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During recent epidemics there has been much debate about policy, including how and when to impose restrictions on behaviour. Policymakers must balance a complex spectrum of objectives, suggesting a need for quantitative tools. Whether health services might be \u2018overwhelmed\u2019 has emerged as a key consideration. Here we show how costly interventions, such as taxes or subsidies on behaviour, can be used to exactly align individuals\u2019 decision making with government preferences even when these are not aligned. In order to achieve this, we develop a nested optimisation algorithm of both the government intervention strategy and the resulting equilibrium behaviour of individuals. We focus on a situation in which the capacity of the healthcare system to treat patients is limited and identify conditions under which the disease dynamics respect the capacity limit. We find an extremely sharp drop in peak infections at a critical maximum infection cost in the government\u2019s objective function. This is in marked contrast to the gradual reduction of infections if individuals make decisions without government intervention. We find optimal interventions vary less strongly in time when interventions are costly to the government and that the critical cost of the policy switch depends on how costly interventions are.<\/jats:p>","DOI":"10.1371\/journal.pcbi.1011533","type":"journal-article","created":{"date-parts":[[2023,10,16]],"date-time":"2023-10-16T17:31:05Z","timestamp":1697477465000},"page":"e1011533","update-policy":"https:\/\/doi.org\/10.1371\/journal.pcbi.corrections_policy","source":"Crossref","is-referenced-by-count":8,"title":["Rational social distancing policy during epidemics with limited healthcare capacity"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3529-1165","authenticated-orcid":true,"given":"Simon K.","family":"Schnyder","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6132-6862","authenticated-orcid":true,"given":"John J.","family":"Molina","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ryoichi","family":"Yamamoto","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew S.","family":"Turner","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2023,10,16]]},"reference":[{"issue":"5","key":"pcbi.1011533.ref001","doi-asserted-by":"crossref","first-page":"e1000793","DOI":"10.1371\/journal.pcbi.1000793","article-title":"Game Theory of Social Distancing in Response to an Epidemic","volume":"6","author":"TC Reluga","year":"2010","journal-title":"PLoS Comput Biol"},{"issue":"15","key":"pcbi.1011533.ref002","doi-asserted-by":"crossref","first-page":"6306","DOI":"10.1073\/pnas.1011250108","article-title":"Adaptive human behavior in epidemiological models","volume":"108","author":"EP Fenichel","year":"2011","journal-title":"Proceedings of the National Academy of Sciences of the United States of America"},{"key":"pcbi.1011533.ref003","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.physrep.2016.10.006","article-title":"Statistical physics of vaccination","volume":"664","author":"Z Wang","year":"2016","journal-title":"Physics Reports"},{"issue":"1","key":"pcbi.1011533.ref004","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1080\/17513758.2020.1720322","article-title":"Game theoretic modelling of infectious disease dynamics and intervention methods: a review","volume":"14","author":"SL Chang","year":"2020","journal-title":"Journal of Biological Dynamics"},{"issue":"125","key":"pcbi.1011533.ref005","doi-asserted-by":"crossref","DOI":"10.1098\/rsif.2016.0820","article-title":"Behavioural change models for infectious disease transmission: A systematic review (2010-2015)","volume":"13","author":"F Verelst","year":"2016","journal-title":"Journal of the Royal Society Interface"},{"issue":"1","key":"pcbi.1011533.ref006","first-page":"23","article-title":"Game dynamic model of social distancing while cost of infection varies with epidemic burden","volume":"84","author":"S Bhattacharyya","year":"2019","journal-title":"IMA J Appl Math (Institute Math Its Appl"},{"key":"pcbi.1011533.ref007","unstructured":"Makris M, Toxvaerd F. 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