.9

  Min          23            124        8       11.9      64.8                  23            124        8       11.9      64.8

  STD          63.0          597.5      58.7    31.9      55.7                  63.0          597.5      58.7    31.9      55.7

  Reduction    91.8%         64.5%      65.9%   -153.9%   -156.4%               91.8%         64.5%      65.9%   -153.9%   -156.4%
  from 0%                                                                                                                  
  Compliance                                                                                                               

  80%                                                               100                                                    
  Compliance                                                                                                               

  Average      493.1         4491.6     421.6   58.8      163.7                 493.1         4491.6     421.6   58.8      163.7

  Max          730           5245       500     99.9      239.4                 730           5245       500     99.9      239.4

  Min          341           3991       360     36.6      116.9                 341           3991       360     36.6      116.9

  STD          68.5          240.3      30.1    13.4      21.4                  68.5          240.3      30.1    13.4      21.4

  Reduction    78.9%         38.5%      41.0%   -117.2%   -93.4%                78.9%         38.5%      41.0%   -117.2%   -93.4%
  from 0%                                                                                                                  
  Compliance                                                                                                               

  70%                                                               100                                                    
  Compliance                                                                                                               

  Average      819.8         5491.6     517.0   47.7      134.1                 819.8         5491.6     517.0   47.7      134.1

  Max          1085          5885       580     70.8      190.1                 1085          5885       580     70.8      190.1

  Min          622           5075       433     33.1      99.8                  622           5075       433     33.1      99.8

  STD          82.1          187.5      29.6    8.1       17.5                  82.1          187.5      29.6    8.1       17.5

  Reduction    65.0%         24.8%      27.6%   -76.2%    -58.4%                65.0%         24.8%      27.6%   -76.2%    -58.4%
  from 0%                                                                                                                  
  Compliance                                                                                                               

  60%                                                               100                                                    
  Compliance                                                                                                               

  Average      1132.4        6113.0     577.1   41.5      116.9                 1132.4        6113.0     577.1   41.5      116.9

  Max          1326          6423       658     61.8      155.6                 1326          6423       658     61.8      155.6

  Min          912           5769       504     30.4      84.9                  912           5769       504     30.4      84.9

  STD          86.6          106.6      28.3    6.1       13.1                  86.6          106.6      28.3    6.1       13.1

  Reduction    51.6%         16.3%      19.2%   -53.1%    -38.1%                51.6%         16.3%      19.2%   -53.1%    -38.1%
  from 0%                                                                                                                  
  Compliance                                                                                                               

  0%                                                                100                                                    
  Compliance                                                                                                               

  Average      2340.7        7306.3     714.2   27.1      84.7                  2340.7        7306.3     714.2   27.1      84.7

  Max          2543          7483       788     34.3      122.8                 2543          7483       788     34.3      122.8

  Min          2157          7145       650     21.6      68.2                  2157          7145       650     21.6      68.2

  STD          81.7          74.4       27.4    2.5       8.9                   81.7          74.4       27.4    2.5       8.9
  ------------ ------------- ---------- ------- --------- --------- ----------- ------------- ---------- ------- --------- ---------

**SOM Table 14: *I~D~* increased by 25%, Vaccination Strategy: Percent
Coverage of Children and Teens. Results for 100 simulations each.**

  ----------- ------------- ---------- ------- --------- -------- ----------- ------------- ---------- ------- --------- ---------
              Statistics                                                      Statistics                                 
              for all 100                                                     for                                        
              simulations                                                     simulations                                
              including                                                       with                                       
              those without                                                   epidemics                                  
              epidemics                                                       (total                                     
                                                                              infected \>                                
                                                                              100)                                       

              Peak Infected Total      Dead    Time to   Total    Number of   Peak Infected Total      Dead    Time to   Total
                            Infected           Peak      Time     Epidemics                 Infected           Peak      Time
                                               (days)    (days)                                                (days)    (days)

  100%                                                            4                                                      
  Coverage                                                                                                               

  Average     16.2          46.3       4.8     7.3       37.3                 24.5          130.5      13.5    36.1      87.7

  Max         31            175        22      92.3      112.9                31            175        22      92.3      112.9

  Min         10            12         0       0.1       9.9                  18            110        8       10.0      60.7

  STD         4.4           26.3       3.6     10.6      19.0                 5.3           29.9       6.2     38.3      26.7

  Reduction   99.1%         99.3%      99.2%   77.9%     60.7%                98.6%         98.0%      97.8%   -9.7%     7.5%
  from 0%                                                                                                                
  Coverage                                                                                                               

  90%                                                             8                                                      
  Coverage                                                                                                               

  Average     16.8          54.1       5.4     6.8       40.9                 26.4          156.3      17.4    19.5      83.2

  Max         35            221        21      37.7      132.8                35            221        21      37.7      132.8

  Min         10            14         0       0.1       9.9                  19            114        13      5.0       57.7

  STD         5.1           38.1       4.7     7.3       21.5                 5.7           38.0       3.1     13.2      24.7

  Reduction   99.0%         99.2%      99.1%   79.2%     56.9%                98.5%         97.6%      97.2%   40.7%     12.3%
  from 0%                                                                                                                
  Coverage                                                                                                               

  80%                                                             23                                                     
  Coverage                                                                                                               

  Average     18.6          79.0       7.8     10.4      53.0                 27.4          175.2      17.1    23.6      90.3

  Max         46            363        41      72.2      154.2                46            363        41      72.2      154.2

  Min         10            12         0       0.1       10.0                 17            101        6       8.3       54.8

  STD         6.6           66.3       7.0     12.8      30.5                 6.4           74.4       8.3     18.6      27.7

  Reduction   98.9%         98.8%      98.7%   68.4%     44.2%                98.4%         97.3%      97.2%   28.3%     4.8%
  from 0%                                                                                                                
  Coverage                                                                                                               

  70%                                                             57                                                     
  Coverage                                                                                                               

  Average     26.6          188.6      18.6    24.4      83.1                 35.3          296.0      29.4    38.1      117.5

  Max         79            884        93      150.1     272.9                79            884        93      150.1     272.9

  Min         10            18         0       0.1       16.0                 17            104        9       2.8       53.6

  STD         14.2          187.9      19.0    26.2      57.1                 12.9          186.6      18.8    27.2      53.0

  Reduction   98.5%         97.1%      97.0%   25.8%     12.4%                97.9%         95.4%      95.2%   -15.7%    -23.9%
  from 0%                                                                                                                
  Coverage                                                                                                               

  60%                                                             68                                                     
  Coverage                                                                                                               

  Average     55.4          613.0      60.6    55.3      127.5                74.2          880.2      87.0    78.0      170.7

  Max         144           1980       205     190.1     349.7                144           1980       205     190.1     349.7

  Min         10            14         1       0.1       8.8                  17            104        9       7.8       41.3

  STD         39.7          562.4      56.2    50.4      84.0                 34.7          490.6      49.5    45.7      66.3

  Reduction   96.8%         90.5%      90.1%   -67.9%    -34.4%               95.7%         86.3%      85.8%   -136.8%   -79.9%
  from 0%                                                                                                                
  Coverage                                                                                                               

  50%                                                             86                                                     
  Coverage                                                                                                               

  Average     189.0         1986.0     194.0   71.0      169.0                217.3         2303.3     225.0   81.7      191.5

  Max         380           3006       292     168.3     326.5                380           3006       292     168.3     326.5

  Min         11            16         0       0.2       13.7                 22            102        11      15.2      60.1

  STD         95.4          941.3      92.9    35.3      69.3                 69.3          551.3      56.0    24.9      43.8

  Reduction   89.0%         69.1%      68.4%   -115.7%   -78.1%               87.3%         64.2%      63.4%   -148.2%   -101.9%
  from 0%                                                                                                                
  Coverage                                                                                                               

  40%                                                             93                                                     
  Coverage                                                                                                               

  Average     420.8         3228.3     312.0   60.1      145.4                451.2         3468.3     335.2   64.1      154.5

  Max         595           3899       388     118.0     207.5                595           3899       388     118.0     207.5

  Min         14            17         2       2.0       12.9                 289           2978       275     42.3      115.0

  STD         129.3         902.8      89.9    20.6      38.8                 67.7          212.1      30.4    14.9      20.9

  Reduction   75.5%         49.8%      49.2%   -82.4%    -53.3%               73.7%         46.1%      45.4%   -94.6%    -62.9%
  from 0%                                                                                                                
  Coverage                                                                                                               

  30%                                                             97                                                     
  Coverage                                                                                                               

  Average     697.7         4203.9     407.3   51.5      130.4                718.9         4333.2     419.8   53.1      133.8

  Max         914           4761       487     116.8     207.7                914           4761       487     116.8     207.7

  Min         11            13         1       0.1       14.7                 501           3952       360     31.0      99.6

  STD         144.6         756.9      76.8    15.5      28.3                 80.2          164.9      27.7    13.0      20.9

  Reduction   59.3%         34.7%      33.7%   -56.4%    -37.5%               58.1%         32.7%      31.6%   -61.1%    -41.1%
  from 0%                                                                                                                
  Coverage                                                                                                               

  20%                                                             100                                                    
  Coverage                                                                                                               

  Average     1032.9        5120.8     492.3   43.3      116.5                1032.9        5120.8     492.3   43.3      116.5

  Max         1211          5470       552     64.5      165.3                1211          5470       552     64.5      165.3

  Min         847           4750       424     30.5      89.3                 847           4750       424     30.5      89.3

  STD         76.6          138.1      23.9    6.9       13.3                 76.6          138.1      23.9    6.9       13.3

  Reduction   39.7%         20.4%      19.8%   -31.4%    -22.8%               39.7%         20.4%      19.8%   -31.4%    -22.8%
  from 0%                                                                                                                
  Coverage                                                                                                               

  10%                                                             100                                                    
  Coverage                                                                                                               

  Average     1370.6        5806.3     552.8   37.7      105.4                1370.6        5806.3     552.8   37.7      105.4

  Max         1616          6110       622     55.2      137.9                1616          6110       622     55.2      137.9

  Min         1238          5488       494     28.6      83.9                 1238          5488       494     28.6      83.9

  STD         72.6          111.4      26.7    4.7       12.4                 72.6          111.4      26.7    4.7       12.4

  Reduction   20.0%         9.8%       10.0%   -14.5%    -11.1%               20.0%         9.8%       10.0%   -14.5%    -11.1%
  from 0%                                                                                                                
  Coverage                                                                                                               

  0% Coverage                                                     100                                                    

  Average     1714.1        6435.0     614.0   32.9      94.8                 1714.1        6435.0     614.0   32.9      94.8

  Max         1899          6637       666     54.4      126.7                1899          6637       666     54.4      126.7

  Min         1562          6247       559     25.6      80.5                 1562          6247       559     25.6      80.5

  STD         71.8          86.0       25.3    4.4       9.6                  71.8          86.0       25.3    4.4       9.6
  ----------- ------------- ---------- ------- --------- -------- ----------- ------------- ---------- ------- --------- ---------

**SOM Table 15: *I~D~* increased by 50%, Vaccination Strategy: Percent
Coverage of Children and Teens. Results for 100 simulations each.**

  ----------- ------------- ---------- ------- --------- --------- ----------- ------------- ---------- ------- --------- ---------
              Statistics                                                       Statistics                                 
              for all 100                                                      for                                        
              simulations                                                      simulations                                
              including                                                        with                                       
              those without                                                    epidemics                                  
              epidemics                                                        (total                                     
                                                                               infected \>                                
                                                                               100)                                       

              Peak Infected Total      Dead    Time to   Total     Number of   Peak Infected Total      Dead    Time to   Total
                            Infected           Peak      Time      Epidemics                 Infected           Peak      Time
                                               (days)    (days)                                                 (days)    (days)

  100%                                                             28                                                     
  Coverage                                                                                                                

  Average     20.4          87.1       9.1     12.8      54.0                  29.2          175.2      19.4    27.0      89.8

  Max         51            390        46      108.4     182.4                 51            390        46      108.4     182.4

  Min         10            17         0       0.1       11.9                  18            102        5       3.7       52.2

  STD         7.8           70.7       8.5     15.8      32.3                  8.0           74.6       9.2     22.5      34.8

  Reduction   99.1%         98.8%      98.7%   53.1%     35.4%                 98.7%         97.6%      97.3%   0.9%      -7.3%
  from 0%                                                                                                                 
  Coverage                                                                                                                

  90%                                                              54                                                     
  Coverage                                                                                                                

  Average     27.2          169.6      17.6    20.6      75.0                  35.2          266.1      28.1    32.5      105.5

  Max         81            789        83      98.0      228.7                 81            789        83      98.0      228.7

  Min         10            13         0       0.1       12.3                  18            103        6       3.6       51.8

  STD         13.8          160.4      17.6    21.6      45.9                  13.9          164.1      18.1    23.1      41.2

  Reduction   98.8%         97.7%      97.5%   24.3%     10.4%                 98.5%         96.4%      96.1%   -19.5%    -26.0%
  from 0%                                                                                                                 
  Coverage                                                                                                                

  80%                                                              70                                                     
  Coverage                                                                                                                

  Average     38.5          363.4      37.6    41.3      116.7                 47.6          493.3      51.2    55.5      146.4

  Max         116           1448       152     201.4     312.9                 116           1448       152     201.4     312.9

  Min         11            20         1       1.0       14.1                  18            101        5       1.9       47.3

  STD         24.1          349.5      36.0    42.0      71.6                  23.4          343.4      35.0    42.7      65.0

  Reduction   98.3%         95.0%      94.7%   -51.8%    -39.4%                98.0%         93.2%      92.8%   -104.1%   -74.9%
  from 0%                                                                                                                 
  Coverage                                                                                                                

  70%                                                              88                                                     
  Coverage                                                                                                                

  Average     94.6          1285.0     130.0   84.3      203.2                 105.3         1453.4     147.1   94.7      225.9

  Max         197           2296       247     270.2     438.3                 197           2296       247     270.2     438.3

  Min         11            16         0       0.4       18.5                  20            119        7       7.4       56.8

  STD         50.3          699.9      72.5    59.1      95.4                  43.7          564.0      59.4    55.3      77.2

  Reduction   95.9%         82.4%      81.7%   -209.9%   -142.7%               95.5%         80.1%      79.3%   -248.1%   -169.9%
  from 0%                                                                                                                 
  Coverage                                                                                                                

  60%                                                              96                                                     
  Coverage                                                                                                                

  Average     289.5         2777.1     284.5   72.6      179.7                 300.9         2891.2     296.2   75.3      186.0

  Max         446           3388       361     136.9     379.8                 446           3388       361     136.9     379.8

  Min         10            23         0       0.1       15.8                  126           1798       163     33.6      125.0

  STD         87.7          636.1      68.2    23.4      48.9                  68.6          304.8      37.3    19.6      38.7

  Reduction   87.6%         61.9%      59.9%   -167.1%   -114.7%               87.1%         60.4%      58.3%   -176.9%   -122.2%
  from 0%                                                                                                                 
  Coverage                                                                                                                

  50%                                                              99                                                     
  Coverage                                                                                                                

  Average     549.5         3871.0     390.6   55.6      142.0                 554.9         3909.5     394.5   56.0      143.1

  Max         746           4430       466     106.5     216.2                 746           4430       466     106.5     216.2

  Min         18            56         4       14.2      33.6                  362           3428       324     38.8      106.3

  STD         89.5          431.6      48.4    12.0      23.5                  72.0          195.4      28.7    11.3      20.9

  Reduction   76.4%         46.9%      45.0%   -104.3%   -69.7%                76.2%         46.4%      44.5%   -105.9%   -71.0%
  from 0%                                                                                                                 
  Coverage                                                                                                                

  40%                                                              99                                                     
  Coverage                                                                                                                

  Average     863.2         4748.7     478.5   45.9      122.1                 871.8         4796.5     483.4   46.4      123.2

  Max         1087          5167       534     71.9      160.4                 1087          5167       534     71.9      160.4

  Min         15            24         1       3.5       13.8                  658           4357       415     35.7      96.3

  STD         120.6         501.7      54.5    7.7       17.9                  85.3          155.5      25.5    6.5       14.3

  Reduction   63.0%         34.9%      32.6%   -68.9%    -45.9%                62.6%         34.2%      31.9%   -70.5%    -47.2%
  from 0%                                                                                                                 
  Coverage                                                                                                                

  30%                                                              100                                                    
  Coverage                                                                                                                

  Average     1196.7        5486.3     543.1   39.1      107.4                 1196.7        5486.3     543.1   39.1      107.4

  Max         1404          5778       610     57.5      169.1                 1404          5778       610     57.5      169.1

  Min         990           5104       469     29.4      82.5                  990           5104       469     29.4      82.5

  STD         90.2          130.4      29.8    5.0       14.1                  90.2          130.4      29.8    5.0       14.1

  Reduction   48.7%         24.8%      23.5%   -43.7%    -28.3%                48.7%         24.8%      23.5%   -43.7%    -28.3%
  from 0%                                                                                                                 
  Coverage                                                                                                                

  20%                                                              100                                                    
  Coverage                                                                                                                

  Average     1594.0        6177.7     609.2   33.7      97.2                  1594.0        6177.7     609.2   33.7      97.2

  Max         1795          6452       671     45.3      149.1                 1795          6452       671     45.3      149.1

  Min         1380          5943       520     26.2      73.5                  1380          5943       520     26.2      73.5

  STD         87.9          117.7      26.3    3.7       12.4                  87.9          117.7      26.3    3.7       12.4

  Reduction   31.7%         15.3%      14.2%   -23.8%    -16.1%                31.7%         15.3%      14.2%   -23.8%    -16.1%
  from 0%                                                                                                                 
  Coverage                                                                                                                

  10%                                                              100                                                    
  Coverage                                                                                                                

  Average     1957.4        6767.3     665.8   29.3      89.1                  1957.4        6767.3     665.8   29.3      89.1

  Max         2163          6981       724     39.2      117.3                 2163          6981       724     39.2      117.3

  Min         1761          6561       581     23.1      74.8                  1761          6561       581     23.1      74.8

  STD         83.3          87.9       25.9    2.9       9.2                   83.3          87.9       25.9    2.9       9.2

  Reduction   16.1%         7.2%       6.3%    -7.7%     -6.5%                 16.1%         7.2%       6.3%    -7.7%     -6.5%
  from 0%                                                                                                                 
  Coverage                                                                                                                

  0% Coverage                                                      100                                                    

  Average     2332.9        7294.0     710.3   27.2      83.7                  2332.9        7294.0     710.3   27.2      83.7

  Max         2534          7451       817     35.7      116.6                 2534          7451       817     35.7      116.6

  Min         2184          7082       659     22.7      68.9                  2184          7082       659     22.7      68.9

  STD         62.0          65.0       26.3    2.7       8.0                   62.0          65.0       26.3    2.7       8.0
  ----------- ------------- ---------- ------- --------- --------- ----------- ------------- ---------- ------- --------- ---------