Table 1.
Community non-pharmaceutical interventions used during the COVID-19 pandemic
| Category of NPI | Description | Mitigation objective |
|---|---|---|
| Individual or personal level | ||
| Face masks | Use of masks that cover the nose and mouth. Effectiveness depends on proper use and fitting, the particle size filtering efficiency of the material used, the amount of use and reuse, and virus levels in the respiratory tract of the symptomatic or asymptomatic infected wearer (for source control) or in expelled particles of the infected individuals (for prevention) | Reduce virus transmission to and from individuals by mitigating dispersal of respiratory droplets and aerosols containing infectious virus |
| Respiratory etiquette | Cover coughs and sneezes of symptomatic persons with tissues, sleeves and elbows and avoid the use of hands | Limit virus transmission by reducing suspension and dispersal of respiratory droplets and aerosols containing infectious virus expelled by symptomatic infected persons to the surrounding environment, hands, and high-touch surfaces |
| Hand hygiene | Hand washing with soap and water or hand sanitation with an alcohol-based hand sanitizer | Reduce virus transmission through contact with surfaces and fomites |
| Social distancing | Maintain a separation of 2 m or more from others and avoid crowds | Reduce likelihood of virus transmission through respiratory droplets and aerosols from infected persons to exposed persons |
| Screening and isolation of sick individuals | Physically separate ill individuals from others at home, in public, at school and at work, combined with virus testing | Reduce virus transmission from infected symptomatic persons during the infectious period to close contacts (does not identify infected persons who are asymptomatic/presymptomatic) |
| Quarantine of exposed individuals in the community | Identify exposed individuals and encourage or require them to stay at home. Monitor them for the onset of symptoms, combined with virus testing | Identify high-risk exposures early and mitigate virus transmission to others before a potentially infected individual is contagious. Identify infected contacts and isolate them early in the infection course to further reduce spread to their contacts |
| Community | ||
| Face mask mandates in public spaces | Require the use of face masks in closed public settings and on public transportation | Limit virus transmission in situations with limited ability for social distancing |
| School and childcare facility closures | Close childcare facilities and limit social gatherings outside school and childcare facilities | Reduce virus infections among members of vulnerable age groups that may have difficulty with implementation of individual or personal NPIs and reduce virus introduction into households and the risk of secondary transmission |
| Close schools, colleges and universities; implement distance learning | Reduce virus infections among paediatric and young adult populations in locations where social distancing may be difficult to implement and reduce virus introduction into households and the risk of secondary transmission | |
| Postponing or cancelling gatherings and events | Limit large gatherings, particularly in enclosed spaces | Reduce community virus transmission and burden of infection |
| Stay-at-home and lockdown measures |
Close non-essential businesses and prohibit indoor dining at restaurants (with the option to offer takeaway orders only) Implement stay-at-home measures and limit movement in the community to essential workers |
Reduce community virus transmission and density of people in public spaces Maximize protection of essential workers to ensure essential businesses remain functional |
| Encourage teleworking in professions where in-person attendance is not essential | Reduce workplace virus transmission and encourage workers to stay at home when ill by allowing them to work as they are able. Minimize the impact on businesses | |
| Home delivery of necessities including groceries, food and medications | Reduce community spread of virus and protect essential workers in these fields. Reduce virus transmission in enclosed settings | |
| Contact tracing |
Identify and test exposed close contacts combined with quarantine Educate and promote individual or personal-level NPIs. Identify symptomatic high-risk individuals for early initiation of targeted pharmaceutical interventions |
Identify, evaluate, quarantine and monitor close contacts with high-risk exposures to reduce further virus transmission among first-responders, providers and patients in health care settings, residents of congregate settings, household members and individuals at high risk of disease complications. Provides surveillance data to quickly identify locations of outbreaks to provide appropriate education to mitigate further transmission |
| Reduction in public transport availability and use | Limit public transportation use except when essential. Limit availability of public transportation during periods of high community burden of infection | Minimize exposure and virus transmission in enclosed spaces where social distancing is difficult, and ventilation or air exchanges may be inadequate |
| Public health education | Distribute educational materials on individual and community mitigation strategies including updated information on virus transmission routes and dynamics. Use of multiple communication modalities, including social media | Provide individuals and the community with current information to prevent and control virus spread for themselves and others, and to combat misinformation |
| Community surveillance | Routine screening and virus testing for communicable disease in specific community populations | Assess community burden of infection and reduce further virus spread, allowing rapid implementation of other community measures to mitigate community disease burden |
| Environmental | ||
| Air quality improvement | Upgrade and improve ventilation systems in homes and buildings in consultation with heating, ventilation and air conditioning professionals. Enhance air filtration, including the use of portable air filters, HEPA filters, improvements to central air filtration and the use of restroom exhaust fans | Reduce the concentration of viral particles in the air in enclosed spaces to reduce transmission in enclosed spaces, including workplaces, health care settings, public indoor spaces and congregate settings |
| Increase air exchanges through opening of windows and doors and the use of fans particularly when indoor social distancing may not be possible | Reduce the concentration of viral particles in the air at home to reduce transmission, particularly in situations where social distancing may be difficult and in homes with a high density of people | |
| Use of ultraviolet germicidal irradiation where other systems may not be available | Reduce the concentration of viable viral particles in the air capable of causing infection to reduce transmission where other forms of air filtration are not available | |
| Disinfection of high-touch surfaces | Routine surface cleaning of high-touch objects, including toys, refrigerator handles, desks, doorknobs, railings, bathroom fixtures | Reduce transmission of virus from fomites, including in community health care settings |
| Country policies | ||
| Border closures | Restrict travel into countries and between political borders | Reduce the introduction of virus from geographic locations with a high burden of infections. Limit the introduction of asymptomatic and symptomatic infected people. Slow down the introduction of virus and variants of concern |
| Health screening at points of entry/exit | Identify infected individuals through various screening methods before they leave or enter a country. Screening and virus testing of symptomatic persons or testing of all persons | Reduce or slow down international spread of virus in or out of a country, including for variants of concern |
| Quarantine measures for inbound travel | Quarantine of inbound travellers to certain countries and locations upon entry | Reduce the introduction of virus into a country, including from infected persons in their incubation period who are asymptomatic/presymptomatic or who have not yet yielded a positive test result |
| Travel advisories, mandates and restrictions | Require negative test results and/or up-to-date vaccination | Reduce the spread of virus from infected individuals |
| Travel alerts to visiting locations with a high burden of infection | Educate individuals before travel, including to practise precautions or to avoid non-essential travel, particularly to locations with a high burden of infection, and provide educational materials to visitors to these locations when travel is necessary | |
| Face mask mandates for air travel | Reduce the spread of virus when social distancing may not be possible. Limit virus transmission from asymptomatic and minimally symptomatic infected individuals | |
| Zero COVID-19 policy | NPIs and vaccination implemented at all community levels. Isolation of ill individuals and quarantine of exposed close contacts. Restriction of movement in the community | Contain and suppress levels of community infections to prevent sustained virus spread |
HEPA, high-efficiency particulate air; NPI, non-pharmaceutical intervention.