Quarantäne alleine oder in Kombination mit weiteren Public-Health-Maßnahmen zur Eindämmung der COVID-19 Pandemie: Ein Cochrane Rapid Review

Zusammenfassung

Hintergrund Die Coronavirus-Krankheit COVID-19 ist eine neue, sich rasch ausbreitende zoonotische Infektionskrankheit, die der Weltgesundheitsorganisation (WHO) erstmals am 31. Dezember 2019 gemeldet wurde. Da zurzeit keine wirksamen Medikamente oder Impfstoffe zur Behandlung oder Prävention von COVID-19 zur Verfügung stehen, rücken nicht-pharmakologische Public-Health-Maßnahmen zur Eindämmung der COVID-19 Pandemie stärker in den Fokus.

Studienziele Ziel dieses Rapid Reviews war es, den Effekt von Quarantäne – alleine oder in Kombination mit weiteren Public-Health-Maßnahmen – zur Eindämmung von COVID-19 zu untersuchen.

Methodik Der vorliegende Rapid Review wurde von der WHO in Auftrag gegeben. Um der Dringlichkeit der Anfrage gerecht zu werden, wurde die Methodik eines systematischen Reviews punktuell abgeändert. Die vorliegende Publikation umfasst die wichtigsten Aspekte des Rapid Reviews und wurde vom WHO Collaborating Centre an der Donau Universität Krems (Österreich) auf Deutsch übersetzt.

Ergebnisse Insgesamt wurden 29 Studien eingeschlossen. Zehn Modellierungsstudien befassten sich direkt mit COVID-19, 15 weitere Modellierungsstudien und 4 Beobachtungsstudien lieferten indirekte Evidenz zu SARS und MERS. Die Studien zeichneten alle ein ähnliches Bild – einen Vorteil von Quarantäne. Beispielsweise schätzten Modellierungsstudien, dass durch Quarantäne von Personen, die Kontakt mit Infizierten hatten 44–81% neuer Fälle und 31–63% an Todesfällen verhindert werden können, im Vergleich zu keinen Maßnahmen. Zwei Studien zu SARS zeigten, dass Quarantäne effektiver war und weniger kostete, je früher sie startete. Alleinige Quarantäne von Personen, die Kontakt mit Infizierten hatten, würde aber wahrscheinlich nicht ausreichen, um den Ausbruch von COVID-19 einzudämmen. Die Kombination mit anderen Maßnahmen wie physische Distanzierung oder Schulschließungen zeigte größere Effekte als Quarantäne alleine. Bei der individuellen Quarantäne für Rückkehrende aus Risikogebieten fand der Review vergleichsweise geringe Effekte.

Schlussfolgerung Die Vertrauenswürdigkeit der Evidenz ist niedrig bzw. sehr niedrig, da die einzigen Studien zu COVID-19 Modellierungsstudien sind, die zwar aktuelle aber noch unsichere und unterschiedliche Parameter zur Modellberechnung verwendeten. Die indirekte Evidenz von SARS und MERS ist nur begrenzt auf COVID-19 übertragbar. Trotz dieser Limitationen, kommen alle Studien zu dem Schluss, dass Quarantäne eine wichtige Maßnahme ist, um die Pandemie einzudämmen. Im Hinblick auf die kommenden Monate ist es wichtig, das Infektionsgeschehen sowie die Auswirkungen der Maßnahmen genau zu überwachen, um die bestmögliche Balance der Maßnahmen zu finden.

Abstract

BackgroundCOVID-19 (coronavirus disease 2019) is a new, rapidly emerging zoonotic infectious disease, that was reported to the World Health Organization for the first time on 31 December 2019. Currently, no effective pharmacological interventions or vaccines are available to treat or prevent COVID-19, therefore nonpharmacological public health measures are more in focus.

ObjectivesThe aim was to assess the effects of quarantine – alone or in combination with other measures – during coronavirus outbreaks.

MethodsBecause of the current COVID-19 pandemic, WHO commissioned a rapid review. To save time, the method of systematic reviews was slightly and with caution modified. This publication is a summary of the most important aspects of the rapid review, translated into German by members of the WHO Collaborating Centre at the Danube University Krems (Austria).

ResultsOverall, 29 studies were included. Ten modeling studies focused on COVID-19, 4 observational studies and 15 modeling studies focused on SARS and MERS. The modeling studies consistently reported a benefit of the simulated quarantine measures. For example, the models estimated that quarantine of people exposed to confirmed or suspected cases of COVID-19 prevented between 44 and 81% of the cases that would otherwise have happened and 31 to 63% of the deaths, when compared to no such measures. In regard to costs, the earlier the quarantine measures are implemented, the greater the cost savings will be.

ConclusionOur confidence in the evidence is very limited. This is mainly because the COVID-19 studies based their models on the limited data that have been available in the early weeks of the pandemic and made different assumptions about the virus. The studies of SARS and MERS are not completely generalizable to COVID-19. Despite only having limited evidence, all the studies found quarantine to be important for controlling the spread of severe coronavirus diseases. Looking to the coming months, in order to maintain the best possible balance of measures, decision makers must continue to constantly monitor the outbreak situation and the impact of the measures they implement.

Schlüsselwörter

Pandemie - Coronavirus - SARS-COV-2 - Weltgesundheitsorganisation - WHO

Key words

Pandemic - coronavirus - SARS-COV-2 - World Health Organization - WHO

Publikationsverlauf

Artikel online veröffentlicht:
15. Mai 2020

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