In epidemiology, a non-pharmaceutical intervention (NPI), also known as a public health and social measure, is a method used to reduce the spread of an epidemic disease without requiring pharmaceutical drug treatments. Examples of non-pharmaceutical interventions that reduce the spread of infectious diseases include wearing a face mask and staying away from sick people. The US Centers for Disease Control and Prevention (CDC) points to personal, community, and environmental interventions. NPIs have been recommended for pandemic influenza at both local and global levels and studied at large scale during the 2009 swine flu pandemic and the COVID-19 pandemic. NPIs are typically used in the period between the emergence of an epidemic disease and the deployment of an effective vaccine.
Types Choosing to stay home to prevent the spread of symptoms of a potential sickness, covering coughs and sneezes, and washing one's hands regularly, are all examples of non-pharmaceutical interventions. Another example is when administrators of schools, workplaces, community areas, etc., take proper preventive actions and remind people to take precautions when need be in order to avoid the spread of disease. Most NPIs are simple, requiring little effort to put into practice, and, if implemented correctly, have the potential to save lives.
Personal protective measures
Hand hygiene
Respiratory etiquette
Face masks
Environmental measures
Surface and object cleaning Germs can survive outside the body on hard surfaces for periods ranging from hours to weeks, depending on the virus and environmental conditions. The disinfection of high-touch surfaces with substances such as bleach or alcohol kills germs, preventing indirect contact transmission. Dirty surfaces should be washed before the use of disinfectant.
Ultraviolet lights Ultraviolet (UV) light can be used to destroy micro-organisms that exist in the environment. The installation of UV light fixtures can be costly and time consuming; it is unlikely that they could be used at the outbreak of an epidemic. There are possible health concerns involving UV light, as it may cause cancer and eye problems. The WHO does not recommend its use.
Increased ventilation Increased ventilation of a room through opening a window or through mechanized ventilation systems may reduce transmission within the room. Although opening a window may introduce allergens and air pollution, or, in some climates, cold air, it is overall a cheap and effective type of intervention, and its advantages probably outweigh its disadvantages.
Modifying humidity Viruses such as influenza and coronavirus thrive in cold, dry environments, and increasing the humidity of a room may reduce their transmission. Higher humidity, however, may cause mold and mildew, which may in turn cause respiratory problems. Humidifiers are also expensive and will probably be in short supply at the start of an epidemic.
Social distancing measures
Contact tracing
Isolation of sick individuals
Quarantine of exposed individuals
Quarantine involves the voluntary or imposed confinement of potentially non-ill persons who have been exposed to an illness, regardless of whether they have contracted it. Quarantine will often happen at home, but it may happen elsewhere, such as aboard ships (maritime quarantine) or airlines (onboard quarantine). Like isolation of sick individuals, forced quarantine of exposed individuals brings with it ethical concerns, although in this case the concerns may be greater; quarantine involves restricting the movement of those who may otherwise be well, and in some cases may even cause them greater risk if they are quarantining with the sick person to whom they were exposed, such as a sick family member or roommate with whom they live. Like isolation, quarantine brings with it financial risk, because of work absenteeism.
School measures and closures
Measures taken involving schools range from making changes to operations within schools to complete school closures. Lesser measures may involve reducing the density of students, such as by distancing desks, cancelling activities, reducing class sizes, or staggering class schedules. Sick students may be isolated from the greater student body, such as by having them stay at home or otherwise segregate them from other students. More drastic measures include class dismissal, in which classes are cancelled but the school stays open to provide childcare to some children, and complete school closure. Both measures may be either reactive or proactive: In a reactive case, the measure takes place after an outbreak has occurred in the school; in a proactive case, the measure takes place in order to prevent spread within the community. Closures of schools may affect the families of affected children, especially low-income families. Parents may be forced to miss work to care for their children, affecting financial stability; children may also miss out on free school meals, causing nutritional concerns. Long absences from schools because of closures can also have negative effects on students' education. However, in the months following the onset of the COVID-19 pandemic, instead of closures, remote learning was turned to as an intervention against infection by SARS-CoV-2 in the days before vaccines.
Workplace measures and closures
Measures taken in the workplace include: remote work; paid leave; staggering shifts such that arrival, exit, and break times are different for each employee; reduced contact; and extended weekends. Workplace closure is a more drastic measure. The financial effect of workplace closure on both the individual and the economy can be severe. When remote work is not possible, such as in essential services, businesses may not be able to comply with guidelines. In one simulation study school closure coupled with 50% absenteeism in the workplace would have had the highest financial impact of all the scenarios studied, although some studies have found that the combination would be effective in reducing both the attack rate and the height of an epidemic. One benefit of workplace closure is that when used in conjunction with school closures they avoid the need for parents to make childcare arrangements for children who are staying away from school. The WHO recommends workplace closure in the case of extraordinarily severe epidemics and pandemics.
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