The non-pharmaceutical interventions (NPI, for its acronym in English) are public health measures that aim to prevent and/or control the transmission of SARS-CoV-2 in the community. After vaccination, NPIs are the most effective public health interventions against COVID-19. According to the European Center for Disease Prevention and Control (ECDC), interventions include individual measures (such as hand hygiene and the use of masks), other group measures (such as ventilation of classrooms or offices) and others. general (such as limiting meetings, working from home, or remote education)
Thanks to their initial implementation, NPIs have played a fundamental role in reducing transmission rates and the impact of COVID-19 in the European Union, according to the ECDC and became the main tool until the vaccine became available.
They are not homogeneous
There are numerous studies that speak of its positive effect. According to research published in Frontiers in Public Health, NPIs were associated with a slower spread of COVID-19 in those cities that complied with the measures. The length of time they were in effect also contributed to a lower rate of cases. But this study also highlights that there is no homogeneity in the NPIs. The socioeconomic level of the population It is a very important variable to take into account since lower income means less compliance with regulations. The start of measures also influences: many regions responded quickly with NPI measures for the entire population, while others delayed this response and obtained less favorable results. The weather It is another variable that the study has pointed out. For example, higher minimum temperature and specific humidity were associated with higher mortality rates.
It should also be noted that most NPIs can have a negative impact on the general well-being of people, the functioning of society and the economy, As they point out from the ECDC: “therefore, its use must be guided by data on the local epidemiological situation, with the general objective of protect the most vulnerable people in society. Specific recommendations to protect the most vulnerable include enhanced surveillance, extensive testing, and intensified infection prevention and control practices in settings that house high-risk individuals, such as long-term care facilities.” It is also effective to impose travel restrictions on those coming from countries or areas that have not yet achieved transmission control. This, according to the data, will make a significant difference in the epidemiology of SARS-CoV-2 within the population.
Another study, published in the European Journal of Epidemiology, with data from 37 OECD member states, shows that during the initial phase of the covid epidemic, restrictions on gatherings were very effective for transmission control. the requirements of workplace closures, school closure requirements and the use of masks, as well as the volume of antigen tests available also successfully reduced the average daily growth rate. “The use of NPI for epidemic control is important – the authors point out -, even with current advances in immunization. To the extent that SARS-CoV-2 transmission is active, the virus will mutate, and some mutations may increase infectivity, virulence, and/or lethality. Currently available vaccines prevent the development of severe forms of covid, but it is not fully known how much they prevent transmission of the virus.
Masks and capacity, the most effective measures
One of the latest studies linked to the effectiveness of NPIs, published this week in Health Affairs, has focused on one of the countries most affected by the pandemic: Brazil. When the first cases of the infection appeared in this country, at the end of February 2020, the twenty-seven Brazilian states responded by implementing a variety of non-pharmaceutical interventions: restrictions on public events, schools and non-essential commerce, and somewhat later, the mandatory use of masks. Those responsible for the study, led by Louise Russell of the University of Pennsylvania, estimated the independent effects of seven of these non-pharmaceutical interventions on the number of cases and deaths from COVID-19 in twelve Brazilian states.
The findings showed that there was two interventions that unequivocally tipped the balance: restrictions on public events and the mandatory use of masks. Both significantly reduced the spread of the disease. Total restrictions on public events decreased the infection rate by 90%. At the same time, partial restrictions on public events were equally effective, suggesting that some relaxation was possible without increasing cases. The mandatory use of a mask had a similar impact. Russell’s team pointed out that the combined effect of suspending public events and imposing the use of masks reduced the growth rate to almost 1, the point at which cases are no longer increasing.
“The selective use of non-pharmaceutical interventions is important in all countries to minimize economic and social burdens in controlling the pandemic – the authors conclude – but it can be especially important in low- and middle-income countries such as Brazil, that has more workers in informal jobs that lack security, network services, infrastructure for distance learning, and less ability to stimulate their economies.”
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