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However, an initial high treatment level followed by a reduction in antiviral use due to shortage in drug supply or emergence of highly transmissible drug-resistant strains in the population appears to be a poor strategy for disease control.
Figure 4a shows that, since the transmission of the sensitive infection is largely blocked by a high treatment level, resistance emerges and causes the first infection wave of the outbreak.
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Very high costs of drug resistance would have been required for the wild-type refuge to emerge under high treatment levels.
Regardless of the feasibility of such antiviral strategy, high treatment levels can exert strong selective pressures that confer resistance that frequently evolves far more rapidly than the natural rate.
However, for high treatment levels and low to moderate costs of resistance, this probability remains above 0.5, implying that clinical immunity has not increased enough to tip the balance in favor of the wild-type by creating a refuge, an that the majority of the solutions have not crossed the threshold.
Our finding that systolic BP levels were not low enough in diabetic MI patients, despite high treatment levels with antihypertensives is consistent with that in EUROASPIRE.
Our results show that if high treatment levels are enforced too early during the outbreak, a second wave of infections can potentially occur with a substantially larger magnitude.
However, moderate to high treatment levels can result in a more rapid depletion of stockpiles, leading to run-out, by promoting wide-spread drug resistance.
The early administration of high treatment levels significantly reduces prophylaxis waste, but increasing prophylaxis coverage in some scenarios contributes to increased waste.
However, for moderate to high treatment levels, the spread of resistance leads to a more rapid consumption of available stockpiles, and run-out is likely to occur even for low values of R0.
The increase in the total number of clinical infections for high treatment levels is consistent with previous observations [ 19, 27], as a direct consequence of emergence of resistant mutants with HTF.
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