Interventions and evidence
Pillar 2: Interventions and Evidence
Abstract
The use of non-pharmacological interventions (NPIs) on a global scale to reduce the transmission of SARS-CoV-2 was unprecedented. However, there was a lack of high-quality evidence to fully understand the benefits and harms of these interventions. There was a dearth of randomised controlled trials (RCTs) of NPIs during the COVID‐19 pandemic, highlighting the lack of evidence relative to the significant role NPIs played during the pandemic from a societal perspective.
As a result, there was limited understanding of how infrastructure and physical barriers affect the transmission of respiratory viruses and how environmental factors impact the effects of NPIs. There was also a lack of understanding of how to best apply evidence for NPIs to individuals and populations and identify their benefits, harms and unintended consequences, all of which should receive equal weighting.
The lack of high-quality research on the use of physical barriers, physical distancing, facial coverings, avoidance of crowds, closures of schools, businesses, and large gatherings, disinfection of high-touch surfaces, use of ultraviolet light and air purifiers, ventilation, CO2 monitors, screen and test strategies and travel restrictions limits our ability to deduce the benefits, harms and unintended consequences. Furthermore, the widespread nosocomial transmission in hospitals and long-term care homes and its devastating effects on the elderly require a better understanding of the role of the built environment as a risk factor.
High-quality evidence requires the development and testing in RCTs to assess the feasibility, applicability, effectiveness and unintended consequences of NPIs. However, the lack of preparation meant RCTs were difficult to develop and undertake during the pandemic. Pilot and feasibility studies are needed to determine how we may best develop evidence for NPIs for viral respiratory pathogens in seasonal endemic and epidemic settings and how this evidence should be optimally applied in the intervening years to reduce uncertainties during future pandemics.
Pillar 2 Pandemic EVIDENCE Collaborators: Atle Fretheim, Igho Onakpoya, Jessica Bartoszko, Mark Jones, Sara Gandini, Mark Loeb and Paul Glasziou