Volume 26, Number 5—May 2020
Nonpharmaceutical Measures for Pandemic Influenza in Nonhealthcare Settings—Social Distancing Measures
|Intervention||Knowledge gaps||Suggested studies|
|Isolation of sick persons
||Few observational studies use laboratory-confirmed influenza as outcome and study isolation as a single intervention; most observational studies were in atypical settings; transmission dynamics of influenza: role of presymptomatic contagiousness, fraction of infections that are asymptomatic, duration of infectivity; optimal strategy for symptomatic persons, trigger to stop isolation
||Randomized trials in community settings to evaluate the effectiveness of voluntary isolation against transmission of laboratory-confirmed influenza; epidemiologic studies to understand transmission dynamics of influenza, including symptomatic profiles and duration of infectiousness; compliance of the public with voluntary isolation at home
||Value of adding contact tracing on top of other existing interventions remain unclear; strategy for feasible implementation
||Might not be a research priority for pandemic preparedness because of the lack of feasibility of this intervention
|Quarantine of exposed persons
||Few observational studies use laboratory-confirmed influenza as outcome and provide evidence on the effect of quarantine as a single intervention or the value quarantine adds to existing interventions; transmission dynamics of influenza: fraction of infections that are asymptomatic, possibility of superspreaders; optimal duration of quarantine
||Randomized trials in community settings to evaluate the effectiveness of quarantine against transmission of laboratory-confirmed influenza; epidemiologic studies to understand transmission dynamics of influenza including the incubation period and the asymptomatic fraction
||Triggers to close and reopen schools; optimal timing and duration of school closures, taking into account the possible disruptions to the public; compliance of persons of different socioeconomic status; alternative school-based measures, such as staggering lunch breaks and increasing spacing between desks: feasibility and effectiveness
||Observational studies on optimal closure triggers and duration, taking into account the possible disruptions brought by school closures; comprehensive review of the acceptance and compliance of the interventions by different subgroups of the population; develop tools to enable real-time estimation of epidemic or pandemic growth, and the effect of implementing closures at different time points of the epidemic/pandemic; while school-based measures were not specifically covered in our systematic review, it would be useful to examine randomized trials of measures to prevent influenza transmission in schools, such as increasing spacing between desks during influenza seasons
|Workplace measures and closures
||Triggers to close and reopen workplaces; optimal timing and duration of workplace closure, taking into account the possible disruption to the public; alternative workplace measures (e.g., improving teleworking infrastructure, or providing segregated working areas for persons with mild symptoms): feasibility and effectiveness, cost-benefit
||Randomized control trials to evaluate the effectiveness of workplace measures (e.g., telework from home, staggered shifts, weekend extension and paid-leave policies) against laboratory-confirmed influenza transmission; studies on optimal triggers, timing and duration for workplace measures and closures, taking into account the possible disruptions caused by workplace measures; cost-benefit analyses of alternative workplace measures
||Methods to reduce population density in different settings (e.g., transport hub, mass events, and public places): feasibility and effectiveness
||More observational or simulation studies on the alternative methods to avoid crowding in different settings.
|Combined interventions||Limited evidence on synergy of alternative interventions or the best combinations of interventions||Policy studies to identify feasible interventions that would complement each other when combined|
1These first authors contributed equally to this article.
Page created: April 16, 2020
Page updated: April 16, 2020
Page reviewed: April 16, 2020
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