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Living Evidence - Risk mitigation strategies and levers

Living evidence tables provide high level summaries of key studies and evidence on a particular topic, and links to sources. They are reviewed regularly and updated as new evidence and information is published.

COVID-19 is highly transmissible and can be spread by people who do not know they have the disease. Community mitigation activities are actions that people and communities can take to slow the spread of a new virus with pandemic potential. As communities work to reduce the spread of COVID-19, they are also addressing the economic, social, and secondary health consequences of the disease.

Factors to consider for determining mitigation strategies include the level of community transmission, number and type of outbreaks in specific settings or with vulnerable populations, severity of the disease, the impact of community transmission on healthcare capacity, public health capacity, community characteristics such as the size if a community and level of engagement and support, and the epidemiology in surround jurisdictions.

While some strategies are distinct others are unified. While as a strategy, test, trace, isolate and quarantine are generally integrated, we have included these separately in the risk mitigation strategies below to provide clear evidence and examples of each component.

COVID-19 risk mitigation strategies

Strategy Vaccination

Evidence from the COVID-19 pandemic Evidence not specific to COVID-19 Considerations for community and population groupsLevers

Vaccines have proven safe, effective and lifesaving with estimated effectiveness against symptomatic COVID-19 disease ranging from 70% to 95%.

Concerns about vaccine safety and efficacy, access to vaccines, and inadequate information or misinformation are contributors to vaccine hesitancy.

Demographic factors are associated with vaccination intention and evidence suggests significant variability in vaccine intention rates worldwide.

Previous conditions suggest disparities in vaccination rates for people from culturally and linguistically diverse backgrounds living in Australia.

Barriers to immunisation for migrants, refugees and asylum seekers: language, cost, unfamiliarity with navigating healthcare and a lack of culturally appropriate services.

The Community Preventive Services Task Force (CPSTF) recommends home visits to increase vaccination rates.

Cultural and ethnic differences can increase COVID-19 vaccine hesitancy.

There are barriers to communicating COVID-19 vaccination information with culturally and linguistically diverse communities. Translated information can be slow and not available in all languages, and often ethnic newspapers are not effectively used to disseminate messages.

Effective platforms to deliver COVID-19 specific information can vary between cultural groups.

Mandate comprehensive and quality collection of data on cultural, ethnic and linguistic diversity as part of existing routine data collection systems.

Vaccine accessibility

Financial incentives

Information

Opinion and community leaders

Tailored communication

Campaigns

Population incentives (promise of greater mobility and less restrictions)

Strategy Contact tracing

Evidence from the COVID-19 pandemic Considerations for community and population groupsLevers

Contact tracing is effective in the prevention of COVID-19, and the World Health Organization has an operational guide.

Engagement with contact tracing relies on a sense of collective responsibility and outweighs other factors, including privacy concerns.

Digital contact tracing should be used in combination with manual contact tracing. It may be more beneficial in subpopulations even if uptake is low in the general population.

Some evidence for mass testing with contact tracing compared to test and trace for effective suppression.

Digital contact tracing may have equity implications for at-risk populations with poor internet and digital technology access.

Economic position and racial inequality are also associated with levels of trust in social institutions, including the healthcare system.

For some populations, there are immigration concerns for COVID-19 testing, contract tracing and treatment*^

Tailored communication

Cultural observances

Community health workers and contact tracers (bi-lingual)

Strategy Testing

Evidence from the COVID-19 pandemic Considerations for community and population groupsLevers

Quantitative reverse transcription-PCR (RT-qPCR) assay for COVID-19 using upper and lower respiratory tract specimens (nasopharyngeal swab, throat swab and sputum) is considered the gold standard for diagnosing COVID-19.

Different types of rapid COVID-19 tests are available:

  • Antigen tests – identify constituent proteins of the virus
  • Molecular tests – detect the viral RNA (often referred to as nucleic acid tests)
  • Antibody tests – detect SARS-CoV-2-specific antibodies produced after a person is infected.

A Cochrane systematic review of 22 antigen and molecular tests studies concluded that the evidence is not strong enough to determine how useful the tests are in clinical practice. Head-to-head comparisons are limited.

A living systematic review and meta-analysis on the accuracy of rapid antigen tests found that some available tests have high sensitivity for detecting SARS-CoV-2.

Systematic reviews and meta-analyses have reported that saliva offers sensitivity and specificity for detection comparable to the current standard of nasopharyngeal and throat swabs.

Modelling suggests minimising testing delay had a significant impact on reducing onward transmission.

In the UK, a pilot study offered close contacts of confirmed cases an option of daily testing using lateral flow device antigen tests at home instead of self-isolation for 10-14 days.   Rapid testing available through schools, colleges, nurseries and some universities and workplaces.

In Canada, there is rapid testing and screening in workplaces.

NSW: Employers, industries, schools and government agencies can implement rapid antigen testing screening.

The NSW Health State Health Emergency Operations Centre (SHEOC) operations rapid deployment plan outlines ongoing engagement and communication with the local community and community leaders to rapidly undertake

COVID-19 testing in the event of a major cluster.

Testing accessibility

Financial incentives

Non-financial incentives

Tailored communication

Opinion and community leaders

Community health workers and contact tracers (bi-lingual)

Strategy Physical distancing

Evidence from the COVID-19 pandemic Considerations for community and population groupsLevers

Physical distancing is associated with reducing the reproduction number, the growth rate, and the epidemic growth of COVID-19.

Factors affecting compliance with physical distancing include fear of the virus, psychosocial factors, institutional variables, and situation variables.

One study found people with low health literacy are less likely to rate physical distancing as important.

Tailored communication

Cultural observances

Strategy Mask wearing

Evidence from the COVID-19 pandemic Considerations for community and population groupsLevers

Depending on the type, masks can be used for either protection of healthy persons or to prevent onward transmission.

An evidence review of face masks suggests that near-universal adoption of nonmedical mask-wearing in public, along with other public health measures, can substantially lower community transmission.

The World Health Organization does not advise using masks or respirators with exhalation valves in the community.

Varying levels of acceptance forface mask-wearing across different cultural, governmental, and religious environments. One study suggests people who are religious or religiously conservative may be less likely to wear masks.

Various attitudes towards facemasks and experiences wearing them in Australia.

Tailored communication

Opinion and community leaders

Mask accessibility

Strategy Quarantine

Evidence from the COVID-19 pandemicLevers

Many countries have mandatory quarantine measures in place for international travellers.

Quarantine at home or other suitable location (not hotel or dedicated facility) is available for certain travellers to some countries including Singapore.

Exemption from mandatory quarantine for fully vaccinated travellers is available in some countries including the United States and the United Kingdom.

In Australia, temporary travel restrictions and quarantine measures may be implemented for domestic travellers, depending on travellers’ travel history to COVID-19 affected areas (hotspots) as declared by local state or territory health authorities.

South Australia is trialing Home Quarantine SA, allowing quarantine at home rather than in a medi-hotel environment.

Financial support

Tailored communication

Strategy Border restrictions

Evidence from the COVID-19 pandemicLevers

Travel restrictions and border control measures have been reported to reduce the spread of COVID-19.

Vaccine passports have been introduced internationally.

There is a request for the National Cabinet to consider giving fully vaccinated Australians the freedom to travel interstate, exempting them from border closures.

The Australian Government is working on introducing international COVID vaccine passports.

Population incentives (promise of greater mobility and less restrictions)

Strategy Lockdown

Evidence from the COVID-19 pandemic Considerations for community and population groupsLevers

Several countries suggest COVID-19 lockdown or travel restrictions reduced the long-distance travel and work-related short-range mobility, encouraged physical distancing, and helped to slow down the spatial spread of the virus.

In Victoria, Australia, a six-week lockdown and other strategies such as the mandatory wearing of masks, helped eliminate community transmission.

Responses to lockdown policies depend on socioeconomic conditions. Lower socioeconomic groups may need to travel, despite measures to restrict mobility, and socioeconomic contexts may impact working from home, using savings, postponing consumption, stocking food and essential goods and, more generally, the ability to respond to lockdown policies.

Financial support

Workforce supports

Wrap around support

Vaccine accessibility

Tailored communication

Reduce school activity

Levers to support risk mitigation strategies

Lever Vaccine accessibility

Evidence from the COVID-19 pandemic Evidence not specific to COVID-19 Australian interventions International interventions Micro interventions for specific community and population groups

Vaccines close to home and in local facilities for specific population groups.

Information about vaccines distributed in multiple languages in both written and graphic formats.

Vaccination strategies for populations with high transmission can be designed by: geographic ’hotspot’ identification, occupational risk, age-targeting of population at risk, overall number of social contacts, housing situation and ring vaccination.

Proposed two-ring strategy for COVID‐19 vaccines in medium‐ and high‐risk areas of countries with low incidence of SARS‐CoV‐2 infection.

Proactively planning vaccination distribution in ways to mitigate likely disparities.

The World Health Organization has a roadmap for prioritising vaccines for limited supply.

Ring vaccination was effectively used against Ebola Virus Disease and Smallpox in settings where mass vaccination was not possible.

Marginal benefit of ring vaccination was predicted to be most significant in settings where there are more contacts per individual, greater clustering and when contact tracing has low efficacy or vaccination confers post-exposure protection.

An ethical rationale for ring vaccination (for Ebola).

NSW: modelling of COVID-19 vaccination strategies including age-targeted or ring-vaccination for limited supply.

Churches, mosques and community centres used as pop-up vaccination clinics hotspots.

Mobile Outreach COVID Testing and Vaccination clinics are being used.

Victoria: Churches, mosques, temples are used as mass-vaccination hubs and are staffed by translators and workers who can speak community languages.

Mobile vaccination vans/buses to be used to provide outreach vaccination in communities, workplaces and regional areas.

Queensland: “Grab a jab and a kebab”: a vaccination hub is located in a shopping centre.

UK: NHS is using geographic targeting to increase vaccination uptake. 

Israel: Decentralised vaccination sites distributed vaccines.

USA: The COVID-19 vaccine equity initiative works with the populations and communities hardest hit by COVID-19 to increase awareness and acceptance of the vaccine, access to vaccination locations, and vaccine administration rates.

Federal government directly allocates additional vaccine supplies (on top of jurisdictional supplies) to health centres serving high proportions of underserved communities, including public housing residents, people with limited English proficiency, migrants, minority groups and individuals experiencing homelessness. Mobile vans are used.

Canada: ring vaccination approach in Montreal for parents and staff at select school communities with variant outbreak.

USA: Block party in Massachusetts with vaccination, food, raffles for prizes and entertainment. Preliminary data show higher rates of vaccination compared to mobile units.

Community Health Ambassador Outreach - Door Knocking Project.

Give65 provides rides to COVID-19 vaccine appointments and grocery shopping for older adults.

UK: Lessons from the UK COVID-19 vaccination strategy: delivered in local hospitals, pharmacies and community centres, including religious buildings such as churches and mosques, and ‘pop up’ and mobile sites.

Canada: Vaccivan: a mobile vaccination clinic travelling to parks and other outdoor public spaces.

Strategies: VaccinationLockdown

Lever Testing accessibility

Evidence from the COVID-19 pandemic Evidence not specific to COVID-19 Australian interventions International interventions Micro interventions for specific community and population groups

Testing can be difficult for people who speak a language other than English. One study suggests non-English speaking people were overall less likely to have completed testing compared with people who speak English, along with other disparities in testing and infection across language groups*^

The Centers for Disease Control and Prevention suggest self-collection tests for people unable to get tested by a health provider.

Home test kits are also available in the United Kingdom.

In Australia, the supply and advertising of COVID-19 self-tests for use at home are prohibited. Organisations such as Laverty Pathology have programs for private testing where samples can be collected on site at a business.

Self-testing for HIV was associated with increased uptake and frequency of testing; however there can be ambivalence in some communities*^

Victoria: a case study found that a collaborative community response that engaged with residents who were locked down in public housing via remote meetings with doctors they trusted and understood encouraged residents to access testing onsite.

NSW: Churches, mosques and community centres used as pop-up testing clinics in hotspots

USA: a community mobile health clinic outreach model and drive-through collection sites improved access to testing for communities with higher vulnerability, including minority populations*^

Spain: a large-scale population COVID-19 testing at home found most participants correctly performed the self-test the first time.

USA: a modelling study suggests COVID-19 tests could be provisioned through the United States Postal Service facilities to improve access in remote and at-risk communities.

SHOW: ‘Street health Outreach and Wellness’; a new model of mobile units from NYC Health + Hospitals providing COVID-19 tests and vaccines.

Strategies: Testing

Lever Mask accessibility

Evidence from the COVID-19 pandemic Australian interventions International interventions

Evidence suggests cost decreases willingness to wear face masks.

Victoria: free masks in some circumstances

Saudi Arabia: mandated the wearing of face masks in public places and available at a low cost.

Strategies: Mask wearing

Lever Population incentives (greater promise of mobility and less restrictions)

Evidence from the COVID-19 pandemic Evidence not specific to COVID-19 Australian interventions International interventions

Scientific and ethical considerations for the feasibility of immunity passports and travel including perceived benefits and risks*^ Suggested challenges include: potential erosion of civil liberties, societal inequalities and healthcare inequities, including limited access to COVID-19 vaccines and fraud.

The World Health Organization published guidance that the use of immunity passports may increase the risks of continued transmission; and further published temporary recommendations that proof of COVID-19 vaccination should not be introduced as a condition for travel.

Vaccine passports was successful in increasing coverage in people living with HIV.

NSW: New freedoms, including less restrictions, for vaccinated individuals are announced.

Victoria: curfews from 8pm to 5am were used in metropolitan Melbourne in second-wave lockdown in 2020.

France: in locations where curfews were implemented before lockdown, the viral circulation decreased earlier than other locations.

USA: Centers for Disease Control and Prevention provides recommendations for fully vaccinated people including resuming domestic travel.

UK: fully vaccinated adults avoid quarantine after travel to amber listed countries and self-isolation after a close contact tests positive

Canada: fully vaccinated adults can avoid quarantine after travel.

Strategies: VaccinationBorder restrictions

Lever Financial incentives

Evidence from the COVID-19 pandemic Evidence not specific to COVID-19 Australian interventions International interventions Micro interventions for specific community and population groups

Financial incentives could promote adherence to COVID-19 vaccines*^

Evidence suggests lottery-based incentives are not associated with increased rates of COVID-19 vaccinations.

Personal financial incentives can increase positive health behaviour and improve treatment completion for some health conditions.

The Australian the ‘no jab no pay’ child benefit scheme.

Lottery-based incentives are not associated with increased rates of screening and testing for other health conditions.

Victoria: All public sector employees to be give half a day’s paid time off to receive vaccination.

Northern Territory: Aboriginal community-controlled health services introduced using vouchers to encourage vaccination.  The Central Land Council is offering all of its staff and councilors a $500 cash incentive for vaccination

Lottery-based incentives for multiple countries.

USA: An overview of state-based vaccine incentives include cash incentives, gift voucher, lottery entries, scholarships and grants.

Federation of Ethnic Communities’ Councils of Australia administers COVID-19 small grants to fund short-term, one-off, communication and outreach projects.

Canada: some provinces are offering grants (up to $20,000) to community, religious, sports and art organisations in areas where vaccine uptake has been low.

Strategies: VaccinationTesting

Lever Non-financial incentives (point of entry and individual incentives)

Evidence from the COVID-19 pandemic Australian interventions International interventions

perspective on incentives for increasing COVID-19 vaccination.

Various Australian organisations, such as Qantas, HAG and Virgin Australia, offers rewards for fully vaccinated.

USA: An overview of state-based vaccine incentives including entertainment passes, signed sporting merchandise and memorabilia, complimentary food and drinks aligned to a campaign #CTDrinksofUs, grocery vouchers, scholarships, discounts on holiday and vacation venues, an additional 4 hours of paid leave and lotteries for cash.

Alabama state sponsored a TikTok Contest for people aged 13 to 29 to encourage vaccination.

Canada: tickets for sporting matches and season passes, meet and greets with celebrities and other leisure and recreational activities.

New reports on other non-cash incentives from around the world.

UK: Uber and Deliveroo discounts, as well as cinema tickets, pizza or kababs are used to encourage young people to get vaccinated.

Strategies: Testing

Lever Financial support

Evidence from the COVID-19 pandemic Australian interventions International interventions

Inadequate financial support is a factor in not following self-isolation or quarantine rules, and financial loss may result in socioeconomic distress and increase the risk for psychological symptoms.

People with low household incomes can be impacted by even a temporary reduction in income due to isolation and quarantine, and this impact may be greater for ethnic and minority groups*^

An Australian study suggest young people are concerned about financial loss and are often aware of available financial support*^

Higher compliance with self-quarantine is more likely when financial support is available.

NSW: Financial support available for individuals and households include: COVID-19 disaster payment, pandemic leave disaster payment, test and isolate payment, extreme hardship payment. Business and employment support is also available.

Victoria: various types of financial support are available for people and businesses affected by COVID-19.

USA: The option for eligible US employees to receive 14 days of emergency sick leave at full pay is estimated to have reduced the number of confirmed daily COVID-19 cases by 400 per state, or 1 case for every 1300 employees.

UK: Test and Trace Support Payment for people on low incomes and furlough scheme.

Canada: Canada Recovery Benefit and multiple financial supports

Strategies: QuarantineLockdown

Lever Opinion and community leaders

Evidence not specific to COVID-19 Australian interventions International interventions Micro interventions for specific community and population groups

Social networks and the popular opinion leader model is often used in the HIV epidemic control.

Australian Department of Health has established a Culturally and Linguistically Diverse Communities COVID-19 Health Advisory Group, comprising of leaders from communities and their representative organisations.

Victoria: priority response to multicultural communities including a Taskforce and providing guidance to communities through community and faith leaders.

USA: partnering with religious leaders and community organisations to increase uptake of COVID-19 testing.

UK: Give Hope campaign has been organised by Your Neighbour, a movement of more than 1,100 churches from over 40 denominations. Include church leader resources and stories.

Canada: Letter to faith community leaders from Canada’s Chief Public Health Officer, October 15, 2020

Israel: Israeli Ministry of Health secured endorsements from religious leaders.

Strategies: VaccinationMask wearingTesting

Lever Community health workers and contact tracers (bi-lingual)

Evidence not specific to COVID-19 Australian interventions International interventions Micro interventions for specific community and population groups

Bi-lingual community health workers can promote disease prevention strategies, and community-based navigators can be used to reduce existing healthcare barriers and improve access to health services.

ACT: the Australian National University has produced a ‘what?’ and ‘how?’ to inform approaches to contact tracing and the cultural and social determinants of health.

USA: consultation team of bilingual nurses, physicians, and social workers improve communication with Spanish-speaking patients with COVID-19.

USA: The Bilingual Community Health Outreach WorkerTraining Program trains and employs community health outreach workers to assist with public health outreach.

Houston Health hire bilingual community health workers as ‘Community Relations Specialists

Strategies: Contact tracingTesting

Lever Communication

Evidence from the COVID-19 pandemic Evidence not specific to COVID-19 Micro interventions for specific community and population groups

Effective health communication is a critical factor in responding to the COVID-19 pandemic.

The World Health Organization interim guidance is underpinned by a socio-behavioural trends analysis and outlines four objectives: be community-led, data-driven, and collaborative and reinforce capacity and local solutions.

Effective mass public health communication requires an understanding of behavioural psychology principles and information about how to tailor key messages to the various populations within a society.

Avenues for strengthening the marketing communications mix as a foundational element of communication in health and medicine.

Ethical issues in public health communication interventions.

People with low health literacy may have a poorer understanding of COVID-19 symptoms and be less likely to identify behaviours to prevent infection or understand government messaging.

Unclear or contradictory communication can reinforce stigma and may lead to some population groups not adopting physical distancing or isolation measures, not accessing testing or vaccination, or not engaging in contact tracing.

Solutions for communicating health information include partnerships between cultural or religious leaders, community and government; moving beyond disseminating information to designed tailored solutions; behaviour change strategies; and written materials in plain English and translated to appropriate community language.

Strategies: VaccinationLockdownContact tracingPhysical distancingMask wearingTestingLockdown

Lever Tailored communication for cultural and community groups

Evidence from the COVID-19 pandemic Evidence not specific to COVID-19 Australian interventions International interventions Micro interventions for specific community and population groups

Fund, develop and implement culturally competent COVID-19 education and prevention campaigns, including effective messaging to counter racial prejudice and discrimination.

Effective platforms to deliver COVID-19 specific information can vary between population groups.

The diverse needs and circumstances of people and communities must be at the centre of health communication and tailored messaging will only work when information is captured about the behavioural drivers relevant to the community.

Multicultural communities’ advice on communicating COVID-19 advice: involve communities, tailor messages to community values, and use trusted messengers and channels the audience can access.

A review of population health social marketing campaigns targeting culturally and linguistically diverse communities.

Cultural targeting and cultural tailoring considerations when designing health communication materials.

Technological advancement provides opportunities to explore computational means of engendering culturally and linguistically appropriate communication during emergency events.

Lessons about communication inequalities during the H1N1 pandemic and media coverage on the Zika virus cases.

NSW: has released Glossary of Medical Terminology for Immunisation and Vaccine development in 31 languages to provide easy-to-understand information.

Victoria: collaboration between Culturally and linguistically diverse community leaders and health behaviour change scientists for communicating COVID-19 health information. The Government translated COVID-19 communications materials into 57 languages, funded a daily broadcast multilingual news service in priority languages, developed a cultural observances campaign strategy, provided regular briefings to the multicultural sector, established a WhatsApp Community Leaders group.

USA: CDC has developed materials on how to tailor COVID-19 information to a specific audience. partnerships between immigrant community leaders, faith-based organisations, hospitals, and local authorities to facilitate the dissemination of COVID-19-relevant information through virtual patient navigators and using social media to reach community*^

UK: UK has developed a guidance document for public health messaging for communities from different cultural backgrounds.

Cultural Formulation Interview guide for communicating COVID-19 diagnosis and quarantine measures.

Strategies: Vaccination Contact tracingPhysical distancingMask wearingTestingQuarantineLockdown

Lever Campaigns

Evidence from the COVID-19 pandemic Evidence not specific to COVID-19 Australian interventions International interventions Micro interventions for specific community and population groups

Word of mouth messages and conversations may increase the uptake of vaccines.

E-government and COVID-19 word of mouth positively impacts online social presence.

A social media toolkit with social media ready COVID-19 content on a variety of topics to help successfully communicate with audiences.

Social media and word-of-mouth effective communication methods during emergencies.

In disaster preparedness, word of mouth is the preferred information source for linguistically isolated groups, and migrant groups rely heavily on word-of-mouth information when seeking healthcare. Evidence suggests word-of-mouth health communication can reduce communication inequalities.

Word-of-mouth health examples include:

Evidence suggests longer and more intensive campaigns are likely to be more effective, and there are benefits to using social media for health communication, such as increased interactions and accessibility.

Victoria: news report demonstrating how word of mouth and family connections are used to disseminate health messages.

USA: #Vaccinate4Love: Doctors’ Orders, a grassroots campaign aimed at overcoming Covid-19 vaccine hesitancy among minority communities, was launched in New York.

UK: #TakeTheVaccine campaign video featuring celebrities urging people from ethnic minority communities to get the Covid vaccine was shown across the UK's main commercial TV channels at the same time.

Pakistan: one study showed that a significant proportion of people in Shorkot relied on word of mouth to disseminate information on symptoms and prevention measures.

Canada: campaign and ‘movement’ to encourage each other to replace vaccine hesitancy with confidence so we can get back to things we love. Includes ‘This is our Shot’ and ‘Faster Together’

Across Sydney, grassroot campaigns using social media videos, posts and online community Q&A sessions were utilised among some communities.

Strategies: Vaccination

Lever Cultural observances

Evidence from the COVID-19 pandemic International interventions

Religious groups can offer more innovative means of reaching out to communities (e.g., online religious services) and disseminating practical health information.

Relationship between cultural tightness-looseness and COVID-19 cases and deaths.

WHO: guidance on mass gatherings and safe COVID-19 practices, including religious events.

Strategies: Contact tracingPhysical distancing

Lever Workforce supports

Evidence from the COVID-19 pandemic International interventions

Workforce reconfigurations such as splitting teams have been described for various specialties to minimise staff exposure to COVID-19.

Northern Ireland: free rapid testing is available to all employers with 10 or more employees.

Canada: Businesses and not-for-profit organisations are eligible to apply for free rapid COVID-19 tests.

Strategies: Lockdown

Lever Wrap around support

Evidence from the COVID-19 pandemic Evidence not specific to COVID-19 Australian interventions International interventions Micro interventions for specific community and population groups

Food support: food insecurity may increase for some Aboriginal people in response to COVID‐19.

Social support: effective interventions to reduce social isolation during COVID-19 physical distancing measures.

Food support: Indigenous, culturally and linguistically diverse and socially isolated people may also experience food insecurity at a higher rate.

Social support: being socially isolated and lonely is associated with the most social support gaps and worse cardiovascular and mental health outcomes.

For some communities, feeling lonely and isolated can be a source of shame and embarrassment

Food support: older people who need emergency support or live in a COVID-19 hotspot may be able to access home delivery of prepared meals, food staples, and essential daily items or prioritise grocery shopping by ordering via phone or online.

NSW: Food relief services

UK: England are trialling a self-isolation support program in nine areas with higher COVID-19 infection rates.

USA: The American Rescue plan addresses food insecurity during COVID-19.

UK: COVID-19 support hubs to provide help with grocery shopping, household supplies, pick up prescriptions and purchasing pet food.

Strategies: Lockdown

Lever Reduce school activity

Evidence from the COVID-19 pandemic Evidence not specific to COVID-19 Australian interventions International interventions

A systematic review of observational studies found mixed effects on school closures reducing transmission.

A scoping review suggests organisational, structural and environmental, and surveillance and response measures to contain transmission in school settings.

School closures may also have adverse effects on a child’s physical and mental health and wellbeing.

School closures during Ebola outbreak in Guinea, Liberia and Sierra Leone had disproportionally affected girls and widened the gender gap in school attendance.

The National Centre for Immunisation Research and Surveillance publishes regular reports on COVID-19 in educational settings, including during periods of school closures.

The early NAPLAN results for 2021 shows relatively small impact of school closure on literacy and numeracy.

Netherlands: a study found that students, especially those from disadvantaged homes, made little or no learning progress while studying from home.

USA: school closure may have been associated with a significant reduction in incidence rates.

Canada: a simulating study found that school closure may have limited impact without other measures to interrupt the chain of transmission.

Strategies: Lockdown

Lever Temporary accommodation for close contacts

Evidence from the COVID-19 pandemic Australian interventions International interventions Micro interventions for specific community and population groups

Several well described models have been shown to enhance compliance with quarantine and isolation, including free hotel accommodation such as in the US.

The screening and isolation of suspected cases and quarantine of close contacts as early as possible could be used to avoid cluster infection among family members and subsequent transmission in the community.

Hotel-based COVID-19 isolation used as a strategy in the US for homelessness, which was associated with averting hospital admissions.

In Victoria, if people cannot safety isolate at home following being a close contact, the Department of Health will support isolation in a quarantine hotel

In Australia, temporary accommodation has been set up by the Ministry of Business, Innovation and Employment which may be accessed if self-isolation in a tenancy where multiple people are living at one address.

In NSW, Public Health Units will help find another place for self-isolation for close-contacts if they are unsure that they can completely self-isolate from other members of your household.

In Europe, where self-isolation at home was not possible, several countries (including Italy, Finland, Poland and Serbia and Lithuania) adopted measures whereby hotels and hostels have been converted to accommodate self-isolating individuals.

UK news opinion piece, people in overcrowded housing should have been given COVID-19 isolation hotel rooms.

Temporary quarantine villages and facilities were set up in Hong Kong, South Africa and China for individuals who have had close contact with confirmed coronavirus patients.

In New York, a community based approach of isolation hotels was established and as October 2020 has served almost 100 people.

The CDC in the US has guidance on operational considerations for community isolation centres in low-resource settings.

In a survey from BAME and low income communities, factors influencing likely uptake of accommodation included perceived 1) vulnerability of household 2) exposure to the virus and 3) options for isolation at home. Barriers to accepting the offer of accommodation included 1) being able to isolate at home 2) wanting to be with family 3) caring responsibilities 4) concerns about mental wellbeing 5) upheaval of moving when ill and 6) concerns about infection control.

Notes

* Preliminary data, not fully established, in some cases small numbers or short follow up, or based on previous data; interpret with caution.
^ Commentary, grey literature, pre peer review or news.

Living evidence tables include some links to low quality sources and an assessment of the original source has not been undertaken. Sources are monitored daily but due to rapidly emerging information, tables may not always reflect the most current evidence. The tables are not peer reviewed, and inclusion does not imply official recommendation nor endorsement of NSW Health.

Last updated on 28 Sep 2021

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