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      The unintended consequences of COVID-19 mitigation measures matter: practical guidance for investigating them

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          Abstract

          Background

          COVID-19 has led to the adoption of unprecedented mitigation measures which could trigger many unintended consequences. These unintended consequences can be far-reaching and just as important as the intended ones. The World Health Organization identified the assessment of unintended consequences of COVID-19 mitigation measures as a top priority. Thus far, however, their systematic assessment has been neglected due to the inattention of researchers as well as the lack of training and practical tools.

          Main text

          Over six years our team has gained extensive experience conducting research on the unintended consequences of complex health interventions. Through a reflexive process, we developed insights that can be useful for researchers in this area. Our analysis is based on key literature and lessons learned reflexively in conducting multi-site and multi-method studies on unintended consequences. Here we present practical guidance for researchers wishing to assess the unintended consequences of COVID-19 mitigation measures.

          To ensure resource allocation, protocols should include research questions regarding unintended consequences at the outset. Social science theories and frameworks are available to help assess unintended consequences. To determine which changes are unintended, researchers must first understand the intervention theory. To facilitate data collection, researchers can begin by forecasting potential unintended consequences through literature reviews and discussions with stakeholders. Including desirable and neutral unintended consequences in the scope of study can help minimize the negative bias reported in the literature. Exploratory methods can be powerful tools to capture data on the unintended consequences that were unforeseen by researchers. We recommend researchers cast a wide net by inquiring about different aspects of the mitigation measures. Some unintended consequences may only be observable in subsequent years, so longitudinal approaches may be useful. An equity lens is necessary to assess how mitigation measures may unintentionally increase disparities. Finally, stakeholders can help validate the classification of consequences as intended or unintended.

          Conclusion

          Studying the unintended consequences of COVID-19 mitigation measures is not only possible but also necessary to assess their overall value. The practical guidance presented will help program planners and evaluators gain a more comprehensive understanding of unintended consequences to refine mitigation measures.

          Supplementary Information

          The online version contains supplementary material available at 10.1186/s12874-020-01200-x.

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          Most cited references55

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          The psychological impact of quarantine and how to reduce it: rapid review of the evidence

          Summary The December, 2019 coronavirus disease outbreak has seen many countries ask people who have potentially come into contact with the infection to isolate themselves at home or in a dedicated quarantine facility. Decisions on how to apply quarantine should be based on the best available evidence. We did a Review of the psychological impact of quarantine using three electronic databases. Of 3166 papers found, 24 are included in this Review. Most reviewed studies reported negative psychological effects including post-traumatic stress symptoms, confusion, and anger. Stressors included longer quarantine duration, infection fears, frustration, boredom, inadequate supplies, inadequate information, financial loss, and stigma. Some researchers have suggested long-lasting effects. In situations where quarantine is deemed necessary, officials should quarantine individuals for no longer than required, provide clear rationale for quarantine and information about protocols, and ensure sufficient supplies are provided. Appeals to altruism by reminding the public about the benefits of quarantine to wider society can be favourable.
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            Predicting the impacts of epidemic outbreaks on global supply chains: A simulation-based analysis on the coronavirus outbreak (COVID-19/SARS-CoV-2) case

            Highlights • Epidemic outbreaks are a special case of supply chain (SC) risks. • We articulate the specific features of epidemic outbreaks in SCs. • We demonstrate a simulation model for epidemic outbreak analysis. • We use an example of coronavirus COVID-19 outbreak.
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              Indirect effects of COVID-19 on the environment

              This research aims to show the positive and negative indirect effects of COVID-19 on the environment, particularly in the most affected countries such as China, USA, Italy, and Spain. Our research shows that there is a significant association between contingency measures and improvement in air quality, clean beaches and environmental noise reduction. On the other hand, there are also negative secondary aspects such as the reduction in recycling and the increase in waste, further endangering the contamination of physical spaces (water and land), in addition to air. Global economic activity is expected to return in the coming months in most countries (even if slowly), so decreasing GHG concentrations during a short period is not a sustainable way to clean up our environment.
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                Author and article information

                Contributors
                anne-marie.turcotte-tremblay@umontreal.ca
                Journal
                BMC Med Res Methodol
                BMC Med Res Methodol
                BMC Medical Research Methodology
                BioMed Central (London )
                1471-2288
                10 February 2021
                10 February 2021
                2021
                : 21
                : 28
                Affiliations
                [1 ]GRID grid.14848.31, ISNI 0000 0001 2292 3357, School of Public Health, , Université de Montréal, ; 7101 Avenue du Parc, Montreal, QC H3N 1X9 Canada
                [2 ]GRID grid.38142.3c, ISNI 000000041936754X, Department and Population, , Harvard T.H. Chan School of Public Health, ; 665 Huntington Avenue, Building 1, Boston, MA 02115 USA
                [3 ]Bureau d’Appui Santé et Environnement, N’Djamena, Chad
                [4 ]GRID grid.508487.6, ISNI 0000 0004 7885 7602, IRD (French Institute for Research on Sustainable Development), CEPED, , Université de Paris, ; 45 Rue des Saints-Pères, 75006 Paris, France
                Author information
                http://orcid.org/0000-0002-6138-9908
                Article
                1200
                10.1186/s12874-020-01200-x
                7873511
                33397292
                b6473910-6cb9-43f4-a3f8-ffb8a03448bf
                © The Author(s) 2021

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 10 September 2020
                : 21 December 2020
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100000036, Institute of Population and Public Health;
                Award ID: 337391
                Award Recipient :
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                © The Author(s) 2021

                Medicine
                unintended consequences,mitigation measures,covid-19,pandemic
                Medicine
                unintended consequences, mitigation measures, covid-19, pandemic

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