Public health implications of SARS-CoV-2 variants of concern: a rapid scoping review

  1. Mari Somerville
  2. Janet A Curran
  3. Justine Dol
  4. Leah Boulos
  5. Lynora Saxinger
  6. Alexander Doroshenko
  7. Stephanie Hastings
  8. Bearach Reynolds
  9. Allyson J Gallant
  10. Hwayeon Danielle Shin
  11. Helen Wong
  12. Daniel Crowther
  13. Marilyn Macdonald
  14. Ruth Martin-Misener
  15. Jeannette Comeau
  16. Holly McCulloch
  17. Andrea C Tricco

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Abstract

The four SARS-CoV-2 variants of concern (VOC; Alpha, Beta, Gamma and Delta) identified by May 2021 are highly transmissible, yet little is known about their impact on public health measures. We aimed to synthesise evidence related to public health measures and VOC.

Design

A rapid scoping review.

Data sources

On 11 May 2021, seven databases (MEDLINE, Embase, the Cochrane Database of Systematic Reviews, Central Register of Controlled Trials, Epistemonikos’ L-OVE on COVID-19, medRxiv, bioRxiv) were searched for terms related to VOC, public health measures, transmission and health systems. No limit was placed on date of publication.

Eligibility criteria

Studies were included if they reported on any of the four VOCs and public health measures, and were available in English. Only studies reporting on data collected after October 2020, when the first VOC was reported, were included.

Data extraction and synthesis

Titles, abstracts and full-text articles were screened by two independent reviewers. Data extraction was completed by two independent reviewers using a standardised form. Data synthesis and reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines.

Results

Of the 37 included studies, the majority assessed the impact of Alpha (n=32) and were conducted in Europe (n=12) or the UK (n=9). Most were modelling studies (n=28) and preprints (n=28). The majority of studies reported on infection control measures (n=17), followed by modifying approaches to vaccines (n=13), physical distancing (n=6) and either mask wearing, testing or hand washing (n=2). Findings suggest an accelerated vaccine rollout is needed to mitigate the spread of VOC.

Conclusions

The increased severity of VOC requires proactive public health measures to control their spread. Further research is needed to strengthen the evidence for continued implementation of public health measures in conjunction with vaccine rollout. With no studies reporting on Delta, there is a need for further research on this and other emerging VOC on public health measures.

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  1. Version published to 10.1136/bmjopen-2021-055781
  2. ScreenIT

    SciScore for 10.1101/2021.05.20.21257517: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Ethicsnot detected.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    The electronic database search was executed on March 15, 2021 and again on April 7, 2021 in MEDLINE (Ovid MEDLINE All), Embase (Elsevier Embase.com), the Cochrane Database of Systematic Reviews (CDSR) and Central Register of Controlled Trials (CENTRAL) (Cochrane Library, Wiley), Epistemonikos’ L·OVE on COVID-19, and medRxiv and bioRxiv concurrently.
    MEDLINE
    suggested: (MEDLINE, RRID:SCR_002185)
    Embase
    suggested: (EMBASE, RRID:SCR_001650)
    Cochrane Database of Systematic Reviews
    suggested: None
    Cochrane Library
    suggested: (Cochrane Library, RRID:SCR_013000)
    bioRxiv
    suggested: (bioRxiv, RRID:SCR_003933)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Although an adapted version of NOS was used to score cross-sectional studies,20 there may be some limitations in applying this adapted version. We applied an additional quality control measure to observational studies by decreasing preprint study scores by two points. While this approach of downgrading preprints provides further appraisal of study quality, it is not considered in the standard NOS scoring instructions. For the purpose of presenting the most recent evidence on this topic, it was important to include preprint studies, which are typically excluded from systematic reviews, but are an essential consideration in COVID-19 reviews. Twenty-one guidance documents were appraised, highlighting the breadth of grey literature included in this review. No guidance documents were classified as clinical practice guidelines, but the AGREE II tool was applied to all guidance documents as it is recognised as the gold standard for quality assessment of guidelines.19 While we acknowledge the AGREE II tool was designed for clinical practice guidelines, due to a lack of alternative standard critical appraisal options, it was the best choice for this review. Guidance documents ranged from low to high quality, with sources consistently scoring low in Domain 3: Rigour of Development. This was largely due to the limited inclusion of methodological consideration and the heterogeneity across sources. It is important to note that within Domain 3, one item assessed whether a link between refe...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2021.05.20.21257517v1 on medRxiv