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Quarantine alone or in combination with other public health measures to control COVID-19: a rapid review.
Cochrane Database Syst Rev. 2020 04 08; 4:CD013574.CD

Abstract

BACKGROUND

Coronavirus disease 2019 (COVID-19) is a rapidly emerging disease that has been classified a pandemic by the World Health Organization (WHO). To support WHO with their recommendations on quarantine, we conducted a rapid review on the effectiveness of quarantine during severe coronavirus outbreaks.

OBJECTIVES

We conducted a rapid review to assess the effects of quarantine (alone or in combination with other measures) of individuals who had contact with confirmed cases of COVID-19, who travelled from countries with a declared outbreak, or who live in regions with high transmission of the disease.

SEARCH METHODS

An information specialist searched PubMed, Ovid MEDLINE, WHO Global Index Medicus, Embase, and CINAHL on 12 February 2020 and updated the search on 12 March 2020. WHO provided records from daily searches in Chinese databases up to 16 March 2020.

SELECTION CRITERIA

Cohort studies, case-control-studies, case series, time series, interrupted time series, and mathematical modelling studies that assessed the effect of any type of quarantine to control COVID-19. We also included studies on SARS (severe acute respiratory syndrome) and MERS (Middle East respiratory syndrome) as indirect evidence for the current coronavirus outbreak.

DATA COLLECTION AND ANALYSIS

Two review authors independently screened 30% of records; a single review author screened the remaining 70%. Two review authors screened all potentially relevant full-text publications independently. One review author extracted data and assessed evidence quality with GRADE and a second review author checked the assessment. We rated the certainty of evidence for the four primary outcomes: incidence, onward transmission, mortality, and resource use.

MAIN RESULTS

We included 29 studies; 10 modelling studies on COVID-19, four observational studies and 15 modelling studies on SARS and MERS. Because of the diverse methods of measurement and analysis across the outcomes of interest, we could not conduct a meta-analysis and conducted a narrative synthesis. Due to the type of evidence found for this review, GRADE rates the certainty of the evidence as low to very low. Modeling studies consistently reported a benefit of the simulated quarantine measures, for example, quarantine of people exposed to confirmed or suspected cases averted 44% to 81% incident cases and 31% to 63% of deaths compared to no measures based on different scenarios (incident cases: 4 modelling studies on COVID-19, SARS; mortality: 2 modelling studies on COVID-19, SARS, low-certainty evidence). Very low-certainty evidence suggests that the earlier quarantine measures are implemented, the greater the cost savings (2 modelling studies on SARS). Very low-certainty evidence indicated that the effect of quarantine of travellers from a country with a declared outbreak on reducing incidence and deaths was small (2 modelling studies on SARS). When the models combined quarantine with other prevention and control measures, including school closures, travel restrictions and social distancing, the models demonstrated a larger effect on the reduction of new cases, transmissions and deaths than individual measures alone (incident cases: 4 modelling studies on COVID-19; onward transmission: 2 modelling studies on COVID-19; mortality: 2 modelling studies on COVID-19; low-certainty evidence). Studies on SARS and MERS were consistent with findings from the studies on COVID-19.

AUTHORS' CONCLUSIONS

Current evidence for COVID-19 is limited to modelling studies that make parameter assumptions based on the current, fragmented knowledge. Findings consistently indicate that quarantine is important in reducing incidence and mortality during the COVID-19 pandemic. Early implementation of quarantine and combining quarantine with other public health measures is important to ensure effectiveness. In order to maintain the best possible balance of measures, decision makers must constantly monitor the outbreak situation and the impact of the measures implemented. Testing in representative samples in different settings could help assess the true prevalence of infection, and would reduce uncertainty of modelling assumptions. This review was commissioned by WHO and supported by Danube-University-Krems.

Authors+Show Affiliations

Danube University Krems, Cochrane Austria, Department for Evidence-based Medicine and Evaluation, Dr.-Karl-Dorrek-Str. 30, Krems, Austria, 3500.Danube University Krems, Cochrane Austria, Department for Evidence-based Medicine and Evaluation, Dr.-Karl-Dorrek-Str. 30, Krems, Austria, 3500.Danube University Krems, Cochrane Austria, Department for Evidence-based Medicine and Evaluation, Dr.-Karl-Dorrek-Str. 30, Krems, Austria, 3500.Danube University Krems, Cochrane Austria, Department for Evidence-based Medicine and Evaluation, Dr.-Karl-Dorrek-Str. 30, Krems, Austria, 3500.Danube University Krems, Cochrane Austria, Department for Evidence-based Medicine and Evaluation, Dr.-Karl-Dorrek-Str. 30, Krems, Austria, 3500.Danube University Krems, Cochrane Austria, Department for Evidence-based Medicine and Evaluation, Dr.-Karl-Dorrek-Str. 30, Krems, Austria, 3500.Danube University Krems, Cochrane Austria, Department for Evidence-based Medicine and Evaluation, Dr.-Karl-Dorrek-Str. 30, Krems, Austria, 3500.Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Department of Public Health, Hall in Tirol, Austria. Oncotyrol - Center for Personalized Cancer Medicine, Division of Health Technology Assessment and Bioinformatics, Innsbruck, Austria. Harvard T.H. Chan School of Public Health, Center for Health Decision Science, Department of Health Policy and Management, Boston, USA. Massachusetts General Hospital, Harvard Medical School, Institute for Technology Assessment and Department of Radiology, Boston, Massachusetts, USA.Danube University Krems, Cochrane Austria, Department for Evidence-based Medicine and Evaluation, Dr.-Karl-Dorrek-Str. 30, Krems, Austria, 3500.Danube University Krems, Cochrane Austria, Department for Evidence-based Medicine and Evaluation, Dr.-Karl-Dorrek-Str. 30, Krems, Austria, 3500.Danube University Krems, Cochrane Austria, Department for Evidence-based Medicine and Evaluation, Dr.-Karl-Dorrek-Str. 30, Krems, Austria, 3500. RTI International, Research Triangle Park, North Carolina, USA.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Systematic Review

Language

eng

PubMed ID

32267544

Citation

Nussbaumer-Streit, Barbara, et al. "Quarantine Alone or in Combination With Other Public Health Measures to Control COVID-19: a Rapid Review." The Cochrane Database of Systematic Reviews, vol. 4, 2020, p. CD013574.
Nussbaumer-Streit B, Mayr V, Dobrescu AI, et al. Quarantine alone or in combination with other public health measures to control COVID-19: a rapid review. Cochrane Database Syst Rev. 2020;4:CD013574.
Nussbaumer-Streit, B., Mayr, V., Dobrescu, A. I., Chapman, A., Persad, E., Klerings, I., Wagner, G., Siebert, U., Christof, C., Zachariah, C., & Gartlehner, G. (2020). Quarantine alone or in combination with other public health measures to control COVID-19: a rapid review. The Cochrane Database of Systematic Reviews, 4, CD013574. https://doi.org/10.1002/14651858.CD013574
Nussbaumer-Streit B, et al. Quarantine Alone or in Combination With Other Public Health Measures to Control COVID-19: a Rapid Review. Cochrane Database Syst Rev. 2020 04 8;4:CD013574. PubMed PMID: 32267544.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Quarantine alone or in combination with other public health measures to control COVID-19: a rapid review. AU - Nussbaumer-Streit,Barbara, AU - Mayr,Verena, AU - Dobrescu,Andreea Iulia, AU - Chapman,Andrea, AU - Persad,Emma, AU - Klerings,Irma, AU - Wagner,Gernot, AU - Siebert,Uwe, AU - Christof,Claudia, AU - Zachariah,Casey, AU - Gartlehner,Gerald, Y1 - 2020/04/08/ PY - 2020/4/9/entrez PY - 2020/4/9/pubmed PY - 2020/4/14/medline SP - CD013574 EP - CD013574 JF - The Cochrane database of systematic reviews JO - Cochrane Database Syst Rev VL - 4 N2 - BACKGROUND: Coronavirus disease 2019 (COVID-19) is a rapidly emerging disease that has been classified a pandemic by the World Health Organization (WHO). To support WHO with their recommendations on quarantine, we conducted a rapid review on the effectiveness of quarantine during severe coronavirus outbreaks. OBJECTIVES: We conducted a rapid review to assess the effects of quarantine (alone or in combination with other measures) of individuals who had contact with confirmed cases of COVID-19, who travelled from countries with a declared outbreak, or who live in regions with high transmission of the disease. SEARCH METHODS: An information specialist searched PubMed, Ovid MEDLINE, WHO Global Index Medicus, Embase, and CINAHL on 12 February 2020 and updated the search on 12 March 2020. WHO provided records from daily searches in Chinese databases up to 16 March 2020. SELECTION CRITERIA: Cohort studies, case-control-studies, case series, time series, interrupted time series, and mathematical modelling studies that assessed the effect of any type of quarantine to control COVID-19. We also included studies on SARS (severe acute respiratory syndrome) and MERS (Middle East respiratory syndrome) as indirect evidence for the current coronavirus outbreak. DATA COLLECTION AND ANALYSIS: Two review authors independently screened 30% of records; a single review author screened the remaining 70%. Two review authors screened all potentially relevant full-text publications independently. One review author extracted data and assessed evidence quality with GRADE and a second review author checked the assessment. We rated the certainty of evidence for the four primary outcomes: incidence, onward transmission, mortality, and resource use. MAIN RESULTS: We included 29 studies; 10 modelling studies on COVID-19, four observational studies and 15 modelling studies on SARS and MERS. Because of the diverse methods of measurement and analysis across the outcomes of interest, we could not conduct a meta-analysis and conducted a narrative synthesis. Due to the type of evidence found for this review, GRADE rates the certainty of the evidence as low to very low. Modeling studies consistently reported a benefit of the simulated quarantine measures, for example, quarantine of people exposed to confirmed or suspected cases averted 44% to 81% incident cases and 31% to 63% of deaths compared to no measures based on different scenarios (incident cases: 4 modelling studies on COVID-19, SARS; mortality: 2 modelling studies on COVID-19, SARS, low-certainty evidence). Very low-certainty evidence suggests that the earlier quarantine measures are implemented, the greater the cost savings (2 modelling studies on SARS). Very low-certainty evidence indicated that the effect of quarantine of travellers from a country with a declared outbreak on reducing incidence and deaths was small (2 modelling studies on SARS). When the models combined quarantine with other prevention and control measures, including school closures, travel restrictions and social distancing, the models demonstrated a larger effect on the reduction of new cases, transmissions and deaths than individual measures alone (incident cases: 4 modelling studies on COVID-19; onward transmission: 2 modelling studies on COVID-19; mortality: 2 modelling studies on COVID-19; low-certainty evidence). Studies on SARS and MERS were consistent with findings from the studies on COVID-19. AUTHORS' CONCLUSIONS: Current evidence for COVID-19 is limited to modelling studies that make parameter assumptions based on the current, fragmented knowledge. Findings consistently indicate that quarantine is important in reducing incidence and mortality during the COVID-19 pandemic. Early implementation of quarantine and combining quarantine with other public health measures is important to ensure effectiveness. In order to maintain the best possible balance of measures, decision makers must constantly monitor the outbreak situation and the impact of the measures implemented. Testing in representative samples in different settings could help assess the true prevalence of infection, and would reduce uncertainty of modelling assumptions. This review was commissioned by WHO and supported by Danube-University-Krems. SN - 1469-493X UR - https://www.unboundmedicine.com/medline/citation/32267544/Quarantine_alone_or_in_combination_with_other_public_health_measures_to_control_COVID_19:_a_rapid_review_ L2 - https://doi.org/10.1002/14651858.CD013574 DB - PRIME DP - Unbound Medicine ER -