The effectiveness of non-pharmaceutical interventions in reducing SARS-CoV-2 transmission and COVID-19 incidence and mortality: systematic review and meta-analysis

Stella Talic, Shivangi Shah, Holly Wild, Danijela Gasevic, Ashika Maharaj, Zanfina Ademi, Xue Li, Wei Xu, Ines Mesa Eguiagaray, Jasmin Rostron, Evropi Theodoratou, Xiaomeng Zhang, Ashmika Motee, Danny Liew, Dragan Ilic

Research output: Contribution to journalArticlepeer-review

Abstract / Description of output

Objective: The novel coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) presents a great challenge to public health and economy globally. Non-pharmaceutical interventions (NPIs) have been used as a first-line prevention against SARS-CoV-2 transmission. The objective of the study was to review the evidence on the effectiveness of NPIs in reducing COVID-19 incidence and mortality, and SARS-CoV-2 transmission.
Data sources: Electronic databases MEDLINE, EMBASE, CINAHL, Biosis, Joanna Briggs, Global Health and WHO COVID-19 database (preprints) were searched; and review of search results, data extraction, meta-analysis, and risk of bias assessment were performed.
Eligibility criteria for selecting studies: Observational and interventional studies assessing the effectiveness of NPIs in reducing COVID-19 incidence and mortality, and SARS-CoV-2 transmission were included.
Main outcome measures: The main outcome measure was incidence of COVID-19. Secondary outcomes included transmission of SARS-CoV-2 and mortality.
Data synthesis: DerSimonian Laird random-effects meta-analyses were performed to investigate the effect of face masks, hand hygiene and physical distance measures on COVID-19 incidence. Pooled effect estimates with their 95% confidence interval (CI) were computed and heterogeneity among studies was detected using Cochran’s Q test and the I2 metrics with all p values being two-tailed.
Results: Overall, 72 studies met the inclusion criteria, out of which 35 evaluated individual NPIs, and 37 assessed multiple NPIs as a “package of interventions” and were included as supplementary material. Eight out of 35 studies were included in the meta-analyses, which indicated an association with reduction in the incidence of COVID-19; handwashing (relative risks (RR)= 0.47, 95%CI: 0.19 to 1.12, I2=12%), face masks (RR= 0.47, 95%CI: 0.29 to 0.75, I2=84%) and physical distance (RR= 0.75, 95%CI: 0.59 to 0.95, I2=87%). Due to heterogeneity of studies, meta-analyses were not possible for outcomes measuring quarantine/isolation, universal lockdowns and border, school and workplace closures. The effects of these interventions were synthesised descriptively.
Conclusions: This systematic review and meta-analysis suggests that several NPIs, including use of handwashing, face masks, and physical distancing, were associated with reductions in COVID-19 incidence. Public health efforts to implement NPIs should consider community health and socio-cultural needs and future research is needed to better understand NPI effectiveness in the context of COVID-19 vaccination.
Original languageEnglish
Article numbere068302
JournalBritish Medical Journal (BMJ)
Volume2021
Issue number375
DOIs
Publication statusPublished - 18 Nov 2021

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