Physical interventions to interrupt or reduce the spread of respiratory viruses
Department of Health and Social Care
Cochrane Acute Respiratory Infections Group
Acute respiratory infection (ARI) is the leading cause of infectious disease morbidity and mortality and imposes a significant burden on healthcare systems. Viral epidemics or pandemics of ARIs pose a global threat, such as severe acute respiratory syndrome (SARS) in 2003, influenza (H1N1) in 2009, and the current coronavirus pandemic (COVID-19).  ARIs are complex syndromes. Agent-specific interventions or preventive measures are seldom completely effective. Physical methods have clear advantages in reducing ARI transmission: they can be implemented quickly, independent of specific infective agents, at local, or wider geographic or social sectors, and are relatively cheap.  This review assesses a range of interventions to prevent infection including physical barriers (e.g. masks), hygiene (e.g. handwashing), and distancing. For COVID-19, these are vitally important strategies that need a solid and reliable evidence-base.  The previous update of the review in November 2020 was partly funded by the World Health Organization. It has been cited 740 times and has contributed to global decision-making. It has also been cited in a guideline.1  This review is amongst the most highly accessed during the pandemic, and it is imperative it is kept up to date with evidence from recent trials in the context of COVID-19, e.g. DANMASK.2  1. [S1-Guideline: Prevention of infection by wearing masks] Bartenschlager, Becker, Brandt, Dittmer, Eckerle, Liese, Mattner, Vogel, Wessels, Ziebuhr Deutsche Gesellschaft für Hygiene und Mikrobiologie, Gesellschaft für Virologie, Publication date: November 2020 2. https://clinicaltrials.gov/ct2/show/NCT04337541
3.1 Primary prevention interventions to modify behaviours or promote well-being / ESP