Essay Sample: Are Public Health Interventions Effective in Reducing the Spread of Covid-19?

Introduction 

Covid-19 had a vast impact on the lives of the English population1 . There was significant stress upon the population, high burden on the NHS, and a loss in national and international business. To help control this spread and return to normality as quickly as possible, the UK government put forward a range of public health interventions. Initially introduced was the national lockdown, before gradual opening of some amenities. Next was the “hands, face, space” measures with promotion of hand washing, face masks and social distancing including the “rule-of-6”. The current regime promoted is the vaccine rollout. Other methods that have been promoted include test and trace, isolation after travel, local lockdowns, tiering systems, asymptomatic lateral flow testing, among many others2.  This essay aims to look at 3 of the main campaigns used and assess whether they were effective using both the statistics of spread during that period, as well as briefly looking at the scientific backing that each of the schemes had. 

Main issues

National Lockdown

The first public health measure to control the spread of covid-19 introduced in England was the national lockdown. On 16th March 2020 the government announced a closure of all non-essential shops, schools, and general guidance not to leave home unless essential, with specific emphasis on not mixing between separate households. This was in an effort to prevent any spread of Covid-19 in the general population on the basis that if people couldn’t see one another, they couldn’t spread the virus. 

Jarvis et al questioned 1356 on their contact habits between 24th-27th March 2020. They reported a 74% reduction in the average number of daily contacts, suggesting that the national lockdown implemented was effective at reducing the number of contacts made by the average person living in the UK. However, this data does not reflect under 18s, and as it was conducted in the first few days of lockdown, there may have been an increase in support of the lockdown, which then dwindled in the following weeks and months. Furthermore, it may be unreliable to ask individuals to self-report their own habits due to recall bias leading to inaccurate results, and self-desirability bias due to individuals not wanting to report that they have broken the law. 3 

Mahase researched into how effective a reduction in contacts actually is on the preventing the spread of covid-19. They looked at one the Italian village of Vo with a population of 3275, finding that pre-lockdown 2.6% of the population tested positive for Covid, and after a 2 week lockdown, this fell by more than half to 1.2%, where in both instances most the population were tested regardless of symptoms.  This shows a significant impact on the spread of the virus. The droplet spread of covid means that without close contact, it is far less likely to spread between individuals. They modelled that without the lockdown measure, 86.2% of the population would have tested positive in this two week period. However in this research there are confounding factors such as the fact that the initial 2.6% may have natural immunity and thus be less susceptible, meaning that naturally the percentage of people testing positive would fall. Also, the PCR tests used are now not recommended to be used within 90 days of a positive test as they can lead to false positive results which could further alter the final results4. 

On the week commencing the 16th March, there were 6431 cases reported, and on the week commencing 1st June, there were 7495 cases reported 5, showing there was not a drastic change in cases from the beginning to the end of this phase. 

Therefore, the national lockdown did at least to some extent control the spread of covid-19 in England. 

Hands, Face, Space

On the 9th September 2020 the government launched the now famous “Hands, Face, Space” initiative to control the spread of Covid-19. The purpose of this campaign was to encourage thorough and frequent hand washing, the proper use of high-grade face masks, and social distancing of 2m to non-household contacts. 

In May 2020, Xiao et al published a meta-analysis looking at the effectiveness of hand washing and other non-pharmacological measures of preventing the spread of illness. They used evidence from 14 randomised control trials and found that these measures did not have a significant effect on reducing the spread of influenza. 6The reason for this is unclear, and may be due to poor hand-washing methods as opposed to it being ineffective in itself. During the Covid-19 pandemic, the UK government did promote proper hand washing technique (washing for at least 20 seconds, washing frequently etc), but it is unclear whether these public health messages were effective 7.

Laing et al performed a meta-analysis of data regarding the effectiveness of face masks. They looked at 21 studies, and found that in healthcare workers, mask use reduced risk of contracting respiratory virus infections by 80%. In non-healthcare workers, mask use reduced risk by 47%. They discussed the reasons for mask effectiveness, mainly the physical barrier that a mask forms, preventing droplet spread. They also mentioned the possible causes for why in non-healthcare workers the effectiveness is reduced, such as the use of “social masks” as opposed to medical grade. However, any level of reduction in spread of Covid-19 should mean that they are an effective measure in helping to control the spread8.

Jarvis et al researched into how effective the social distancing methods were in England. They found that after each change in social distancing rules, the number of daily contacts did decrease. They did find that some of the specific methods were not as effective as a national lockdown however. As stated previously, the national lockdown reduced daily contacts by 74%3, but the rule of six made little difference, with most people reporting 2 daily contacts before and after this rule was introduced. This data may be inaccurate however, as peoples daily contacts will have already been reduced due to pre-existing measures9.

On the week commencing 2nd September 2020, there were 18,580 covid cases reported in England by specimen date, and on the week commencing 2nd November 2020, there were 89,908 cases5 , a rise by almost 5 times. 

The “Hands, Face, Space” scheme does make sense in principle and if it could be followed perfectly it may indeed help control the spread of the virus, but in reality the methods are not perfectly executed, and thus this campaign may be deemed as much less effective than the previous lockdown measures. 

Vaccination 

On the 30th December 2020, the first vaccine was approved for use in the UK2. The national vaccine rollout scheme has been a continuous process since then, with the promotion of 2 initial vaccines given 12 weeks apart, and then a booster vaccination. Initially the astrazeneca vaccine was mainly used, but after recent information regarding side effects and long term effects the Pfizer and Moderna vaccines are being used primarily.

Zheng et al performed a meta-analysis of the effectiveness of the Covid-19 vaccination programme. They used 51 studies and found that in fully vaccinated populations, there is a 89.1% reduction in severe covid-19 infection. Furthermore, they found that the vaccine had the lowest efficacy in elderly populations, with only 83.8% reduction in infection10. Their research only looked at the Pfizer-BioNTech, Moderna and CoronaVac vaccines, and hence may not be completely applicable in England due use of the Astrazenica vaccine. The Pfizer vaccine was found to be less effective than the moderna, at 91.2% and 98.1% respectively10. In theory the use of the vaccine will reduce risk of severe covid-19 infection, and if there is a less severe infection, there will be less symptoms and thus less droplets to spread. 

It is yet to be seen how effective the vaccine may be over time and as of February 2022 this is the main public health campaign being used. The vaccine does have scientific backing and therefore should be at least somewhat effective at controlling the spread of covid-19. 

Conclusion

The public health methods looked at in this essay were all at least partially effective at controlling the spread of the virus. Without any measures, it is likely that the cases would have been astronomically higher, and thus any measures that are introduced that prevent that must be deemed to have some efficacy. Of the measures looked at in this essay, vaccine rollout seems to be the most effective method of controlling he spread, with a 89.1% reduction in severe infection, followed by lockdown with a reduction by just over half, and then “hands, face, space” with varying degrees of success. However it cannot be ignored that during this pandemic in England there have been over 139,000 deaths from Covid-195. No measure can be 100% effective at controlling spread, but this is far from that. Different measures may have scientific backing, but in reality they may not work as well, such as the rule-of-6 having little impact on number of contacts. In summary, the methods did help control the spread, but to varying degrees, and they helped less in reality than they did theoretically.