May 6, 2020
A third of the world’s population is currently under lockdown. While this slows down the spread of COVID-19, it could lead to adverse health effects. Moreover, it has unprecedented implications for the global economy, and it raises serious ethical concerns. Meanwhile, some countries emphasize other measures, like contact tracing. Which measures are most effective? Which are most cost-effective? Evidence is urgently needed to guide policy and avoid unnecessary harms.
What is the evidence? When we started our search, we found that it looked slim. Indeed, earlier reviews have concluded that the evidence for these interventions is lacking (except for hand washing and face masks). But those reviews included only randomized trials (considered high-quality evidence).
In our systematic review, we included a broad range of study designs to summarize the evidence of all levels of strength and guide urgent decision making. In this context, we believe that evidence of lower quality is better than no evidence at all. Especially if it can help avoid unnecessary damage to the economy and other harms.
One such popular intervention is school closures, which currently affect over 1.5 billion (almost 90%) of the world’s students. This has been estimated to cost $10 to $47 billion (for 4 weeks) in the US alone. It could, however, lead to a greater number of deaths than it prevents by creating unintended downstream effects, such as child-care obligations and losses in health-care workforce capacity. Another intervention, contact tracing and case isolation, has been estimated to be 4,363 times more cost-effective than school closures for H1N1 influenza ($2,260 vs. $9,860,000 per death prevented). While these estimates of cost-effectiveness will vary for COVID-19, we believe that the above illustrates the urgent need for evidence on the effectiveness and cost-effectiveness of interventions available.
Our team has been working around the clock on a comprehensive review of the cost-effectiveness of social distancing and other epidemic control interventions. As states around the world vary in their urgent response to COVID-19, the evidence we are finding, interpreted with caution, could lead to more informed and cost-effective action and avoid unnecessary damage to the economy and other harms.
To learn more, see Evidence-based, Cost-effective Interventions to Suppress the COVID-19 Pandemic: a Rapid Systematic Review.
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