Results of the meta-analysis showed that adoption of NPHIs has resulted in a 4.68% (95% CI, -6.94 to -2.78) decrease in daily case growth rates, 4.8% (95 CI, -8.34 to -1.40) decrease in daily death growth rates, 1.90 (95% CI, -2.23 to -1.58) decrease in the COVID-19 reproduction number, and 16.5% (95% CI, -19.68 to -13.32) decrease in COVID-19 daily ICU admission. Although studies were from both low-income and high-income countries, the majority of them were from the United States (13 studies) and China (five studies).
Finally, 35 articles qualified to be included in the systematic review among which 23 studies were included in the meta-analysis. Our search strategies in major databases yielded 12,523 results, which decreased to 7,540 articles after eliminating duplicates. Main outcomes included COVID-19 case growth rate (percentage daily changes), COVID-19 mortality growth rate (percentage daily changes), COVID-19 ICU admission (percentage daily changes), and COVID-19 reproduction number changes. Hartung-Knapp-Sidik-Jonkman random-effects model was performed.
We used PRISMA 2020 guidance for abstracting the data and used Cochrane Effective Practice and Organization of Practice (EPOC) Risk of Bias Tool for quality appraisal of the studies. Interventions were NPHIs categorized as lockdown, stay-at-home orders, social distancing, and other interventions (mask-wearing, contact tracing, and school closure). The PROSPERO registration number is CRD42020186855. Peer-reviewed quasi-experimental studies were included in the review. The key terms were primarily drawn from Medical Subject Heading (MeSh and Emtree), literature review, and opinions of experts. from late December 2019 to February 1, 2021. We searched relevant electronic databases, including Medline (via PubMed), Scopus, CINAHL, Web of Science, etc. In this systematic review, we aimed to examine the effects of NPHIs on the COVID-19 case growth rate, death growth rate, Intensive Care Unit (ICU) admission, and reproduction number in countries, where NPHIs have been implemented. Therefore, they cannot individually prove if these interventions have been effective in reducing the spread of the infection and its adverse health outcomes. Studies on the effectiveness of NPHSs are single studies conducted in specific communities. Despite available evidence regarding the effectiveness of NPHSs, there is still no consensus about how policymakers can trust these results. Non-Pharmaceutical Public Health Interventions (NPHIs) have been used by different countries to control the spread of the COVID-19.
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