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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 11 17; 375:e068302.BMJ

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.

Authors+Show Affiliations

School of Public Health and Preventive Medicine, Monash University, Melbourne, 3004 VIC, Australia stella.talic@monash.edu. Monash Outcomes Research and health Economics (MORE) Unit, Monash University, VIC, Australia.School of Public Health and Preventive Medicine, Monash University, Melbourne, 3004 VIC, Australia.School of Public Health and Preventive Medicine, Monash University, Melbourne, 3004 VIC, Australia. Torrens University, VIC, Australia.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.School of Public Health and Preventive Medicine, Monash University, Melbourne, 3004 VIC, Australia.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.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.Centre for Global Health, The Usher Institute, University of Edinburgh, Edinburgh, UK.Centre for Global Health, The Usher Institute, University of Edinburgh, Edinburgh, UK.Centre for Global Health, The Usher Institute, University of Edinburgh, Edinburgh, UK.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.Centre for Global Health, The Usher Institute, University of Edinburgh, Edinburgh, UK.Centre for Global Health, The Usher Institute, University of Edinburgh, Edinburgh, UK.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.School of Public Health and Preventive Medicine, Monash University, Melbourne, 3004 VIC, Australia.

Pub Type(s)

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

Language

eng

PubMed ID

34789505

Citation

Talic, Stella, et al. "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 (Clinical Research Ed.), vol. 375, 2021, pp. e068302.
Talic S, Shah S, Wild H, et al. 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.
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. (2021). 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 (Clinical Research Ed.), 375, e068302. https://doi.org/10.1136/bmj-2021-068302
Talic S, et al. 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 11 17;375:e068302. PubMed PMID: 34789505.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - 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. AU - Talic,Stella, AU - Shah,Shivangi, AU - Wild,Holly, AU - Gasevic,Danijela, AU - Maharaj,Ashika, AU - Ademi,Zanfina, AU - Li,Xue, AU - Xu,Wei, AU - Mesa-Eguiagaray,Ines, AU - Rostron,Jasmin, AU - Theodoratou,Evropi, AU - Zhang,Xiaomeng, AU - Motee,Ashmika, AU - Liew,Danny, AU - Ilic,Dragan, Y1 - 2021/11/17/ PY - 2021/11/18/entrez PY - 2021/11/19/pubmed PY - 2021/11/24/medline SP - e068302 EP - e068302 JF - BMJ (Clinical research ed.) JO - BMJ VL - 375 N2 - 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. SN - 1756-1833 UR - https://www.unboundmedicine.com/medline/citation/34789505/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_ L2 - https://www.bmj.com/lookup/pmidlookup?view=long&pmid=34789505 DB - PRIME DP - Unbound Medicine ER -