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• W3112769897 abstract "Although it has been known for some time that mask-wearing, hand hygiene and physical distancing all contribute to reducing infection risk with non-Severe Acute Respiratory Syndrome (SARS) viruses such as influenza and respiratory syncitial virus,1 these simple interventions were not adopted widely, the exception being mask-wearing in predominantly Asian countries. In the West, we were slow to seize the opportunity of these non-pharmacological interventions to prevent respiratory virus transmission. This is despite the fact that reducing transmission of common respiratory viruses could potentially reduce infective exacerbations of chronic diseases such as chronic obstructive pulmonary disease (COPD), asthma and heart failure, which are extremely costly to the healthcare system, contribute to worsening disease and have major impacts on patients' quality of life and life expectancy. The arrival of a global pandemic has revived this evidence and triggered rapid uptake of these interventions. Early observations of the containment of infection in countries which imposed these public health strategies and very strict lockdown measures2, 3 have added weight to evidence for their effectiveness. However, key questions remain, particularly which has the greatest impact, and which should be maintained when countries begin easing restrictions as incidence rates fall with change of season or in response to community measures. Despite their huge impact on daily life, human interaction and national economies, hard and fast lockdowns have mostly met with success. Strong messaging and measures to ensure social distancing have become key pillars of the strategy to control the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in communities worldwide. Increasing numbers of studies during the pandemic support the key role of social distancing in reducing transmission, particularly in crowded communities and households.4 The arguments in favour of physical distancing are based on the concept that virus is spread by exhaled breath in both droplet and aerosol form and may remain airborne for variable periods of time depending on the atmospheric conditions, propulsion of air, available ventilation and the viral load in exhaled breath.5, 6 In a systematic review of 172 observational studies, transmission of viruses was lower with physical distancing of 1 m or more, compared with a distance of less than 1 m (adjusted odds ratio (OR): 0.18, 95% CI: 0.09–0.38) and protection was increased as distance was lengthened (change in relative risk (RR): 2.02 per m).7 In a Swiss study, social distancing slowed the spread of SARS-CoV-2 in a cohort of young, healthy adults which still induced an immune response and colonized nasal passages.8 This may be related to dose and intensity of exposure, allowing a low-dose immune stimulation rather than a higher exposure–dose progressing to infection. Although transmission of SARS-CoV-2 has been thought to predominantly occur through droplet spread, the evidence for aerosol spread has been growing, even though its relative contribution to transmission is not fully elucidated. However, it may be particularly important in situations of crowding and poor ventilation.9 Many factors influence aerosol spread and virus transmission, including type of phonation, loudness, speed of exhalation and atmospheric conditions (dry vs humid). Air sampling has found virus RNA in some locations in which infected persons have spent time, but not in others, and duration of exposure plus these factors are probably key influences of persistence. As controversy regarding the relative benefits of various physical intervention measures continues, it has become clear that each measure plays some role in reducing the overall risk of infection transmission.5, 7 In addition, testing, contact-tracing and quarantine are essential complements to physical distancing, mask-wearing and hand hygiene to contain SARS-CoV-2 infection in communities. The interaction of these effects is exemplified in a US study of participants enrolled and using a coronavirus disease 2019 (COVID-19) smartphone application. Individuals living in communities with the greatest social distancing had a 31% lower risk of predicted COVID-19 compared with those living in communities with poor social distancing; even among individuals living in a community with poor social distancing, self-reported masking was associated with a 63% reduced risk of predicted COVID-19.10 Even so the added value of masks to social distancing remains unclear. The DANMASK study11 wherein all participants were encouraged to socially distance in public reported only a 0.3% between-group difference over 1 month in seroconversion rates, between no mask recommendation or a recommendation to wear a mask when outside the home for more than 3 h among other people (1.8% vs 2.1% seroconversion). On the other hand, household mask-wearing in the pre-symptomatic phase may be of great value,12 although this too requires testing in prospective studies. It is of particular interest that patients with airways disease, COPD in particular, appear to be suffering fewer exacerbations than is usual for the winter season in several countries.13 This may be a consequence of these patients taking the public health messaging very seriously, social distancing especially, related to their awareness of risk and their generally older age. In NSW, Australia, respiratory infections and pneumonia rates of presentation at emergency departments are also significantly lower than the 5-year average rates. A similar phenomenon has been reported in Hong Kong and the USA.14 Importantly, in real-world modelling, it appears that regardless of whether active case finding, contact tracing and quarantine are implemented, maximum benefit occurs through generalized, community-wide interventions such as mask-wearing and distancing,10, 15 which function as a ‘force multiplier’. Thus, no single intervention can replace an array of defences against transmission that range from public health and government interventions such as test, trace and isolate strategies to individual behaviours which are essential to maximize virus suppression. When the pandemic finally wanes, evidence regarding the preventive effects of social distancing will be highly applicable to the common viral respiratory infections which have a major impact on patients, families, practitioners and health service delivery, especially in the winter months. The effectiveness of hand hygiene, mask-wearing and social distancing should be tested prospectively in settings where those with chronic cardiorespiratory disease suffer viral-induced exacerbations. In our relief that the threat of COVID has been minimized, we must not forget that lessons learnt during this pandemic about social distancing and mask-wearing in particular, have the potential to reduce viral exacerbations in a much broader context over many years ahead." @default.
• W3112769897 created "2020-12-21" @default.
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• W3112769897 date "2020-12-15" @default.
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• W3112769897 title "Social distancing as a strategy to prevent respiratory virus infections" @default.
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• W3112769897 doi "https://doi.org/10.1111/resp.13990" @default.
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