WHO REGIONAL OFFICE FOR AFRICA COVID-19 RAPID POLICY BRIEF SERIES SERIES 6: COVID-19 PREVENTION
NUMBER 006-01: Effectiveness of different hygiene practices in interrupting household and community transmission of COVID-19
Based on information as at 29 October 2020
Rapid Policy Brief Number: 006-01 - Effectiveness of different hygiene practices in interrupting household and community transmission of COVID-19
WHO/AF/ARD/DAK/18/2020
© WHO Regional Office for Africa 2020
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RAPID POLICY BRIEF 1
NUMBER: 006-01
RESEARCH DOMAIN: COVID-19 prevention
TITLE: Effectiveness of different hygiene practices in interrupting household and community transmission of COVID-19 RAPID POLICY BRIEF NUMBER: 006-01
1 RAPID POLICY BRIEF NUMBER: 006-01
2 RESEARCH DOMAIN: COVID-19 prevention
3 TITLE: Effectiveness of different hygiene practices in interrupting household and community transmission of COVID-19
4 DATE OF PUBLICATION: 15/12/2020
5 BACKGROUND
Coronavirus disease 2019 (COVID-19) continues to spread globally, overtaking the capacity and resources of health systems worldwide. A therapeutic vaccine is not yet available, and preventive measures are the up-to-date approach to control the transmission of cases [1]. As the virus is highly contagious via respiratory route (droplets from infected persons, widely spread by coughing or sneezing) and via contact with contaminated surfaces, community transmission and spread can be decreased through non-pharmaceutical interventions (NPIs). This includes practice of social distancing, avoiding group gatherings, regular and diligent hand washing with soap and water or sanitizer, community mask wearing[2]. The population level NPIs that was effective in flattening the COVID-19 epidemic curve in China was national emergency response and travel ban [3]. The effect of other NPIs have not been explored extensively and empirically?
6 SEARCH STRATEGY / RESEARCH METHODS
A systematic search of the following databases was conducted to obtain peer review literature published between December 01, 2019 and October 29, 2020: PubMed, WHO COVID-19 database and Index Medicus. The search term - (COVID-19 or SARS-CoV-2) and (hygiene practices) was left broad to avoid missing any potential study for inclusion. The initial output was to explore papers on the subject and scoped Africa related evidences. With this search strategy, 407 titles and abstracts of studies were found. The full text of 22 articles were further reviewed to determine their final inclusion or not, only 4 was retained according to criteria of consistency to assesses the effectiveness of different hygiene practices in interrupting the community transmission of COVID-19.
7 SUMMARY OF GLOBALLY PUBLISHED LITERATURE RELATED TO THE SUBJECT
Using nationally represented data in Bangladesh, Ahmed and Yunus showed that COVID-19 significantly increased at a higher pace where the prevalence of household handwashing practice is low. Regions with. the hardest hit of COVID-19 had handwashing practice was about 50%. A household is considered to be practicing handwashing if: (1) there was a designated place where members of the household most often wash their hands, (2) availability of water at the place of handwashing and (3) detergent or soap is available at the place of handwashing. It is important to note that these variables were measured by direct observation and not self-reported [4]
Beale et al further established how hand hygiene mitigate the spread of COVID-19. In their report, relationship between frequency of handwashing and risk of coronavirus infection was measured.
This revealed that moderate-frequency handwashing was associated with significantly reduced overall risk of coronavirus infection compared to low handwashing, (risk ratio 0.64, 95%
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confidence interval 0.42 to 0.99). For higher handwashing intensity there was no significant effect (risk ratio 0.83, 95% confidence interval 0.53 to 1.30). This is the first empirical study to examine personal protective effect of hand hygiene in a community setting [5].
Bielecki et al revealed that social distancing can reduce the spread of SARS-CoV-2 and can also prevent the outbreak of COVID-19. This was proved in a somewhat homogenous study that consists of 354 young predominantly male adults who are soldiers infected prior to the implementation of social distancing and hygiene measures, 30% fell ill from COVID-19. While no soldier in an alternate group of 154, in which infections was observed after implementation of social distancing, developed COVID-19 despite the detection of viral RNA and virus specific antibodies [6].
According to Wang et al household transmission (which is in turn the major means of community transmission) is a major driver of the epidemic and this is largely due to a primary case without precautionary measure. In this study, even though the outcome of interest was secondary transmission in the household, three major preventive measures were analyzed in this study: (1) face mask use (2) daily use of ethanol-based disinfectant and (3) social distancing. The use of facemasks by primary case and contacts before the primary case developed symptoms was 79%
effective in reducing transmission (odds ratio 0.21, 95% confidence interval 0.07 to 0.79). Daily use of chlorine or ethanol-based disinfectant in households was 77% effective (odds ratio 0.23, 95%
confidence interval 0.07 to 0.84). The risk of household transmission was 18 times higher and 4 times higher with frequent close contact and if the primary case had diarrhea respectively. This cohort study confirms that the highest risk of transmission is prior to onset of symptoms, as wearing a mask after onset of illness of the index case was not substantially protective [7].
Current clear evidence has shown that using universal facemask provides risk reduction for families living with someone in isolation, quarantine and community transmission.
8 SUMMARY OF AFRICA-SPECIFIC LITERATURE ON THE SUBJECT
While most of the studies on hygiene practices in Africa were focused on knowledge, attitude and perception of COVID-19, we found none with empirical evidence on effectiveness of any transmission routes.
9 POLICY FINDINGS
With limitations in treatment options and vaccine development underway, preventive measures remains the best practice to flatten the pandemic curve.
Some effective measures are active disease surveillance
Physical/social distancing
Routine wearing of masks in public
Frequent hand washing
The stronger and faster these measures are deployed, the optimal control can be obtained.
It has been estimated that earlier interventions of 1 to 2 weeks could result in approximately and 55% reduction in mortality and 60% reduction of new cases [8]
Strong public and government commitment in adhering to these measures intensively is required.
The role of the government in achieving this hygiene practices cannot be over emphasizes as
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TITLE: Effectiveness of different hygiene practices in interrupting household and community transmission of COVID-19 RAPID POLICY BRIEF NUMBER: 006-01
access to water for the populace is crucial in increasing frequency of handwashing [9]. For instance, Ahmed et al measured variables such as improved water source and toilet facility as certain characteristics of the HHs in relation to hand washing practice [4].
It is therefore critical to ensure that the rate-limiting step in bringing about in-frequent hand washing and hygiene need to be addressed. Furthermore, the messaging and to the general public must be precautionary measures specifics and details of how it should be done be addressed in such message, while considering context.
10 ONGOING RESEARCH IN THE AFRICAN REGION Not found
11 AFRO RECOMMENDATIONS FOR FURTHER RESEARCH Additional areas for evidence in the region include:
Researchers are encouraged to scientifically explore the effectiveness of this various measure in the African setting, as the limited evidence available may not be generalizable. For
instance, the generalizability of the Bielecki et al study in an heterogeneous population may give varying outcome
Development of safety and hygiene guideline contextualized to the African region which can be further adapted by countries should be considered
Research focusing on the various hygiene practice in the African context is greatly encourages. Of importance currently, is evidence in the various hygiene practices in the
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12 REFERENCES
1. Cascella, M., et al., Features, evaluation and treatment coronavirus (COVID-19), in Statpearls [internet]. 2020, StatPearls Publishing.
2. Control, C.f.D. and Prevention, Recommendation regarding the use of cloth face coverings, especially in areas of significant community-based transmission. Colorado: CDC, 2020.
3. Tian, H., et al., An investigation of transmission control measures during the first 50 days of the COVID-19 epidemic in China. Science, 2020. 368(6491): p. 638-642.
4. Ahmed, M.S. and F.M. Yunus, Trend of COVID-19 spreads and status of household handwashing practice and its determinants in Bangladesh - situation analysis using national representative data. Int J Environ Health Res, 2020: p. 1-9.
5. Beale, S., et al., Hand Hygiene Practices and the Risk of Human Coronavirus Infections in a UK Community Cohort. Wellcome Open Research, 2020. 5(98): p. 98.
6. Bielecki, M., et al., Social distancing alters the clinical course of COVID-19 in young adults: A comparative cohort study. Clinical Infectious Diseases, 2020.
7. Wang, Y., et al., Reduction of secondary transmission of SARS-CoV-2 in households by face mask use, disinfection and social distancing: a cohort study in Beijing, China. BMJ Global Health, 2020. 5(5): p. e002794.
8. Pei, S., S. Kandula, and J. Shaman, Differential Effects of Intervention Timing on COVID- 19 Spread in the United States. medRxiv, 2020.
9. Malathum, K. and P. Malathum, The COVID-19 Pandemic: What We Have Learned from Thai Experiences. Pacific Rim International Journal of Nursing Research, 2020. 24(4): p. 431- 435.
BRIEF PRODUCED BY: Information Management Cell, of the WHO AFRO Regional Office / IMST and the Cochrane Africa Network
