Public-health measures

We are in the process of identifying and extracting decision-relevant information about the ‘best evidence syntheses’ for each element of the COVID-END sub-taxonomy focused on public-health measures. We will continue to add evidence syntheses to this webpage as we complete this work, and we will make adjustments on a bi-weekly basis to which evidence syntheses are profiled, and to the information made available about included reviews, as the evidence base evolves.

Broad and specific decisions			Criteria for 'best evidence synthesis'			Details to support relevance assessment	Additional decision-relevant details			Citation
Broad and specific decisions			Date of last search	Quality (AMSTAR) rating	Evidence profile	Key findings	Living evidence synthesis	Type of synthesis	Type of question	Citation
Infection prevention
	Personal protection
		Washing hands


		Wearing masks	2020-06-02	7/10	No	Limited evidence from observational studies shows that face mask use may be effective at reducing respiratory virus infections, with stronger evidence from healthcare settings compared to community settings	Yes	Full review	Benefits and harms	Chou R, Dana T, Jungbauer R, Weeks C, McDonagh MS. Masks for Prevention of Respiratory Virus Infections, Including SARS-CoV-2, in Health Care and Community Settings. Ann Intern Med. 2020 Jun 24;M20-3213.
			2020-05-03	9/11	Yes	Low certainty evidence suggests large reductions in risk of viral infections may be possible with the use of masks, with N95 or similar respirators more likely to lead to greater reductions compared to disposible surgical masks or other reusable masks	No	Full review	Benefits and harms	Chu DK, Akl EA, Duda S, et al. Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis [published online ahead of print, 2020 Jun 1]. Lancet. 2020;S0140-6736(20)31142-9. doi:10.1016/S0140-6736(20)31142-9
			2020-04-01	9/10	No	Evidence from existing trials has not found a statistically significant difference in reductions of influenza-like-illness or influenza cases when mask wearing is compared to no masks among the general population	No	Full review	Benefits and harms	Jefferson T, Jones M, Al Ansari L, Bawazeer G, Beller E, Clark J, et al. Physical Interventions to Interrupt or Reduce the Spread of Respiratory Viruses. Part I - Face Masks, Eye Protection and Person Distancing: Systematic Review and Meta-Analysis. MedRxiv 2020.
		Wearing personal protective equipment	2020-05-03	TBD	Yes	Low certainty evidence suggests N95 respirators and eye protection can lead to a reduction in viral infections	No	Full review	Benefits and harms	Chu DK, Akl EA, Duda S, et al. Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis [published online ahead of print, 2020 Jun 1]. Lancet. 2020;S0140-6736(20)31142-9. doi:10.1016/S0140-6736(20)31142-9
			2020-04-24	6/10	No	PPE use by healthcare workers including masks, gloves, gowns and eye protection has been found to be one the strongest factor associated with reduced risk of coronavirus infection, with the most consistent associations observed for masks	Yes	Full review	Benefits and harms	Chou R, Dana T, Buckley D, Selph S, Fu R, Totten A. Epidemiology of and Risk Factors for Coronavirus Infection in Health Care Workers. Ann Intern Med 2020; M20-1632
			2020-04-01	9/10	No	Evidence from existing trials has not found a statistically significant difference in reductions of influenza-like-illness or influenza cases when mask wearing is compared compared to no masks among healthcare workers, and no trials have been identified	No	Full review	Benefits and harms	Jefferson T, Jones M, Al Ansari L, Bawazeer G, Beller E, Clark J, et al. Physical Interventions to Interrupt or Reduce the Spread of Respiratory Viruses. Part I - Face Masks, Eye Protection and Person Distancing: Systematic Review and Meta-Analysis. MedRxiv 2020.
		Disinfecting surfaces and facilities
		Physical distancing	2020-05-03	TBD	Yes	There is evidence of moderate certainty that physical distancing of more than 1 m probably results in a large reduction in risk of viral infections	No	Full review	Benefits and harms	Chu DK, Akl EA, Duda S, et al. Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis [published online ahead of print, 2020 Jun 1]. Lancet. 2020;S0140-6736(20)31142-9. doi:10.1016/S0140-6736(20)31142-9
		Temporal distancing
		Public-focused behaviour-change supports
		Health worker and essential worker-focused behaviour change supports for the above	2020-03-26	7/9	Yes	The design and content of infection prevention and control guidelines, how they are communicated, and whether there is adequate organizational support, training, and access to personal protective equipment affect adherence among healthcare workers	No	Rapid review	Other	Houghton C, Meskell P, Delaney H, et al. Barriers and Facilitators to Healthcare Workers' Adherence with Infection Prevention and Control (IPC) Guidelines for Respiratory Infectious Diseases: a Rapid Qualitative Evidence Synthesis. Cochrane Database Syst Rev 2020;4(4):CD013582.
	Service Limitations
		Essential service designations
		Daycare, school, university and summer camp limitations
		Recreational areas (e.g., parks) limitations
		Religious institutions (e.g., church, mosque or synagogue)
		Public-contact-heavy business limitations
		Other (e.g., public contact free) business limitations
		Service-provider protection
		Service-user protection
		Inspections/enforcement of the above
	Travel limitations
		Travel (air, ground, rail)
		Borders
Infection control
	Screening
		Targets
		Methods	2020-04-07	4/9	No	In children, the most prevalent clinical manifestations of COVID-19 are fever, cough, nasal symptoms, diarrhea, and nausea/vomiting	No	Full review	Other	de Souza T, Nadal J, Nogueira R, Pereira R, Brandão M. Clinical Manifestations of Children with COVID-19: A Systematic Review. Pediatr Pulmonol 2020;10.
		Locations (and frequency if applicable)
	Quarantining of exposed or potentially exposed individuals
		Voluntary or imposed	2020-04-01	9/10	No	One randomized controlled trial has found that quarantining workers during an epidemic when members of their household are infected can control the spread of influenza-like-illness, but increases their individual risk of infection	No	Full review	Benefits and harms	Jefferson T, Jones M, Al Ansari L, Bawazeer G, Beller E, Clark J, et al. Physical Interventions to Interrupt or Reduce the Spread of Respiratory Viruses. Part I - Face Masks, Eye Protection and Person Distancing: Systematic Review and Meta-Analysis. MedRxiv 2020.
	Testing
		Priority individuals (including their contacts)
		Methods (including performance and quality assurance)	2020-04-06	8/10	Yes	The false-negative (patients incorrectly diagnosed as not having COVID-19) rate of patients undergoing RT-PCR tests is uncertain	Yes	Full review	Other	Arevalo-Rodriguez I, Buitrago-Garcia D, Simancas-Racines D, Zambrano-Achig P, del Campo R, Ciapponi A. False-Negative Results of Initial RT-PCR Assays for COVID-19: A Systematic Review. MedRxiv 2020.
		Locations (and frequency if applicable)
		Speeding results
	Isolation of suspected or confirmed cases
	Contact tracing
	Susceptibility tracking
		Antibody testing
		Antibody test usage
Broader public-health measures
	Risk stratification
		Stratifying the population by risk of infection
	Outbreak management
		Locations (essential services or other)	2020-05-29	7/10	Yes	Outbreak investigations show that long-term care facilities are more vulnerable to the COVID-19 pandemic, in terms of disease spread and mortality rate	Yes	Full review	Other	Salcher-Konrad M, Jhass A, Naci H, Tan M, El-Tawil Y, Comas-Herrera A. COVID-19 Related Mortality and Spread of Disease in Long-Term Care: First Findings from a Living Systematic Review of Emerging Evidence. MedRxiv 2020.
	Pandemic tracking
		Levels of re-emergence that trigger action
	Vaccination
		Vaccines to prevent other infections
Future possible public-health measures
	Vaccination (susceptibility reduction)
		Supporting discovery of a vaccine to prevent COVID-19 (followed by its production, distribution, administration)