Factors Associated with the Implementation of Non-Pharmaceutical Interventions for Reducing Coronavirus Disease 2019 (COVID-19): A Systematic Review

There has been much discussion recently about the importance of implementing non-pharmaceutical interventions (NPIs) to protect the public from coronavirus disease 2019 (COVID-19) infection. Different governments across the world have adopted NPIs (e.g., social distancing, quarantine, isolation, lockdowns, curfews, travel restrictions, closures of schools and colleges). Two fundamental strategies, namely a strict containment strategy—also called suppression strategy—and a mitigation strategy have been adopted in different countries, mainly to reduce the reproduction number (R0) to below one and hence to reduce case numbers to low levels or eliminate human-to-human transmission, as well as to use NPIs to interrupt transmission completely and to reduce the health impact of epidemics, respectively. However, the adoption of these NPI strategies is varied and the factors impacting NPI are inconsistent and unclear. This study, therefore, aimed to review the factors associated with the implementation of NPIs (social distancing, social isolation and quarantine) for reducing COVID-19. Following PRISMA guidelines, we searched for published and unpublished studies, undertaking a systematic search of: MEDLINE, EMBASE, Allied and Complementary Medicine, COVID-19 Research, WHO database on COVID-19, and Google Scholar. Thirty-three studies were included in the study. Seven descriptive themes emerged on enablers and barriers to NPIs: the positive impact of NPIs, effective public health interventions, positive change in people’s behaviour and concerns about COVID-19, the role of mass media, physical and psychological impacts, and ethnicity/age associated with COVID-19. This study has highlighted that the effectiveness of NPIs in isolation is likely to be limited, therefore, a combination of multiple measures e.g., SD, isolation and quarantine, and workplace distancing appeared more effective in reducing COVID-19. Studies suggest that targeted approaches alongside social distancing might be the way forward, and more acceptable. Further research to promote country- and context-specific adoption of NPIs to deliver public health measures is needed. Studies comparing the effectiveness of interventions and strategies will help provide more evidence for future pandemics.

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Social, ethical and behavioural aspects of COVID-19

Wellcome Open Research ◽

10.12688/wellcomeopenres.15813.2 ◽

2020 ◽

Vol 5 ◽

pp. 90 ◽

Cited By ~ 1

Author(s):

Wirichada Pan-ngum ◽

Tassawan Poomchaichote ◽

Giulia Cuman ◽

Phee-Kheng Cheah ◽

Naomi Waithira ◽

...

Keyword(s):

Public Health ◽

United Kingdom ◽

Qualitative Interviews ◽

Risk Groups ◽

Social Distancing ◽

Health Measures ◽

Treatment And Prevention ◽

Travel Restrictions ◽

Behavioural Aspects ◽

Pharmaceutical Interventions

Introduction: Vaccines and drugs for the treatment and prevention of COVID-19 require robust evidence generated from clinical trials before they can be used. Decisions on how to apply non-pharmaceutical interventions such as quarantine, self-isolation, social distancing and travel restrictions should also be based on evidence. There are some experiential and mathematical modelling data for these interventions, but there is a lack of data on the social, ethical and behavioural aspects of these interventions in the literature. Therefore, our study aims to produce evidence to inform (non-pharmaceutical) interventions such as communications, quarantine, self-isolation, social distancing, travel restrictions and other public health measures for the COVID-19 pandemic. Methods: The study will be conducted in the United Kingdom, Italy, Malaysia, Slovenia and Thailand. We propose to conduct 600-1000 quantitative surveys and 25-35 qualitative interviews per country. Data collection will follow the following four themes: (1) Quarantine and self-isolation (2) social distancing and travel restrictions (3) wellbeing and mental health (4) information, misinformation and rumours. In light of limitations of travel and holding in-person meetings, we will primarily use online/remote methods for collecting data. Study participants will be adults who have provided informed consent from different demographic, socio-economic and risk groups. Discussion: At the time of the inception of the study, United Kingdom, Italy, Malaysia, Slovenia and Thailand have initiated strict public health measures and varying degrees of “lockdowns” to curb the pandemic. These public health measures will change in the coming weeks and months depending on the number of cases of COVID-19 in the respective countries. The data generated from our study could inform these strategies in real time.

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Social, ethical and behavioural aspects of COVID-19

Wellcome Open Research ◽

10.12688/wellcomeopenres.15813.1 ◽

2020 ◽

Vol 5 ◽

pp. 90

Author(s):

Wirichada Pan-ngum ◽

Tassawan Poomchaichote ◽

Giulia Cuman ◽

Phee-Kheng Cheah ◽

Naomi Waithira ◽

...

Keyword(s):

Public Health ◽

United Kingdom ◽

Qualitative Interviews ◽

Study Participant ◽

Risk Groups ◽

Social Distancing ◽

Health Measures ◽

Travel Restrictions ◽

Behavioural Aspects ◽

Pharmaceutical Interventions

Introduction: Vaccines and drugs for the treatment and prevention of COVID-19 require robust evidence generated from clinical trials before they can be used. Decisions on how to apply non-pharmaceutical interventions such as quarantine, self-isolation, social distancing and travel restrictions should also be based on evidence. There are some experiential and mathematical modelling data for these interventions, but there is a lack of data on the social, ethical and behavioural aspects of these interventions in the literature. Therefore, our study aims to produce evidence to inform (non-pharmaceutical) interventions such as communications, quarantine, self-isolation, social distancing, travel restrictions and other public health measures for the COVID-19 pandemic. Methods: The study will be conducted in the United Kingdom, Italy, Malaysia and Thailand. We propose to conduct 600-1000 quantitative surveys and 25-35 qualitative interviews per country. Data collection will follow the following four themes: (1) Quarantine and self-isolation (2) social distancing and travel restrictions (3) wellbeing and mental health (4) information, misinformation and rumours. In light of limitations of travel and holding in-person meetings, we will use online/remote methods for collecting data. Study participant will be adults who have provided informed consent from different demographic, socio-economic and risk groups. Discussion: At the time of writing, United Kingdom, Italy, Malaysia and Thailand have initiated strict public health measures and varying degrees of “lockdowns” to curb the pandemic. It is anticipated that these public health measures will continue in some countries (e.g. Italy, Malaysia) or be tightened further in other countries (e.g. Thailand, UK) to control the spread of the disease in the coming weeks and months. The data generated from our study could inform these strategies in real time.

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Evaluations of Self-Focused Versus Other-Focused Arguments for Social Distancing: An Extension of Moral Matching Effects

Social Psychological and Personality Science ◽

10.1177/1948550620947853 ◽

2020 ◽

pp. 194855062094785 ◽

Cited By ~ 2

Author(s):

Andrew Luttrell ◽

Richard E. Petty

Keyword(s):

Public Health ◽

Health Communication ◽

Moral Issue ◽

Social Distancing ◽

Public Health Communication ◽

Moral Arguments ◽

Critical Insight ◽

Effective Public Health

The coronavirus pandemic has raised pressing questions about effective public health communication. Prior research has shown a persuasive advantage of arguments emphasizing a behavior’s benefits for others’ health compared to benefits for the recipients. We suggest that other-focused (vs. self-focused) messages function more as moral arguments and should thus be especially persuasive to people who moralize public health. Across three studies, people perceived other-focused (vs. self-focused) appeals for social distancing more as moral arguments. Further, evaluations of these messages’ persuasiveness were moderated by how much the recipient already moralized public health. Other-focused arguments tended to be perceived as more persuasive than self-focused arguments primarily among people who saw public health as a moral issue, which had corresponding effects on social distancing intentions. These findings provide critical insight to health communicators and underscore the importance of understanding that a message’s impact can depend on audience characteristics.

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Modeling the evolution of SARS-CoV-2 under non-pharmaceutical interventions

10.1101/2021.02.20.21252133 ◽

2021 ◽

Author(s):

Yael Gurevich ◽

Yoav Ram ◽

Lilach Hadany

Keyword(s):

Data Analysis ◽

Diagnostic Tests ◽

Viral Strain ◽

Epidemiological Models ◽

Social Distancing ◽

Testing Rate ◽

Travel Restrictions ◽

Evolutionary Trajectories ◽

Pharmaceutical Interventions

AbstractSocial and behavioral non-pharmaceutical interventions (NPIs), such as mask-wearing, social distancing, and travel restrictions, as well as diagnostic tests, have been broadly implemented in response to the COVID-19 pandemic. Epidemiological models and data analysis affirm that wide adoption of NPIs helps to control the pandemic. However, SARS-CoV-2 has extensively demonstrated its ability to evolve. Therefore, it is crucial to examine how NPIs may affect the evolution of the virus. Such evolution could have important effects on the spread and impact of the pandemic.We used evo-epidemiological models to examine the effect of non-pharmaceutical interventions and testing on two evolutionary trajectories for SARS-CoV-2: attenuation and test evasion. Our results show that when stronger measures are taken, selection may act to reduce virulence. Additionally, the timely application of NPIs could significantly affect the competition between viral strains, favoring reduced virulence. Furthermore, a higher testing rate can select for a test-evasive viral strain, even if that strain is less infectious than the detectable competing strain. Importantly, if a less detectable strain evolves, epidemiological metrics such as confirmed daily cases may distort our assessment of the pandemic. Our results highlight the important implications NPIs can have on the evolution of SARS-CoV-2.

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Variations in Non-Pharmaceutical Interventions by State Correlate with COVID-19 Disease Outcomes

10.1101/2021.07.28.21261286 ◽

2021 ◽

Author(s):

Annika J Avery ◽

Jiayi Wang ◽

Xinyu Ma ◽

Qingkai Pan ◽

Elizabeth E McGrady ◽

...

Keyword(s):

Public Health ◽

Respiratory Virus ◽

Intervention Strategies ◽

Health Interventions ◽

Public Health Interventions ◽

The Public ◽

Disease Outcomes ◽

Effective Public Health ◽

Pharmaceutical Interventions

The COVID-19 pandemic highlighted the lack of understanding around effective public health interventions to curtail the spread of an emerging respiratory virus. Here, we examined the public health approaches implemented by each state to limit the spread and burden of COVID-19. Our analysis revealed that stronger statewide interventions positively correlated with fewer COVID-19 deaths, but some neighboring states with distinct intervention strategies had similar SARS-CoV-2 case trajectories. Additionally, more than two weeks is needed to observe an impact on SARS-CoV-2 cases after an intervention is implemented. These data provide a critical framework to inform future interventions during emerging pandemics.

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Non-pharmaceutical interventions for containment, mitigation and suppression of COVID-19 infection

Colombia Medica ◽

10.25100/cm.v51i2.4266 ◽

2020 ◽

pp. 1-25

Author(s):

Daniel F. Patiño-Lugo ◽

Marcela Velez ◽

Pamela Velásquez Salazar ◽

Claudia Yaneth Vera-Giraldo ◽

Viviana Vélez ◽

...

Keyword(s):

Health Care Services ◽

Social Impact ◽

Scientific Evidence ◽

Policy Decision ◽

Substantial Effect ◽

Contact Tracing ◽

Social Distancing ◽

First Case ◽

Travel Restrictions ◽

Pharmaceutical Interventions

The best available scientific evidence is required to design effective non-pharmaceutical interventions (NPIs) to help policymakers to contain COVID-19 outbreaks. The aim of this review is to describe which NPIs used different countries and a when they use them. It also explores how NPIs impact the number of cases, the mortality, and the capacity of health systems. We consulted eight web pages of transnational organizations, 17 of international media, 99 of government institutions in the 19 countries included, and besides, we included nine studies (out of 34 identified) that met inclusion criteria. We found that some countries are focused on establishing travel restrictions, isolation of identified cases, and high-risk people. Others have a more intense combination of mandatory quarantine and other drastic social distancing measures. Some countries have implemented interventions in the first fifteen days after detecting the first case, while others have taken more than 30 days. The effectiveness of isolated NPIs may be limited, but combined interventions have shown to be effective in reducing the transmissibility of the disease, the collapse of health care services, and mortality. When the number of new cases has been controlled, it is necessary to maintain social distancing measures, self-isolation, and contact tracing for several months. The policy decision-making in this time should be aimed to optimize the opportunities of saving lives, reducing the collapse of health services, and minimizing the economic and social impact over the general population, but principally over the most vulnerable. The timing of implementing and lifting interventions is likely to have a substantial effect on those objectives.

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Local Decision Making for Implementing Social Distancing in Response to Outbreaks

Public Health Reports ◽

10.1177/0033354918819755 ◽

2019 ◽

Vol 134 (2) ◽

pp. 150-154 ◽

Cited By ~ 6

Author(s):

Rebecca Katz ◽

Andrea Vaught ◽

Samuel J. Simmens

Keyword(s):

Public Health ◽

Decision Making ◽

Online Survey ◽

Health Impact ◽

The United States ◽

Health Departments ◽

Local Public Health ◽

Social Distancing ◽

Local Decision ◽

Population Demographic

Objectives: Social distancing is the practice of restricting contact among persons to prevent the spread of infection. This study sought to (1) identify key features of preparedness and the primary concerns of local public health officials in deciding to implement social distancing measures and (2) determine whether any particular factor could explain the widespread variation among health departments in responses to past outbreaks. Methods: We conducted an online survey of health departments in the United States in 2015 to understand factors influencing health departments’ decision making when choosing whether to implement social distancing measures. We paired survey results with data on area population demographic characteristics and analyzed them with a focus on broad trends. Results: Of 600 health departments contacted, 150 (25%) responded. Of these 150 health departments, 63 (42%) indicated that they had implemented social distancing in the past 10 years. Only 10 (7%) health departments had a line-item budget for isolation or quarantine. The most common concern about social distancing was public health impact (n = 62, 41%). Concerns about law, politics, finances, vulnerable populations, and sociocultural issues were each identified by 7% to 10% of health departments. We were unable to clearly predict which factors would influence these decisions. Conclusions: Variations in the decision to implement social distancing are likely the result of differences in organizational authority and resources and in the primary concerns about implementing social distancing. Research and current social distancing guidelines for health departments should address these factors.

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“I don’t feel safe sitting in my own yard”: Chicago resident experiences with urban rats during a COVID-19 stay-at-home order

BMC Public Health ◽

10.1186/s12889-021-11095-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Maureen H. Murray ◽

Kaylee A. Byers ◽

Jacqueline Buckley ◽

Seth B. Magle ◽

Dorothy Maffei ◽

...

Keyword(s):

Public Health ◽

Health Risks ◽

Well Being ◽

Health Concern ◽

Rodent Control ◽

Health Crisis ◽

Social Distancing ◽

Factors Associated ◽

Apartment Buildings ◽

At Home

Abstract Background Encounters with rats in urban areas increase risk of human exposure to rat-associated zoonotic pathogens and act as a stressor associated with psychological distress. The frequency and nature of human-rat encounters may be altered by social distancing policies to mitigate the COVID-19 pandemic. For example, restaurant closures may reduce food availability for rats and promote rat activity in nearby residential areas, thus increasing public health risks during a period of public health crisis. In this study, we aimed to identify factors associated with increased perceived exposure to rats during a stay-at-home order, describe residents’ encounters with rats relevant to their health and well-being, and identify factors associated with increased use of rodent control. Methods Urban residents in Chicago, a large city with growing concerns about rats and health disparities, completed an online questionnaire including fixed response and open-ended questions during the spring 2020 stay-at-home order. Analyses included ordinal multivariate regression, spatial analysis, and thematic analysis for open-ended responses. Results Overall, 21% of respondents (n = 835) reported an increase in rat sightings around their homes during the stay-at-home order and increased rat sightings was positively associated with proximity to restaurants, low-rise apartment buildings, and rat feces in the home (p ≤ 0.01). Many respondents described feeling unsafe using their patio or yard, and afraid of rats entering their home or spreading disease. Greater engagement with rodent control was associated with property ownership, information about rat control, and areas with lower incomes (p ≤ 0.01). Conclusions More frequent rat encounters may be an unanticipated public health concern during periods of social distancing, especially in restaurant-dense areas or in low-rise apartment buildings. Rat presence may also limit residents’ ability to enjoy nearby outdoor spaces, which otherwise might buffer stress experienced during a stay-at-home order. Proactive rat control may be needed to mitigate rat-associated health risks during future stay-at-home orders.

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Genetic evidence for the association between COVID-19 epidemic severity and timing of non-pharmaceutical interventions

Nature Communications ◽

10.1038/s41467-021-22366-y ◽

2021 ◽

Vol 12 (1) ◽

Author(s):

Manon Ragonnet-Cronin ◽

Olivia Boyd ◽

Lily Geidelberg ◽

David Jorgensen ◽

Fabricia F. Nascimento ◽

...

Keyword(s):

Public Health ◽

Phylogenetic Analysis ◽

Genetic Evidence ◽

Health Interventions ◽

Morbidity And Mortality ◽

Whole Genome ◽

Public Health Interventions ◽

Epidemic Size ◽

Travel Restrictions ◽

Pharmaceutical Interventions

AbstractUnprecedented public health interventions including travel restrictions and national lockdowns have been implemented to stem the COVID-19 epidemic, but the effectiveness of non-pharmaceutical interventions is still debated. We carried out a phylogenetic analysis of more than 29,000 publicly available whole genome SARS-CoV-2 sequences from 57 locations to estimate the time that the epidemic originated in different places. These estimates were examined in relation to the dates of the most stringent interventions in each location as well as to the number of cumulative COVID-19 deaths and phylodynamic estimates of epidemic size. Here we report that the time elapsed between epidemic origin and maximum intervention is associated with different measures of epidemic severity and explains 11% of the variance in reported deaths one month after the most stringent intervention. Locations where strong non-pharmaceutical interventions were implemented earlier experienced much less severe COVID-19 morbidity and mortality during the period of study.

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Evaluations of Self-Focused versus Other-Focused Arguments for Social Distancing: An Extension of Moral Matching Effects

10.31234/osf.io/t5srq ◽

2020 ◽

Author(s):

Andy Luttrell ◽

Richard Petty

Keyword(s):

Public Health ◽

Health Communication ◽

Moral Issue ◽

Social Distancing ◽

Public Health Communication ◽

Moral Arguments ◽

Critical Insight ◽

Effective Public Health

The coronavirus pandemic has raised pressing questions about effective public health communication. Prior research has shown a persuasive advantage of arguments emphasizing a behavior’s benefits for others’ health, compared to benefits for the recipients. We suggest that other-focused (vs. self-focused) messages function more as moral arguments and should thus be especially persuasive to people who moralize public health. Across three studies, people perceived other-focused (vs. self-focused) appeals for social distancing more as moral arguments. Further, evaluations of these messages’ persuasiveness were moderated by how much the recipient already moralized public health. Other-focused arguments tended to be perceived as more persuasive than self-focused arguments primarily among people who saw public health as a moral issue, which had corresponding effects on social distancing intentions. These findings provide critical insight to health communicators and underscore the importance of understanding that a message’s impact can depend on audience characteristics.

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