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Murphy C, Lim WW, Mills C, Wong JY, Chen D, Xie Y, Li M, Gould S, Xin H, Cheung JK, Bhatt S, Cowling BJ, Donnelly CA. Effectiveness of social distancing measures and lockdowns for reducing transmission of COVID-19 in non-healthcare, community-based settings. PHILOSOPHICAL TRANSACTIONS. SERIES A, MATHEMATICAL, PHYSICAL, AND ENGINEERING SCIENCES 2023; 381:20230132. [PMID: 37611629 PMCID: PMC10446910 DOI: 10.1098/rsta.2023.0132] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 05/23/2023] [Indexed: 08/25/2023]
Abstract
Social distancing measures (SDMs) are community-level interventions that aim to reduce person-to-person contacts in the community. SDMs were a major part of the responses first to contain, then to mitigate, the spread of SARS-CoV-2 in the community. Common SDMs included limiting the size of gatherings, closing schools and/or workplaces, implementing work-from-home arrangements, or more stringent restrictions such as lockdowns. This systematic review summarized the evidence for the effectiveness of nine SDMs. Almost all of the studies included were observational in nature, which meant that there were intrinsic risks of bias that could have been avoided were conditions randomly assigned to study participants. There were no instances where only one form of SDM had been in place in a particular setting during the study period, making it challenging to estimate the separate effect of each intervention. The more stringent SDMs such as stay-at-home orders, restrictions on mass gatherings and closures were estimated to be most effective at reducing SARS-CoV-2 transmission. Most studies included in this review suggested that combinations of SDMs successfully slowed or even stopped SARS-CoV-2 transmission in the community. However, individual effects and optimal combinations of interventions, as well as the optimal timing for particular measures, require further investigation. This article is part of the theme issue 'The effectiveness of non-pharmaceutical interventions on the COVID-19 pandemic: the evidence'.
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Affiliation(s)
- Caitriona Murphy
- World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, People's Republic of China
| | - Wey Wen Lim
- World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, People's Republic of China
| | - Cathal Mills
- Department of Statistics, University of Oxford, Oxford, UK
| | - Jessica Y. Wong
- World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, People's Republic of China
| | - Dongxuan Chen
- World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, People's Republic of China
- Laboratory of Data Discovery for Health, Hong Kong Science and Technology Park, New Territories, Hong Kong, People's Republic of China
| | - Yanmy Xie
- World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, People's Republic of China
| | - Mingwei Li
- World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, People's Republic of China
- Laboratory of Data Discovery for Health, Hong Kong Science and Technology Park, New Territories, Hong Kong, People's Republic of China
| | - Susan Gould
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Tropical and Infectious Disease Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Hualei Xin
- World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, People's Republic of China
| | - Justin K. Cheung
- World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, People's Republic of China
| | - Samir Bhatt
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Kobenhavn, Denmark
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, Imperial College London, London, UK
| | - Benjamin J. Cowling
- World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, People's Republic of China
- Laboratory of Data Discovery for Health, Hong Kong Science and Technology Park, New Territories, Hong Kong, People's Republic of China
| | - Christl A. Donnelly
- Department of Statistics, University of Oxford, Oxford, UK
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, Imperial College London, London, UK
- Pandemic Sciences Institute, University of Oxford, Oxford, UK
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Kimani TN, Nyamai M, Owino L, Makori A, Ombajo LA, Maritim M, Anzala O, Thumbi SM. Infectious disease modelling for SARS-CoV-2 in Africa to guide policy: A systematic review. Epidemics 2022; 40:100610. [PMID: 35868211 PMCID: PMC9281458 DOI: 10.1016/j.epidem.2022.100610] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 06/13/2022] [Accepted: 07/12/2022] [Indexed: 01/21/2023] Open
Abstract
Applied epidemiological models have played a critical role in understanding the transmission and control of disease outbreaks. Their utility and accuracy in decision-making on appropriate responses during public health emergencies is however a factor of their calibration to local data, evidence informing model assumptions, speed of obtaining and communicating their results, ease of understanding and willingness by policymakers to use their insights. We conducted a systematic review of infectious disease models focused on SARS-CoV-2 in Africa to determine: a) spatial and temporal patterns of SARS-CoV-2 modelling in Africa, b) use of local data to calibrate the models and local expertise in modelling activities, and c) key modelling questions and policy insights. We searched PubMed, Embase, Web of Science and MedRxiv databases following the PRISMA guidelines to obtain all SARS-CoV-2 dynamic modelling papers for one or multiple African countries. We extracted data on countries studied, authors and their affiliations, modelling questions addressed, type of models used, use of local data to calibrate the models, and model insights for guiding policy decisions. A total of 74 papers met the inclusion criteria, with nearly two-thirds of these coming from 6% (3) of the African countries. Initial papers were published 2 months after the first cases were reported in Africa, with most papers published after the first wave. More than half of all papers (53, 78%) and (48, 65%) had a first and last author affiliated to an African institution respectively, and only 12% (9) used local data for model calibration. A total of 60% (46) of the papers modelled assessment of control interventions. The transmission rate parameter was found to drive the most uncertainty in the sensitivity analysis for majority of the models. The use of dynamic models to draw policy insights was crucial and therefore there is need to increase modelling capacity in the continent.
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Affiliation(s)
- Teresia Njoki Kimani
- KAVI-Institute of Clinical Research, University of Nairobi, Kenya; Center for Epidemiological Modelling and Analysis, University of Nairobi, Kenya; Paul G Allen School for Global Animal Health, Washington State University, United States; Ministry of Health Kenya, Kiambu County, Kenya.
| | - Mutono Nyamai
- Center for Epidemiological Modelling and Analysis, University of Nairobi, Kenya; Paul G Allen School for Global Animal Health, Washington State University, United States; Institute of Tropical and Infectious Diseases, University of Nairobi, Kenya
| | - Lillian Owino
- Center for Epidemiological Modelling and Analysis, University of Nairobi, Kenya; Institute of Tropical and Infectious Diseases, University of Nairobi, Kenya
| | - Anita Makori
- Center for Epidemiological Modelling and Analysis, University of Nairobi, Kenya; Paul G Allen School for Global Animal Health, Washington State University, United States; Institute of Tropical and Infectious Diseases, University of Nairobi, Kenya
| | - Loice Achieng Ombajo
- Center for Epidemiological Modelling and Analysis, University of Nairobi, Kenya; Department of Clinical Medicine and Therapeutics, University of Nairobi, Kenya
| | - MaryBeth Maritim
- Department of Clinical Medicine and Therapeutics, University of Nairobi, Kenya
| | - Omu Anzala
- KAVI-Institute of Clinical Research, University of Nairobi, Kenya
| | - S M Thumbi
- Center for Epidemiological Modelling and Analysis, University of Nairobi, Kenya; Paul G Allen School for Global Animal Health, Washington State University, United States; Institute of Tropical and Infectious Diseases, University of Nairobi, Kenya; Department of Clinical Medicine and Therapeutics, University of Nairobi, Kenya; South African Center for Epidemiological Modelling and Analysis, South Africa; Institute of Immunology and Infection Research, University of Edinburgh, Scotland
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Sun KS, Lau TSM, Yeoh EK, Chung VCH, Leung YS, Yam CHK, Hung CT. Effectiveness of different types and levels of social distancing measures: a scoping review of global evidence from earlier stage of COVID-19 pandemic. BMJ Open 2022; 12:e053938. [PMID: 35410924 PMCID: PMC9002256 DOI: 10.1136/bmjopen-2021-053938] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE Social distancing is one of the main non-pharmaceutical interventions used in the control of the COVID-19 pandemic. This scoping review aims to synthesise research findings on the effectiveness of different types and levels of social distancing measures in the earlier stage of COVID-19 pandemic without the confounding effect of mass vaccination. DESIGN Scoping review. DATA SOURCES MEDLINE, Embase, Global Health and four other databases were searched for eligible studies on social distancing for COVID-19 published from inception of the databases to 30 September 2020. STUDY SELECTION AND DATA EXTRACTION Effectiveness studies on social distancing between individuals, school closures, workplace/business closures, public transport restrictions and partial/full lockdown were included. Non-English articles, studies in healthcare settings or not based on empirical data were excluded. RESULTS After screening 1638 abstracts and 8 additional articles from other sources, 41 studies were included for synthesis of findings. The review found that the outcomes of social distancing measures were mainly indicated by changes in Rt , incidence and mortality, along with indirect indicators such as daily contact frequency and travel distance. There was adequate empirical evidence for the effect of social distancing at the individual level, and for partial or full lockdown at the community level. However, at the level of social settings, the evidence was moderate for school closure, and was limited for workplace/business closures as single targeted interventions. There was no evidence for a separate effect of public transport restriction. CONCLUSIONS In the community setting, there was stronger evidence for the combined effect of different social distancing interventions than for a single intervention. As fatigue of preventive behaviours is an issue in public health agenda, future studies should analyse the risks in specific settings such as eateries and entertainment to implement and evaluate measures which are proportionate to the risk.
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Affiliation(s)
- Kai Sing Sun
- Centre for Health Systems and Policy Research, The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Terence See Man Lau
- Centre for Health Systems and Policy Research, The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Eng Kiong Yeoh
- Centre for Health Systems and Policy Research, The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Vincent Chi Ho Chung
- Centre for Health Systems and Policy Research, The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Yin Shan Leung
- Centre for Health Systems and Policy Research, The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Carrie Ho Kwan Yam
- Centre for Health Systems and Policy Research, The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Chi Tim Hung
- Centre for Health Systems and Policy Research, The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
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Maan HS, Chaurasia D, Kapoor G, Dave L, Siddiqui A, Pal S, Singh HO, Biswas D, Chowdhary R. Intestinal viral infections of nSARS-CoV2 in the Indian community: Risk of virus spread in India. J Med Virol 2021; 94:1315-1329. [PMID: 34825708 PMCID: PMC9015588 DOI: 10.1002/jmv.27480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 11/14/2021] [Accepted: 11/24/2021] [Indexed: 12/15/2022]
Abstract
In December 2019, novel severe acute respiratory syndrome coronavirus 2 (nSARS‐CoV‐2) virus outbreaks emerged from Wuhan, China, and spread all over the world, including India. Molecular diagnosis of Coronavirus Disease 2019 (COVID) 19 for densely and highly populated countries like India is time‐consuming. A few reports have described the successful diagnosis of nSARS‐CoV‐2 virus from sewage and wastewater samples contaminated with fecal matter, suggesting the diagnosis of COVID 19 from the same to raise an alarm about the community transmission of virus for implementation of evacuation and lockdown strategies. So far, the association between the detection of virus and its concentration in stool samples with severity of the disease and the presence or absence of gastrointestinal symptoms have been rarely reported. We led the search utilizing multiple databases, specifically PubMed (Medline), EMBASE, and Google Scholar. We conducted a literature survey on gastrointestinal infection and the spread of this virus through fecal–oral transmission. Reports suggested that the existence and persistence of nSARS‐CoV‐2 in anal/rectal swabs and stool specimens for a longer period of time than in nasopharyngeal swabs provides a strong tenable outcome of gastrointestinal contamination and dissemination of this infection via potential fecal–oral transmission. This review may be helpful to conduct further studies to address the enteric involvement and excretion of nSARS‐CoV‐2 RNA in feces and control the community spread in both COVID‐19 patients ahead of the onset of symptoms and in asymptomatic individuals through wastewater and sewage surveillance as an early indication of infection. The existence of the viral genome and active viral particle actively participate in genomic variations. Hence, we comprehended the enteric spread of different viruses amongst communities with special reference to nSARS‐CoV‐2. The study concludes here that the faecal route of nSARS‐CoV2 not only enhances risk of infection and COVID19 cases but also contaminate water resources. The hospital and intensive care units (ICU) were reported with higher viral load and risk of nSARS‐CoV2 infections. These cases are not only due to aerosol‐based infections in contained area but also faecal material based infections as well. Poor hygiene and sanitation as primary concerns in low‐income nations are associated with higher risk of nSARS‐CoV2 infections and COVID19 cases. The faecal material provides an ideal habitat for viruses, including nSARS‐CoV2 for genetic variations and maturations that are associated with higher infections and pathogenecity. The water treatment strategies and approaches could be next level preventive measures to tackle spread of nSARS‐CoV2. Low income countries require much effort to control spread of nSARS‐CoV2 from faecal material and sewage water system driven infections.
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Affiliation(s)
- Harjeet S Maan
- State Virology Laboratory, Department of Microbiology, Gandhi Medical College, Bhopal, Madhya Pradesh, India
| | - Deepti Chaurasia
- Department of Microbiology, Gandhi Medical College, Bhopal, Madhya Pradesh, India
| | - Garima Kapoor
- Department of Microbiology, Gandhi Medical College, Bhopal, Madhya Pradesh, India
| | - Lokendra Dave
- Department of Respiratory Medicine, Gandhi Medical College, Bhopal, Madhya Pradesh, India
| | - Arshi Siddiqui
- Department of Biotechnology, Barkatullah University, Bhopal, Madhya Pradesh, India
| | - Savita Pal
- Department of Biochemistry, Central Drug Research Institute, Lucknow, Uttar Pradesh, India
| | - Hari O Singh
- Division of Molecular Biology, Indian Council of Medical Research, National AIDS Research Institute, Pune, Maharashtra, India
| | - Debasis Biswas
- Department of Microbiology, All India Institute of Medical Sciences Bhopal, Bhopal, Madhya Pradesh, India
| | - Rashmi Chowdhary
- Department of Biochemistry, All India Institute of Medical Sciences Bhopal, Bhopal, Madhya Pradesh, India
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Iezadi S, Gholipour K, Azami-Aghdash S, Ghiasi A, Rezapour A, Pourasghari H, Pashazadeh F. Effectiveness of non-pharmaceutical public health interventions against COVID-19: A systematic review and meta-analysis. PLoS One 2021; 16:e0260371. [PMID: 34813628 PMCID: PMC8610259 DOI: 10.1371/journal.pone.0260371] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 11/08/2021] [Indexed: 02/07/2023] Open
Abstract
Non-Pharmaceutical Public Health Interventions (NPHIs) have been used by different countries to control the spread of the COVID-19. Despite available evidence regarding the effectiveness of NPHSs, there is still no consensus about how policymakers can trust these results. Studies on the effectiveness of NPHSs are single studies conducted in specific communities. Therefore, they cannot individually prove if these interventions have been effective in reducing the spread of the infection and its adverse health outcomes. In this systematic review, we aimed to examine the effects of NPHIs on the COVID-19 case growth rate, death growth rate, Intensive Care Unit (ICU) admission, and reproduction number in countries, where NPHIs have been implemented. We searched relevant electronic databases, including Medline (via PubMed), Scopus, CINAHL, Web of Science, etc. from late December 2019 to February 1, 2021. The key terms were primarily drawn from Medical Subject Heading (MeSh and Emtree), literature review, and opinions of experts. Peer-reviewed quasi-experimental studies were included in the review. The PROSPERO registration number is CRD42020186855. Interventions were NPHIs categorized as lockdown, stay-at-home orders, social distancing, and other interventions (mask-wearing, contact tracing, and school closure). We used PRISMA 2020 guidance for abstracting the data and used Cochrane Effective Practice and Organization of Practice (EPOC) Risk of Bias Tool for quality appraisal of the studies. Hartung-Knapp-Sidik-Jonkman random-effects model was performed. Main outcomes included COVID-19 case growth rate (percentage daily changes), COVID-19 mortality growth rate (percentage daily changes), COVID-19 ICU admission (percentage daily changes), and COVID-19 reproduction number changes. Our search strategies in major databases yielded 12,523 results, which decreased to 7,540 articles after eliminating duplicates. Finally, 35 articles qualified to be included in the systematic review among which 23 studies were included in the meta-analysis. Although studies were from both low-income and high-income countries, the majority of them were from the United States (13 studies) and China (five studies). Results of the meta-analysis showed that adoption of NPHIs has resulted in a 4.68% (95% CI, -6.94 to -2.78) decrease in daily case growth rates, 4.8% (95 CI, -8.34 to -1.40) decrease in daily death growth rates, 1.90 (95% CI, -2.23 to -1.58) decrease in the COVID-19 reproduction number, and 16.5% (95% CI, -19.68 to -13.32) decrease in COVID-19 daily ICU admission. A few studies showed that, early enforcement of lockdown, when the incidence rate is not high, contributed to a shorter duration of lockdown and a lower increase of the case growth rate in the post-lockdown era. The majority of NPHIs had positive effects on restraining the COVID-19 spread. With the problems that remain regarding universal access to vaccines and their effectiveness and considering the drastic impact of the nationwide lockdown and other harsh restrictions on the economy and people's life, such interventions should be mitigated by adopting other NPHIs such as mass mask-wearing, patient/suspected case isolation strategies, and contact tracing. Studies need to address the impact of NPHIs on the population's other health problems than COVID-19.
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Affiliation(s)
- Shabnam Iezadi
- Hospital Management Research Center, Health Management Research Institute, Iran University of Medical Science, Tehran, Iran
- * E-mail: (SI); , (KG)
| | - Kamal Gholipour
- Social Determinants of Health Research Center, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
- * E-mail: (SI); , (KG)
| | - Saber Azami-Aghdash
- Tabriz Health Service Management Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Akbar Ghiasi
- HEB School of Business & Administration, University of the Incarnate Word, San Antonio, Texas, United States of America
| | - Aziz Rezapour
- Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Hamid Pourasghari
- Hospital Management Research Center, Health Management Research Institute, Iran University of Medical Science, Tehran, Iran
| | - Fariba Pashazadeh
- Research Center of Evidence-Based Medicine (EBM), Tabriz University of Medical Sciences, Tabriz, Iran
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Talic S, Shah S, Wild H, Gasevic D, Maharaj A, Ademi Z, Li X, Xu W, Mesa-Eguiagaray I, Rostron J, Theodoratou E, Zhang X, Motee A, Liew D, Ilic D. Effectiveness of public health measures in reducing the incidence of covid-19, SARS-CoV-2 transmission, and covid-19 mortality: systematic review and meta-analysis. BMJ 2021; 375:e068302. [PMID: 34789505 PMCID: PMC9423125 DOI: 10.1136/bmj-2021-068302] [Citation(s) in RCA: 254] [Impact Index Per Article: 84.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To review the evidence on the effectiveness of public health measures in reducing the incidence of covid-19, SARS-CoV-2 transmission, and covid-19 mortality. DESIGN Systematic review and meta-analysis. DATA SOURCES Medline, Embase, CINAHL, Biosis, Joanna Briggs, Global Health, and World Health Organization COVID-19 database (preprints). ELIGIBILITY CRITERIA FOR STUDY SELECTION Observational and interventional studies that assessed the effectiveness of public health measures in reducing the incidence of covid-19, SARS-CoV-2 transmission, and covid-19 mortality. MAIN OUTCOME MEASURES The main outcome measure was incidence of covid-19. Secondary outcomes included SARS-CoV-2 transmission and covid-19 mortality. DATA SYNTHESIS DerSimonian Laird random effects meta-analysis was performed to investigate the effect of mask wearing, handwashing, and physical distancing measures on incidence of covid-19. Pooled effect estimates with corresponding 95% confidence intervals were computed, and heterogeneity among studies was assessed using Cochran's Q test and the I2 metrics, with two tailed P values. RESULTS 72 studies met the inclusion criteria, of which 35 evaluated individual public health measures and 37 assessed multiple public health measures as a "package of interventions." Eight of 35 studies were included in the meta-analysis, which indicated a reduction in incidence of covid-19 associated with handwashing (relative risk 0.47, 95% confidence interval 0.19 to 1.12, I2=12%), mask wearing (0.47, 0.29 to 0.75, I2=84%), and physical distancing (0.75, 0.59 to 0.95, I2=87%). Owing to heterogeneity of the studies, meta-analysis was not possible for the outcomes of quarantine and isolation, universal lockdowns, and closures of borders, schools, and workplaces. The effects of these interventions were synthesised descriptively. CONCLUSIONS This systematic review and meta-analysis suggests that several personal protective and social measures, including handwashing, mask wearing, and physical distancing are associated with reductions in the incidence covid-19. Public health efforts to implement public health measures should consider community health and sociocultural needs, and future research is needed to better understand the effectiveness of public health measures in the context of covid-19 vaccination. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020178692.
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Affiliation(s)
- Stella Talic
- School of Public Health and Preventive Medicine, Monash University, Melbourne, 3004 VIC, Australia
- Monash Outcomes Research and health Economics (MORE) Unit, Monash University, VIC, Australia
| | - Shivangi Shah
- School of Public Health and Preventive Medicine, Monash University, Melbourne, 3004 VIC, Australia
| | - Holly Wild
- School of Public Health and Preventive Medicine, Monash University, Melbourne, 3004 VIC, Australia
- Torrens University, VIC, Australia
| | - Danijela Gasevic
- School of Public Health and Preventive Medicine, Monash University, Melbourne, 3004 VIC, Australia
- Centre for Global Health, The Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Ashika Maharaj
- School of Public Health and Preventive Medicine, Monash University, Melbourne, 3004 VIC, Australia
| | - Zanfina Ademi
- School of Public Health and Preventive Medicine, Monash University, Melbourne, 3004 VIC, Australia
- Monash Outcomes Research and health Economics (MORE) Unit, Monash University, VIC, Australia
| | - Xue Li
- Centre for Global Health, The Usher Institute, University of Edinburgh, Edinburgh, UK
- School of Public Health and The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wei Xu
- Centre for Global Health, The Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Ines Mesa-Eguiagaray
- Centre for Global Health, The Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Jasmin Rostron
- Centre for Global Health, The Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Evropi Theodoratou
- Centre for Global Health, The Usher Institute, University of Edinburgh, Edinburgh, UK
- Cancer Research UK Edinburgh Centre, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Xiaomeng Zhang
- Centre for Global Health, The Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Ashmika Motee
- Centre for Global Health, The Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Danny Liew
- School of Public Health and Preventive Medicine, Monash University, Melbourne, 3004 VIC, Australia
- Monash Outcomes Research and health Economics (MORE) Unit, Monash University, VIC, Australia
| | - Dragan Ilic
- School of Public Health and Preventive Medicine, Monash University, Melbourne, 3004 VIC, Australia
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Macheras P, Tsekouras AA, Chryssafidis P. Interpreting airborne pandemics spreading using fractal kinetics’ principles. F1000Res 2021; 10:609. [PMID: 34987769 PMCID: PMC8686328 DOI: 10.12688/f1000research.53196.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/16/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction The reaction between susceptible and infected subjects has been studied under the well-mixed hypothesis for almost a century. Here, we present a consistent analysis for a not well-mixed system using fractal kinetics’ principles. Methods We analyzed COVID-19 data to get insights on the disease spreading in absence/presence of preventive measures. We derived a three-parameter model and show that the “fractal” exponent h of time larger than unity can capture the impact of preventive measures affecting population mobility. Results The h=1 case, which is a power of time model, accurately describes the situation without such measures in line with a herd immunity policy. The pandemic spread in four model countries (France, Greece, Italy and Spain) for the first 10 months has gone through four stages: stages 1 and 3 with limited to no measures, stages 2 and 4 with varying lockdown conditions. For each stage and country two or three model parameters have been determined using appropriate fitting procedures. The fractal kinetics model was found to be more akin to real life. Conclusion Model predictions and their implications lead to the conclusion that the fractal kinetics model can be used as a prototype for the analysis of all contagious airborne pandemics.
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Affiliation(s)
- Panos Macheras
- Faculty of Pharmacy, Laboratory of Biopharmaceutics Pharmacokinetics, National and Kapodistrian University of Athens, Athens, 11526, Greece
- Athena Research Center, Attica, Athens, 15125, Greece
| | - Athanasios A. Tsekouras
- Athena Research Center, Attica, Athens, 15125, Greece
- Department of Chemistry, Laboratory of Physical Chemistry, National and Kapodistrian University of Athens, Athens, 11526, Greece
| | - Pavlos Chryssafidis
- Faculty of Pharmacy, Laboratory of Biopharmaceutics Pharmacokinetics, National and Kapodistrian University of Athens, Athens, 11526, Greece
- Athena Research Center, Attica, Athens, 15125, Greece
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Ahammed T, Anjum A, Rahman MM, Haider N, Kock R, Uddin MJ. Estimation of novel coronavirus (COVID-19) reproduction number and case fatality rate: A systematic review and meta-analysis. Health Sci Rep 2021; 4:e274. [PMID: 33977156 PMCID: PMC8093857 DOI: 10.1002/hsr2.274] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 02/08/2021] [Accepted: 03/16/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND AIMS Realizing the transmission potential and the magnitude of the coronavirus disease 2019 (COVID-19) aids public health monitoring, strategies, and preparation. Two fundamental parameters, the basic reproduction number (R 0) and case fatality rate (CFR) of COVID-19, help in this understanding process. The objective of this study was to estimate the R 0 and CFR of COVID-19 and assess whether the parameters vary in different regions of the world. METHODS We carried out a systematic review to find the reported estimates of the R 0 and the CFR in articles from international databases between January 1 and August 31, 2020. Random-effect models and Forest plots were implemented to evaluate the mean effect size of R 0 and the CFR. Furthermore, R 0 and CFR of the studies were quantified based on geographic location, the tests/thousand population, and the median population age of the countries where the studies were conducted. To assess statistical heterogeneity among the selected articles, the I 2 statistic and the Cochran's Q test were used. RESULTS Forty-five studies involving R 0 and 34 studies involving CFR were included. The pooled estimation of R 0 was 2.69 (95% CI: 2.40, 2.98), and that of the CFR was 2.67 (2.25, 3.13). The CFR in different regions of the world varied significantly, from 2.49 (2.08, 2.94) in Asia to 3.40 (2.81, 4.04) in North America. We observed higher mean CFR values for the countries with lower tests (3.15 vs 2.16) and greater median population age (3.13 vs 2.27). However, R 0 did not vary significantly in different regions of the world. CONCLUSIONS An R 0 of 2.69 and a CFR of 2.67 indicate the severity of the COVID-19. Although R 0 and CFR may vary over time, space, and demographics, we recommend considering these figures in control and prevention measures.
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Affiliation(s)
- Tanvir Ahammed
- Department of StatisticsShahjalal University of Science and TechnologySylhetBangladesh
| | - Aniqua Anjum
- Department of StatisticsShahjalal University of Science and TechnologySylhetBangladesh
| | - Mohammad Meshbahur Rahman
- Department of Health Statistics (Meta‐analysis & Geriatric Health)Biomedical Research FoundationDhakaBangladesh
| | - Najmul Haider
- The Royal Veterinary CollegeUniversity of LondonHertfordshireUnited Kingdom
| | - Richard Kock
- The Royal Veterinary CollegeUniversity of LondonHertfordshireUnited Kingdom
| | - Md Jamal Uddin
- Department of StatisticsShahjalal University of Science and TechnologySylhetBangladesh
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9
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Bennett M. All things equal? Heterogeneity in policy effectiveness against COVID-19 spread in chile. WORLD DEVELOPMENT 2021; 137:105208. [PMID: 32994662 PMCID: PMC7513907 DOI: 10.1016/j.worlddev.2020.105208] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/15/2020] [Indexed: 05/30/2023]
Abstract
Several variables and practices affect the evolution and geographic spread of COVID-19. Some of these variables pertain to policy measures such as social distancing, quarantines for specific areas, and testing availability. In this paper, I analyze the effect that lockdown and testing policies had on new contagions in Chile, especially focusing on potential heterogeneity given by population characteristics. Leveraging a natural experiment in the determination of early quarantines, I use an Augmented Synthetic Control Method to build counterfactuals for high and lower-income areas that experienced a lockdown during the first two months of the pandemic. I find substantial differences in the impact that quarantine policies had for different populations: While lockdowns were effective in containing and reducing new cases of COVID-19 in higher-income municipalities, I find no significant effect of this measure for lower-income areas. To further explain these results, I test for difference in mobility during quarantine for high and lower-income municipalities, as well as delays in test results and testing availability. These findings are consistent with previous results, showing that differences in the effectiveness of lockdowns could be partially attributed to heterogeneity in quarantine compliance in terms of mobility, as well as differential testing availability for higher and lower-income areas.
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Affiliation(s)
- Magdalena Bennett
- Information, Risk, and Operations Management, McCombs School of Business, The University of Texas at Austin, 2110 Speedway, Austin, TX 78712, United States
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10
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Agarwal M, Ranjan P, Baitha U, Mittal A. Hydroxychloroquine as a Chemoprophylactic Agent for COVID-19: A Clinico-Pharmacological Review. Front Pharmacol 2020; 11:593099. [PMID: 33390974 PMCID: PMC7773916 DOI: 10.3389/fphar.2020.593099] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 11/04/2020] [Indexed: 12/11/2022] Open
Abstract
Hydroxychloroquine has gained much attention as one of the candidate drugs that can be repurposed as a prophylactic agent against SARS-CoV-2, the agent responsible for the COVID-19 pandemic. Due to high transmissibility and presence of asymptomatic carriers and presymptomatic transmission, there is need for a chemoprophylactic agent to protect the high-risk population. In this review, we dissect the currently available evidence on hydroxychloroquine prophylaxis from a clinical and pharmacological point of view. In vitro studies on Vero cells show that hydroxychloroquine effectively inhibits SARS-CoV-2 by affecting viral entry and viral transport via endolysosomes. However, this efficacy has failed to replicate in in vivo animal models as well as in most clinical observational studies and clinical trials assessing pre-exposure prophylaxis and postexposure prophylaxis in healthcare workers. An analysis of the pharmacology of HCQ in COVID-19 reveals certain possible reasons for this failure-a pharmacokinetic failure due to failure to achieve adequate drug concentration at the target site and attenuation of its inhibitory effect due to the presence of TMPRSS2 in airway epithelial cells. Currently, many clinical trials on HCQ prophylaxis in HCW are ongoing; these factors should be taken into account. Using higher doses of HCQ for prophylaxis is likely to be associated with increased safety concerns; thus, it may be worthwhile to focus on other possible interventions.
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Affiliation(s)
- Mudit Agarwal
- MBBS, All India Institute of Medical Sciences, New Delhi, India
| | - Piyush Ranjan
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Upendra Baitha
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Ankit Mittal
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
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11
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Rath RS, Lohiya A, Ahamed F, Kathiresan J, Suliankatchi RA. Public health response to COVID-19 in selected countries - Hits and misses. J Family Med Prim Care 2020; 9:5580-5587. [PMID: 33532398 PMCID: PMC7842497 DOI: 10.4103/jfmpc.jfmpc_1482_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 09/17/2020] [Accepted: 10/07/2020] [Indexed: 01/07/2023] Open
Abstract
Background Lack of a cure or vaccine of COVID-19 forced us to rely on public health interventions (PHIs) for combating the pandemic. The main objective of the study to assess the PHI in selected countries and relate the various factors related to the intervention with the case load of the country. Methods An ecological analysis was conducted using secondary data on PHIs and disease burden extracted from official documents and press releases of the respective countries. Disease transmission was described based on calculated doubling time. PHIs were classified into 14 categories within three domains. An intervention score was calculated to reflect the number and stringency of the PHIs. Correlations between intervention scores, daily new cases and doubling time were presented. Results Brazil and the USA had the lowest intervention scores while South Korea had the highest scores. The median doubling time was negatively correlated with the rapidity of the escalation of the PHIs. Conclusion Dynamic government policies and timely PHIs, which are locally relevant and ably supported by the public are key to successful containment of the COVID-19 pandemic.
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Affiliation(s)
- Rama Shankar Rath
- Department of Community Medicine & Family Medicine, All India Institute of Medical Sciences, Gorakhpur, Uttar Pradesh, India
| | - Ayush Lohiya
- Department of Public Health, Public Health Specialist, Super Specialty Cancer Hospital, Uttar Pradesh, India
| | - Farhad Ahamed
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Kalyani, West Bengal, India
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12
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Kant R, Zaman K, Shankar P, Yadav R. A preliminary study on contact tracing & transmission chain in a cluster of 17 cases of severe acute respiratory syndrome coronavirus 2 infection in Basti, Uttar Pradesh, India. Indian J Med Res 2020; 152:95-99. [PMID: 32811800 PMCID: PMC7853285 DOI: 10.4103/ijmr.ijmr_2914_20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background & objectives: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has spread rapidly, causing unprecedented case fatalities across the world. The first laboratory-confirmed case of COVID-19 and also the first death associated with the disease in the eastern part of Uttar Pradesh (UP) was reported from Basti on March 31, 2020. The present study describes a cluster of 17 cases including one death of confirmed COVID-19 in Basti, UP, India. Methods: A 25 year old male from Basti, UP, India, who died of respiratory failure was diagnosed post-mortem as SARS-CoV-2 positive. Contact tracing carried out by the district administration found 16 cases positive among tested contacts. A detailed retrospective investigation in the form of one-to-one interview was carried out with 16 recovered individuals to understand the transmission dynamics and clinical characteristics. Results: The findings showed that the cluster transmission occurred at three levels: first was direct contact with the index case which resulted in two secondary cases. Second, at a household level where four of the seven susceptible contacts got infected, and the third was an event (funeral) where 50 individuals participated and this resulted in seven SARS-CoV-2-infected individuals in whom infection could be directly linked to a funeral gathering. The index case had associated comorbidities and succumbed to death. Most of the cases were asymptomatic except two individuals, who developed mild symptoms. The mean duration of quarantine facility was 21.6±7.3 days, and the average time taken for the first negative test after testing positive to COVID-19 was 12±4.1 days. Interpretation & conclusions: The funeral acted as a super-spreader event for the transmission of infection among family members, relatives and others. Active contact tracing and confirmation of infection among the contacts led to the isolation of 16 SARS-CoV-2 positive cases and hence the limited spread of the disease. Asymptomatic carriers and super-spreader events are among the major challenges in the control and prevention of SARS-CoV-2 transmission. Early testing, quarantine and social distancing may play key role in breaking the chain of transmission.
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Affiliation(s)
- Rajni Kant
- COVID-19 Testing Laboratory, Virology Division, ICMR-Regional Medical Research Centre, Gorakhpur, Uttar Pradesh, India
| | - Kamran Zaman
- COVID-19 Testing Laboratory, Virology Division, ICMR-Regional Medical Research Centre, Gorakhpur, Uttar Pradesh, India
| | - Prem Shankar
- COVID-19 Testing Laboratory, Virology Division, ICMR-Regional Medical Research Centre, Gorakhpur, Uttar Pradesh, India
| | - Rajaram Yadav
- COVID-19 Testing Laboratory, Virology Division, ICMR-Regional Medical Research Centre, Gorakhpur, Uttar Pradesh, India
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13
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Basu S. COVID-19 health facility preparedness for protecting healthcare workers: Designing a tool for rapid self- assessment. INDIAN JOURNAL OF MEDICAL SCIENCES 2020. [PMCID: PMC7485638 DOI: 10.25259/ijms_122_2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Healthcare workers (HCWs) comprise an irreplaceable resource in combating the COVID-19 pandemic. However, thousands of HCWs have been infected with the coronavirus (SARS-CoV-2) globally, and hundreds have died in the line of duty. Increased stress and fear about personal and familial safety also erode the confidence of HCWs in adhering to the best-practices for COVID-19 patient care. A tool and checklist for rapid assessment of health-care facilities for their preparedness in prioritizing the protection of healthcare workers were developed based on a survey of multiple sources. A total of ten domains were identified that are pivotal toward enabling the protection of HCWs involved in the management of suspected or confirmed COVID-19 patients.
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