ABSTRACT
Response to the COVID-19 pandemic included a wide range of Public Health and Social Measures (PHSM). PHSM refer to a broad array of nonpharmaceutical interventions implemented by individuals, communities and governments to reduce the risk and scale of transmission of epidemic- and pandemic-prone infectious diseases. In order to inform decisions by the public, health workforce and policy-makers, there is a need to synthesize the large volume of published work on COVID-19. This study protocol describes the methodology for an overview of reviews focusing on the effectiveness and/or unintended health and socio-economic consequences of PHSM implemented during the COVID-19 pandemic. Findings can shape policy and research related to PHSM moving forward.
Subject(s)
COVID-19ABSTRACT
Background: Some immune-based therapies are efficacious in the treatment of patients with COVID-19 requiring hospitalization. However, safety concerns related to the potential risk of secondary infections may limit their use. We reviewed studies that assessed the risk of secondary infections with immune-based therapies in adult patients hospitalized with COVID-19.Methods: In this systematic review and meta-analysis we run a search in OVID Medline, Ovid EMBASE, SCOPUS, Cochrane Library, clinicaltrials.gov, PROSPERO in October 2020 and updated in January 2021. We included randomized controlled trial (RCT) and non-randomized studies (NRS), addressing the primary objective. We extracted data in duplicate an independent manner. We used RevMan to conduct a meta-analysis for RCTs and NRS using the random effects models to calculate the pooled risk ratio (RR) with 95% confidence interval (CI) for the incidence of infection. Statistical heterogeneity was determined using the I 2 statistic. We assessed the risk of bias for all included studies and rated the certainty of evidence for each outcome using the GRADE approach. We conducted a meta-regression using the R package to meta-explore whether age, sex, and invasive mechanical ventilation modified the risk of infection with immune-based therapies. The protocol is registered with PROSPERO, CRD42021229406.Findings: We identified 74 eligible publications (16 RCT and 58 NRS). Due to high heterogeneity in NRS, we performed meta-analysis only for RCTs, which included 3403 participants (mean age 60 years and 63% male). Infection risk was lower with immune-based therapy (173/1906, 9.1% versus 210/1496, 14%; RR= 0.74 (95% CI, 0.58-0.96; p=0.02 and (I 2 =26 %). Subgroup analysis did not identify any subgroup effect by type of immune-based therapies (p=0.41). Meta-regression revealed no impact of age, sex or mechanical ventilation on the effect of immune-based therapies on the risk of infection. Pneumonia occurred in 65/1131 on immune-based therapy versus 99/998 with placebo; RR= 0.67 (95%CI 0.41-1.09; p=0.11) and (I 2 = 44%).Interpretation: We identified moderate certainty evidence that the use of immune-based therapies in COVID-19 reduces the risk of secondary infections as compared to standard of care in hospitalized patients with COVID-19.Funding Statement: None.Declaration of Interests: We declare no competing interests.
Subject(s)
COVID-19ABSTRACT
Background: Coronavirus disease 2019 (COVID-19) is spread person to person by virus through close contact. The optimal person-person distance and use of facemasks and/or eye protection to prevent disease transmission in healthcare and non-healthcare settings is debated.Methods: We systematically reviewed the impact of distance, masks, and eye protection on transmission of COVID-19, SARS, or MERS from 21 standard, World Health Organization (WHO)-specific and COVID-19-specific data sources from inception to April 15, 2020 for studies of any design and language 1) comparing different distances between those infected and the people close to them, mask use, or eye protection, or 2) contextual factors of acceptability, feasibility, resource use, and equity of these interventions. We screened studies, extracted data, and assessed risk of bias in duplicate. Frequentist and Bayesian meta-analyses and meta-regression for the main outcome of viral transmission were by random effects. Secondary outcomes were contextual factors. We rated certainty of evidence rating per GRADE. PROSPERO: 177047.Findings: We identified 0 RCTs and 164 relevant observational studies in healthcare and non-healthcare (community) settings from 16 countries across 6 continents. A physical distance of one metre or more compared to less than one metre from those infected was associated with 1) a lower risk of viral transmission (n=7782, 5.3% vs 15.5%; RD -10.2% [95%CI -11.5% to -7.5%], pooled adjusted odds ratio [aOR] 0.18 [95%CI 0.09-0.38], moderate certainty) and 2) incremental benefits with increasing distance, change in relative risk (RR) per metre 1.57 (moderate certainty). Facemask use was associated with less infection (n=2647, 2.7% vs 17.4%; RD -14.% [95% credible interval [CrI] -15.9% to -10.7%]; aOR 0.15 [95%CrI 0.07-0.34], low certainty), with stronger associations with N95 or similar (including powered) respirators compared to disposable surgical or similar (e.g. reusable 12-16-layer cotton) masks, p interaction =0.090; posterior probabilities for RR<1 of N95 vs surgical masks were >95% despite minimally informative priors; moderate certainty). Eye protection was associated with quantitatively similar lower risk of infection in 2 adjusted and 15 unadjusted studies (n=3751, 5.4% vs 16.0%; RD -10.6 [95%CI -12.5% to -7.7%]; RR 0.34 [95%CI 0.22-0.52]; aOR 0.22 [95%CI 0.12-0.39], low certainty).Interpretation: This meta-analysis supports physical distancing by more than one metre and provides quantitative estimates for models and contact tracing to inform policy. Although direct evidence is limited, the optimal use of masks, in particular N95 or similar respirators, may depend on risk assessment and contextual factors. Eye protection may provide significant additional benefits. Globally collaborative, well-conducted studies on preventative and therapeutic strategies are required but are challenging to achieve immediately and, thus, recommendations in the interim to curtail the COVID-19 pandemic should be informed by this systematic appraisal of current evidence.Funding Statement: Commissioned by the World Health Organization as a rapid review on March 25, 2020. The funders of the study helped with defining the scope of the question, but otherwise had no role in study design, data collection, data analysis, data interpretation, writing of the report, or the decision to submit it.Declaration of Interests: ML is an investigator of an ongoing clinical trial on medical masks versus N95 respirators for COVID-19 (NCT04296643). All other authors declare no competing interests. Ethics Approval Statement: The authors prospectively submitted the systematic review protocol for registration on PROSPERO (submission number 177047). This study followed PRISMA and MOOSE reporting guidelines.