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Vaccines and medicines are in the spotlight when it comes to the fight against Corona. The so-called non-pharmaceutical measures, on the other hand, are less glamorous. But they played a crucial role in fighting the pandemic, says Udo Buchholz, who is responsible for infectious diseases of the respiratory tract at the Robert Koch Institute: “Especially in the first year. Of course, the pharmacological measures, in particular the vaccines, were not yet available. The focus was on the non-pharmacological ones and we were able to achieve quite a lot.”
The non-pharmacological measures work through behavioral changes that break chains of infection, explains Munich public health researcher Eva Rehfuess: “For example, the mandatory home office regulation that we have experienced for a long time is primarily aimed at reducing contacts. But if you then have an additional obligation to wear a mask at work, it serves to make the contacts that continue to take place as safe as possible.”
Difficult to determine the effectiveness of individual measures
Rehfuess played a key role in the particularly well-documented guideline “Measures to prevent and control SARS-CoV-2 transmission in schools”. “All in all, there are three basic rules for non-pharmaceutical measures. The measures work through their interaction in the package of measures. Measures have to be adapted again and again for each context – for example cultural and sporting events, schools, kindergartens – but also for the respective phase of a pandemic. And thirdly, measures can only be effective if they are feasible and implemented correctly.”
However, it is precisely these three aspects that also make it difficult to precisely determine the effectiveness of a single measure – such as the obligation to wear masks in the classroom. It also depends on whether there are study groups in the school, which virus variant is currently circulating and whether everyone adheres to the guidelines and, for example, really does a test before the start of the lesson. Perhaps the many influencing factors are one reason why little research is being done in this area. The Bessi Collaboration on research into social, environmental and behavioral pandemic measures currently only has 18 published studies in this area, but 974 on vaccines or drugs.
“This is very astonishing given the role of non-pharmaceutical measures in controlling the pandemic and given their very diverse effects on our everyday life, but also on the economy,” says Eva Rehfuess.
Lockdown most effective – with social and economic consequences
One thing is clear: a lockdown is most effective because it prevents almost all social contacts. Restaurant closures alone halved the spread of the corona virus in the first wave in the United States. As a result, however, many companies had to give up permanently.
The effect of school closures is detectable, but smaller. As a side effect, they led to learning deficits, above all the pupils lacked social contacts. At the individual level, mouth and nose protection masks can greatly reduce the risk of infection. However, what is clearly documented today was disputed by many scientific organizations at the beginning of the pandemic. In retrospect, a clear mistake. Eva Rehfuss explains that not enough was known about the corona virus at the time: “And that’s why it’s not really surprising that our level of knowledge and, accordingly, some recommendations have changed again and again.”
Placebo-controlled studies are considered the ideal experimental design
Obtaining reliable data on the effect of non-pharmaceutical measures more quickly in the future – that is certainly an important lesson from the corona pandemic. But in practice this is difficult. Placebo-controlled studies are considered to be the ideal experimental design, for which schools are closed in one district, for example, while they remain open in the next. As a scientific experiment, however, this would hardly be politically feasible.
Udo Buchholz therefore advocates using more coincidences for research. In a British health department, for example, there was a software error that meant that the contacts of infected people could not be informed. As a result, the number of cases there rose faster than in the neighboring districts – a clear indication: contact tracing works! “Of course you can’t plan something like that. But then you have to seize the opportunity and say: Okay, let’s take a look and evaluate the whole thing,” said Buchholz.
Check whether infection control measures are also implemented
From the point of view of RKI researcher Udo Buchholz, it is also important to examine the extent to which infection control measures are implemented in parallel with the introduction of infection control measures. For example, the German Youth Institute systematically asked the day-care centers. Buchholz: “In this way you could make very good statements about which factors were really decisive. And unfortunately there was nothing like that at school level.”
Public health expert Eva Rehfuess demands that things run better in the future and that decision-makers get clarity more quickly about which measures make sense in individual cases and which do not: can be fetched from the drawer and moved.”
The World Health Organization is currently working on standards for studies on the relationship between health and social action. They should enable global comparisons between different approaches. However, this requires money. Pharmaceutical companies have been generously supported by governments around the world for good reason. “We just haven’t seen any comparable investment in the measures that actually restricted and affected us all enormously in everyday life,” says Eva Rehfuess.
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