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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

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          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 I 2 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, I 2=12%), mask wearing (0.47, 0.29 to 0.75, I 2=84%), and physical distancing (0.75, 0.59 to 0.95, I 2=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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          Most cited references134

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          RoB 2: a revised tool for assessing risk of bias in randomised trials

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            ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions

            Non-randomised studies of the effects of interventions are critical to many areas of healthcare evaluation, but their results may be biased. It is therefore important to understand and appraise their strengths and weaknesses. We developed ROBINS-I (“Risk Of Bias In Non-randomised Studies - of Interventions”), a new tool for evaluating risk of bias in estimates of the comparative effectiveness (harm or benefit) of interventions from studies that did not use randomisation to allocate units (individuals or clusters of individuals) to comparison groups. The tool will be particularly useful to those undertaking systematic reviews that include non-randomised studies.
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              Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.

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                Author and article information

                Contributors
                Role: lecturer in clinical epidemiology and public health
                Role: honours student
                Role: lecturer and honours student
                Role: senior lecturer in epidemiology and chronic disease prevention
                Role: lecturer quality and safety and cancer epidemiology
                Role: associate professor of medical outcomes and health economics
                Role: assistant professor
                Role: research student
                Role: statistical geneticist
                Role: research student
                Role: professor of cancer epidemiology and global health
                Role: research student
                Role: research student
                Role: professor of medical outcomes and health economics
                Role: professor of medical education and public health
                Journal
                BMJ
                BMJ
                BMJ-UK
                bmj
                The BMJ
                BMJ Publishing Group Ltd.
                0959-8138
                1756-1833
                2021
                17 November 2021
                17 November 2021
                : 375
                : e068302
                Affiliations
                [1 ]School of Public Health and Preventive Medicine, Monash University, Melbourne, 3004 VIC, Australia
                [2 ]Monash Outcomes Research and health Economics (MORE) Unit, Monash University, VIC, Australia
                [3 ]Torrens University, VIC, Australia
                [4 ]Centre for Global Health, The Usher Institute, University of Edinburgh, Edinburgh, UK
                [5 ]Cancer Research UK Edinburgh Centre, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
                [6 ]School of Public Health and The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
                Author notes
                Correspondence to: S Talic stella.talic@ 123456monash.edu
                Author information
                https://orcid.org/0000-0001-7739-3381
                Article
                BMJ-2021-068302.R1 tals068302
                10.1136/bmj-2021-068302
                9423125
                34789505
                151bb182-3db5-40bd-8277-44d83a589c42
                © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

                This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

                History
                : 21 October 2021
                Categories
                Research
                2474

                Medicine
                Medicine

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