Unintended Consequences of COVID-19 Non-Pharmaceutical Interventions (NPIs) for Population Health and Health Inequalities

Abstract

Since the start of the COVID-19 pandemic in early 2020, governments around the world have adopted an array of measures intended to control the transmission of the SARS-CoV-2 virus, using both pharmaceutical and non-pharmaceutical interventions (NPIs). NPIs are public health interventions that do not rely on vaccines or medicines and include policies such as lockdowns, stay-at-home orders, school closures, and travel restrictions. Although the intention was to slow viral transmission, emerging research indicates that these NPIs have also had unintended consequences for other aspects of public health. Hence, we conducted a narrative review of studies investigating these unintended consequences of NPIs, with a particular emphasis on mental health and on lifestyle risk factors for non-communicable diseases (NCD): physical activity (PA), overweight and obesity, alcohol consumption, and tobacco smoking. We reviewed the scientific literature using combinations of search terms such as ‘COVID-19′, ‘pandemic’, ‘lockdowns’, ‘mental health’, ‘physical activity’, and ‘obesity’. NPIs were found to have considerable adverse consequences for mental health, physical activity, and overweight and obesity. The impacts on alcohol and tobacco consumption varied greatly within and between studies. The variability in consequences for different groups implies increased health inequalities by age, sex/gender, socioeconomic status, pre-existing lifestyle, and place of residence. In conclusion, a proper assessment of the use of NPIs in attempts to control the spread of the pandemic should be weighed against the potential adverse impacts on other aspects of public health. Our findings should also be of relevance for future pandemic preparedness and pandemic response teams.

Impact of Nonpharmaceutical Interventions during the COVID-19 Pandemic on the Prevalence of Respiratory Syncytial Virus in Hospitalized Children with Lower Respiratory Tract Infections: A Systematic Review and Meta-Analysis

“…In severe pandemics, where specific treatments or vaccines are unavailable, NPIs may be the only viable option. This necessitates policymakers to balance the benefits and risks of NPIs to ensure global well-being [ 49 ].…”

Is SARS-CoV-2 elimination or mitigation best? Regional and disease characteristics determine the recommended strategy

“…Non-pharmaceutical Interventions (NPIs) have greatly reduced the spread of SARS-CoV-2 [42, 15], the virus that causes COVID-19, and include: travel measures, such as self-isolation, quarantine, and testing requirements applying to individuals arriving from other jurisdictions; and community measures, such as physical distancing, gathering size restrictions, and business and school closures, that apply to residents. However, these restrictions substantially reduced economic activity, increased unemployment rates, and undermined social wellbeing [40, 81, 78]. As NPIs have substantial economic and societal costs, it is important to establish criteria to adjust restrictions to control infection spread with minimal cost.…”

“…Discussing costs when it comes to fighting a pandemic threat is challenging, and there are trade-offs to be considered. Minimal public health restrictions may lead to many infections, hospitalizations, and deaths, while strict public health restrictions may lead to economic, social and psychological damages [81, 85]. Considering such costs involves finding a complex balance between medical needs, and social and economic freedom.…”

“…Elimination may provide more freedoms during periods of mild restrictions, however, social interactions are substantially limited during periods of strict restrictions, which may cause high occurrence of mental health issues, such as depression and anxiety, or domestic violence [23, 25, 95]. Mitigation requires prolonged periods of moderate restrictions that can be exhausting and negatively impact the population [40, 81, 78]. Social and mental health costs of these two strategies are experienced unequally across population groups.…”

“…Social and mental health costs of these two strategies are experienced unequally across population groups. Different social and psychological stress levels can arise depending on personal living situations, employment sector, gender, ethnicity, and social determinants of health [81], and it is misleading to report only whether elimination or mitigation guarantees lower social costs at a population level without also stratifying these costs for population groups. In many cases social costs of NPIs are to be paid in the future, and it is only recently that researchers have developed methods to determine the direct and indirect impact of NPIs implementation on a population’s health and social functioning [126, 116, 62, 31, 76].…”