What are the non-pharmaceutical management strategies for Covid-19 (Coronavirus disease 2019)?

Non-Pharmaceutical Management Strategies for COVID-19

The most effective non-pharmaceutical management strategies for COVID-19 include mask use, hand hygiene, social distancing, case isolation, and quarantine measures, which should be implemented in combination rather than as isolated interventions to effectively reduce viral transmission and mortality. 1

Infection Prevention and Control Measures

Personal Protective Equipment (PPE)

• Masks and Respirators:

  • Healthcare workers should use appropriate respiratory protection (N95 respirators preferred, surgical masks as alternative) 1, 2
  • General public should wear masks in public settings 1
  • Cloth masks should not be used in healthcare settings when surgical masks or N95 respirators are available 1

• Additional PPE for Healthcare Workers:

  • Gowns, gloves, and eye protection are recommended in healthcare settings 1, 2
  • Proper donning and doffing procedures are critical to avoid self-contamination 1, 2
  • Self-contamination often occurs during removal of PPE, emphasizing the need for training 1

Hand Hygiene

• Frequent handwashing with soap and water for at least 20 seconds 2
• Use of alcohol-based hand sanitizers when soap and water are not available 1
• Hand hygiene should be performed before and after patient contact 2

Social Distancing and Isolation Measures

Case Isolation

• Symptomatic cases should remain at home for 7 days 1
• All forms of social contact must be avoided by symptomatic individuals 1
• Immediate isolation of suspected cases in healthcare settings, preferably in negative pressure rooms 1, 2

Quarantine Measures

• Household members of symptomatic cases should quarantine for 14 days 1
• This measure decreases contacts outside the household by 75% 1
• Travelers arriving from affected areas should be quarantined 3

Social Distancing

• Maintain at least 2 meters distance from others when possible 1
• Avoid gatherings and congregations of any size 1
• Use remote technology to keep in touch with friends and family 1
• Avoid non-essential use of public transport 1
• Work from home arrangements should be made when possible 1

Facility-Based Measures

• Closure of schools and universities 1, 3
• Restriction of mass gatherings 3
• City lockdowns when appropriate 3
• Travel restrictions and border measures 3

Healthcare Setting Considerations

Patient Management

• Immediately provide surgical masks to patients with suspected infection 2
• Place patients in negative pressure isolation rooms or single rooms if negative pressure is not available 2
• Maintain a list of all staff who have contact with infected patients 2
• Restrict visitors to only next of kin/legal guardian 2

Staff Safety

• Healthcare workers should self-monitor for symptoms for 10 days after exposure 2
• Staff should not come to work if they develop fever 2
• Avoid aerosol-generating procedures whenever possible 1, 2
• Surface decontamination of mobile phones and hospital equipment 1

Implementation Considerations

Timing and Duration

• Implementation timing is critical - earlier implementation of control measures has been shown to prevent approximately 67% of cases 1
• Measures may need to remain in place for extended periods (potentially 5+ months) 1
• Lifting measures prematurely may lead to a second peak of infection 1

Combined Approach

• Multiple interventions used together are more effective than single measures 3, 4
• An "adaptive triggering" strategy with "on" and "off" thresholds may be necessary for long-term management 1

Common Pitfalls to Avoid

• Delaying isolation of suspected cases 2
• Inadequate use of appropriate PPE 2
• Failure to notify public health authorities promptly 2
• Performing aerosol-generating procedures without proper precautions 2
• Neglecting to maintain a list of exposed healthcare workers 2
• Premature lifting of control measures 1
• Relying on single interventions rather than a combination approach 3, 4

Non-pharmaceutical interventions remain the cornerstone of COVID-19 management, particularly when implemented early and in combination. These measures have been shown to effectively reduce transmission, prevent healthcare system overload, and ultimately reduce mortality and morbidity associated with COVID-19 3, 4.