Effectiveness of social distancing measures and lockdowns for reducing transmission of COVID-19 in non-healthcare, community-based settings.

Social distancing measures (SDMs) are community-level interventions that aim to reduce person-to-person contacts in the community. SDMs were a major part of the responses first to contain, then to mitigate, the spread of SARS-CoV-2 in the community. Common SDMs included limiting the size of gatherings, closing schools and/or workplaces, implementing work-from-home arrangements, or more stringent restrictions such as lockdowns. This systematic review summarized the evidence for the effectiveness of nine SDMs. Almost all of the studies included were observational in nature, which meant that there were intrinsic risks of bias that could have been avoided were conditions randomly assigned to study participants. There were no instances where only one form of SDM had been in place in a particular setting during the study period, making it challenging to estimate the separate effect of each intervention. The more stringent SDMs such as stay-at-home orders, restrictions on mass gatherings and closures were estimated to be most effective at reducing SARS-CoV-2 transmission. Most studies included in this review suggested that combinations of SDMs successfully slowed or even stopped SARS-CoV-2 transmission in the community. However, individual effects and optimal combinations of interventions, as well as the optimal timing for particular measures, require further investigation. This article is part of the theme issue 'The effectiveness of non-pharmaceutical interventions on the COVID-19 pandemic: the evidence'.

An extensive re-evaluation of evidence and analyses of the Randomised Badger Culling Trial (RBCT) I: Within proactive culling areas.

Here, in the first of two investigations, we evaluate and extend the analyses of the Randomised Badger Culling Trial (RBCT) to estimate the effectiveness of proactive badger culling for reducing incidence of tuberculosis (TB) in cattle within culling areas. Using previously reviewed, publicly available data, alongside frequentist and Bayesian approaches, we re-estimate culling effects for confirmed incidence of herd breakdowns (TB incidents in cattle) within proactive culling areas. We appraise the varying assumptions and statistical structures of individual models to determine model appropriateness. Our re-evaluation of frequentist models provides results consistent with peer-reviewed analyses of RBCT data, due to the consistency of beneficial effects across three analysis periods. Furthermore, well-fitting Bayesian models with weakly informative prior distribution assumptions produce high probabilities (91.2%-99.5%) of beneficial effects of proactive culling on confirmed herd breakdowns within culling areas in the period from the initial culls (between 1998 and 2002) until 2005. Similarly high probabilities of beneficial effects were observed post-trial (from 1 year after last culls until March 2013). Thus, irrespective of statistical approach or study period, we estimate substantial beneficial effects of proactive culling within culling areas, consistent with separate, existing, peer-reviewed analyses of the RBCT data.

An extensive re-evaluation of evidence and analyses of the Randomised Badger Culling Trial II: In neighbouring areas.

In the second investigation in a pair of analyses which re-evaluates the Randomised Badger Culling Trial (RBCT), we estimate the effects of proactive badger culling on the incidence of tuberculosis (TB) in cattle populations in unculled neighbouring areas. Throughout peer-reviewed analyses of the RBCT, proactive culling was estimated to have detrimental effects on the incidence of herd breakdowns (i.e. TB incidents) in neighbouring areas. Using previously published, publicly available data, we appraise a variety of frequentist and Bayesian models as we estimate the effects of proactive culling on confirmed herd breakdowns in unculled neighbouring areas. For the during trial period from the initial culls until 4 September 2005, we estimate consistently high probabilities that proactive culling had adverse effects on confirmed herd breakdowns in unculled neighbouring areas, thus supporting the theory of heightened risk of TB for the neighbouring cattle populations. Negligible culling effects are estimated in the post-trial period across the statistical approaches and imply unsustained long-term effects for unculled neighbouring areas. Therefore, when considered alongside estimated beneficial effects within proactive culling areas, these conflicting adverse side effects render proactive culling complex, and thus, decision making regarding potential culling strategies should include (i) ecological, geographical and scientific considerations and (ii) cost-benefit analyses.