The effects of public health and social measures (PHSM) implemented during the COVID-19 pandemic: An overview of systematic reviews

Abstract

Introduction

To systematically review the effectiveness and unintended health and socioeconomic consequences of public health and social measures (PHSM) aimed at reducing the scale and risk of transmission of coronavirus disease 2019 (COVID-19).

Methods

This review followed guidance about overviews of reviews in the Cochrane handbook for systematic reviews of interventions and used the Epistemonikos database's COVID-19 Living Overview of Evidence repository as a primary search source. Methodological quality was evaluated using the Measurement Tool to Assess Systematic Reviews (AMSTAR 2) checklist.

Results

A total of 94 reviews were included, of which eight (9%) had “moderate” to “high” confidence ratings on the AMSTAR 2. Of 16 reviews (17%) reporting applying the GRADE framework, none found high certainty evidence for any of our outcomes of interest. Across the 94 reviews, the most frequently examined PHSM were personal protection (n = 18, 19%). Within multicomponent interventions, so-called “lockdown” was the most frequently examined component (n = 39, 41%). The most frequently reported outcome category was non-COVID-19-related health outcomes (n = 58, 62%). Only five (5%) reviews reported on socioeconomic outcomes. Findings from the eight reviews with moderate or high confidence ratings on AMSTAR 2 are narratively summarized. There is low-certainty evidence that multicomponent interventions may reduce the transmission of COVID-19 in different settings. For active surveillance and response measures, low-certainty evidence suggests that routine testing of residents and staff in long-term care facilities may reduce the number of infections, hospitalizations, and deaths among residents. We found very low-certainty evidence about the effectiveness of personal protection measures, travel-related control measures, and environmental measures. Unintended consequences were rarely examined by those eight reviews.

Conclusion

We found predominantly low- to very low-certainty evidence regarding the effectiveness and unintended consequences of PHSM in controlling the risk and scale of COVID-19 transmission. There is a need to improve the conduct and reporting of systematic reviews.