Cochrane corner: Effectiveness of quarantine in reducing the spread of COVID-19

Introduction: there is no effective vaccine against coronavirus disease 2019 (COVID-19) at present, so non-pharmacological interventions like quarantine are advocated to control its spread. Quarantine refers to the restriction of the movement of asymptomatic healthy people who have had contact with cases of a communicable disease. We highlight a Cochrane rapid review, published in April 2020, on the effectiveness of quarantine in limiting the spread of COVID-19. Methods: the authors of the Cochrane rapid review searched multiple electronic databases for studies of any design, which assessed the effects of quarantine compared to no intervention. Eligible participants for the review included contacts of confirmed or suspected cases and people returning from countries with a declared outbreak of COVID-19, severe acute respiratory syndrome (SARS), or Middle East respiratory syndrome (MERS). The authors used the evidence from SARS and MERS studies to provide indirect evidence on COVID-19. Results: the authors included 29 observational and mathematical modelling studies and found that quarantine may lead to substantial reductions in new COVID-19 cases and deaths. The review also shows that combining school closures, travel bans and social distancing to quarantine may lead to larger reductions in cases and deaths. Conclusion: the review suggests that quarantine should be part of the COVID-19 combination prevention tool kit for Africa. Therefore, in addition to other public health measures, African countries should roll out COVID-19 testing to identify, isolate and treat infected people and quarantine their contacts.

Convalescent plasma or hyperimmune immunoglobulin for people with COVID-19

Convalescent plasma is being considered as a potential therapy for COVID-19. We highlight and contextualise the findings of a recent Cochrane rapid review that evaluated the effectiveness and safety of convalescent plasma or hyperimmune immunoglobulin transfusion in the treatment of people with COVID-19. The review found low-certainty evidence of the therapeutic effectiveness and safety of convalescent plasma. As the novel coronavirus continues to spread in South Africa (SA), convalescent plasma may offer a therapeutic ray of hope for mitigating the morbidity and mortality burdens of the disease. Further investigation of the clinical benefits of the therapy in well-designed studies is needed to provide more evidence that will guide COVID-19 treatment decision-making in the SA context.

Cochrane corner: Factors that influence compliance by healthcare workers with infection prevention and control guidelines for COVID-19 and other respiratory infections

As rates of novel coronavirus disease 2019 (COVID-19) continue rising in Africa, usage of infection prevention and control (IPC) strategies by healthcare workers (HCW) is critical. We highlight a Cochrane review of qualitative evidence that explored barriers and facilitators to HCW compliance with IPC recommendations for COVID-19 and other respiratory infectious diseases. The review found various individual-and organizational-level barriers and facilitators. The findings suggest that healthcare system constraints that make it difficult for healthcare workers to implement IPC guidelines require urgent prioritisation. This will help lay the foundation for addressing the more individual-level barriers potentially discouraging HCW from implementing IPC guidelines. We draw attention to pan-African initiatives for enhancing healthcare workers’ capacity to undertake IPC measures at such a critical time.

Implementing COVID-19 response within the context of the broader health system: A proposed framework for Africa´s policy makers

Heads of government in Africa responded to the COVID-19 pandemic by setting up high-level task forces at continental and national levels to coordinate preparedness and response strategies, in a bid to mitigate the spread of this virus on the continent. However, the current strategy at both continental and national levels are narrowly focused on COVID-19 and this is not sustainable. This is because Africa has a high burden of communicable and non-communicable diseases and sustaining access to essential life-saving health services is also critical during this pandemic. Therefore, we call for a more holistic health systems-based model for COVID-19 outbreak response. We recommend that response strategies should be transitioned from vertical isolated programmes to a broad-based “time-bound” integrated health system intervention that links with existing health programmes as well as other government and non-governmental sectors.

Healthcare workers' adherence to infection prevention and control guidelines for respiratory infectious diseases: A rapid qualitative evidence synthesis.

COVID-19 spreads easily between people who are in close contact, or through coughs and sneezes. As the number of cases continues to increase, healthcare workers (HCWs) are notably at risk as a result of frequency of contact with suspected cases or infected people. Use of infection prevention and control (IPC) strategies by HCWs is therefore important. We summarise the evidence from a rapid Cochrane qualitative evidence synthesis by Houghton et al. on barriers and facilitators to HCWs' adherence to IPC guidelines for respiratory infectious diseases.