公共卫生措施在降低新冠病毒发病率、SARS-CoV-2 传播率和新冠死亡率方面的有效性：系统评价和荟萃分析。

OBJECTIVE: To review the evidence on the effectiveness of public health measures in reducing the incidence of covid-19, SARS-CoV-2 transmission, and covid-19 mortality. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Medline, Embase, CINAHL, Biosis, Joanna Briggs, Global Health, and World Health Organization COVID-19 database (preprints). ELIGIBILITY CRITERIA FOR STUDY SELECTION: Observational and interventional studies that assessed the effectiveness of public health measures in reducing the incidence of covid-19, SARS-CoV-2 transmission, and covid-19 mortality. MAIN OUTCOME MEASURES: The main outcome measure was incidence of covid-19. Secondary outcomes included SARS-CoV-2 transmission and covid-19 mortality. DATA SYNTHESIS: DerSimonian Laird random effects meta-analysis was performed to investigate the effect of mask wearing, handwashing, and physical distancing measures on incidence of covid-19. Pooled effect estimates with corresponding 95% confidence intervals were computed, and heterogeneity among studies was assessed using Cochran's Q test and the I metrics, with two tailed P values. RESULTS: 72 studies met the inclusion criteria, of which 35 evaluated individual public health measures and 37 assessed multiple public health measures as a "package of interventions." Eight of 35 studies were included in the meta-analysis, which indicated a reduction in incidence of covid-19 associated with handwashing (relative risk 0.47, 95% confidence interval 0.19 to 1.12, I=12%), mask wearing (0.47, 0.29 to 0.75, I=84%), and physical distancing (0.75, 0.59 to 0.95, I=87%). Owing to heterogeneity of the studies, meta-analysis was not possible for the outcomes of quarantine and isolation, universal lockdowns, and closures of borders, schools, and workplaces. The effects of these interventions were synthesised descriptively. CONCLUSIONS: This systematic review and meta-analysis suggests that several personal protective and social measures, including handwashing, mask wearing, and physical distancing are associated with reductions in the incidence covid-19. Public health efforts to implement public health measures should consider community health and sociocultural needs, and future research is needed to better understand the effectiveness of public health measures in the context of covid-19 vaccination. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42020178692.

目的：综述公共卫生措施在降低新冠病毒发病率、SARS-CoV-2 传播率和新冠死亡率方面的有效性证据。

设计：系统综述和荟萃分析。

数据来源：Medline、Embase、CINAHL、Biosis、Joanna Briggs、全球卫生和世界卫生组织 COVID-19 数据库（预印本）。

研究选择的资格标准：评估公共卫生措施在降低新冠病毒发病率、SARS-CoV-2 传播率和新冠死亡率方面有效性的观察性和干预性研究。

主要结果测量：主要结果测量是新冠病毒发病率。次要结果包括 SARS-CoV-2 传播率和新冠死亡率。

数据综合：采用 DerSimonian Laird 随机效应荟萃分析来研究戴口罩、洗手和身体距离措施对新冠病毒发病率的影响。计算了具有相应 95%置信区间的汇总效应估计值，并使用 Cochran's Q 检验和 I 指标评估研究之间的异质性，双侧 P 值。

结果：72 项研究符合纳入标准，其中 35 项评估了单个公共卫生措施，37 项评估了作为“一揽子干预措施”的多项公共卫生措施。35 项研究中有 8 项纳入荟萃分析，结果表明洗手（相对风险 0.47，95%置信区间 0.19 至 1.12，I=12%）、戴口罩（0.47，0.29 至 0.75，I=84%）和身体距离（0.75，0.59 至 0.95，I=87%）与新冠病毒发病率降低相关。由于研究存在异质性，因此无法对检疫和隔离、普遍封锁以及关闭边境、学校和工作场所等结果进行荟萃分析。对这些干预措施的效果进行了描述性综合分析。

结论：本系统综述和荟萃分析表明，包括洗手、戴口罩和保持身体距离在内的几项个人防护和社会措施与降低新冠发病率有关。公共卫生部门应考虑社区健康和社会文化需求，实施公共卫生措施，未来还需要进一步研究以更好地了解新冠疫苗背景下公共卫生措施的有效性。

系统综述注册：PROSPERO CRD42020178692。