Systematic review of empiric studies on lockdowns, workplace closures, and other non-pharmaceutical interventions in non-healthcare workplaces during the initial year of the COVID-19 pandemic: benefits and selected unintended consequences

Abstract

Background: We conducted a systematic review aimed to evaluate the effects of non-pharmaceutical interventions within non-healthcare workplaces and community-level workplace closures and lockdowns on COVID-19 morbidity and mortality, selected mental disorders, and employment outcomes in workers or the general population.

Methods: The inclusion criteria included randomized controlled trials and non-randomized studies of interventions. The exclusion criteria included modeling studies. Electronic searches were conducted using MEDLINE, Embase, and other databases from January 1, 2020, through May 11, 2021. Risk of bias was assessed using the Risk of Bias in Non-Randomized Studies of Interventions (ROBINS-I) tool. Meta-analysis and sign tests were performed.

Results: A total of 60 observational studies met the inclusion criteria. There were 40 studies on COVID-19 outcomes, 15 on anxiety and depression symptoms, and five on unemployment and labor force participation. There was a paucity of studies on physical distancing, physical barriers, and symptom and temperature screening within workplaces. The sign test indicated that lockdown reduced COVID-19 incidence or case growth rate (23 studies, p < 0.001), reproduction number (11 studies, p < 0.001), and COVID-19 mortality or death growth rate (seven studies, p < 0.05) in the general population. Lockdown did not have any effect on anxiety symptoms (pooled standardized mean difference = -0.02, 95% CI: -0.06, 0.02). Lockdown had a small effect on increasing depression symptoms (pooled standardized mean difference = 0.16, 95% CI: 0.10, 0.21), but publication bias could account for the observed effect. Lockdown increased unemployment (pooled mean difference = 4.48 percentage points, 95% CI: 1.79, 7.17) and decreased labor force participation (pooled mean difference = -2.46 percentage points, 95% CI: -3.16, -1.77). The risk of bias for most of the studies on COVID-19 or employment outcomes was moderate or serious. The risk of bias for the studies on anxiety or depression symptoms was serious or critical.

Conclusions: Empiric studies indicated that lockdown reduced the impact of COVID-19, but that it had notable unwanted effects. There is a pronounced paucity of studies on the effect of interventions within still-open workplaces. It is important for countries that implement lockdown in future pandemics to consider strategies to mitigate these unintended consequences.

Systematic review registration: PROSPERO registration # CRD42020182660.

Keywords: Anxiety; COVID-19; Community mitigation; Depression; Employment; Lockdown; Non-pharmaceutical; Novel coronavirus; Social distancing; Systematic review; Workplace.

Fig. 1

Systematic review of the effects of non-pharmaceutical interventions in non-healthcare workplaces, January 1, 2020–May 11, 2021

Fig. 2

Forest plots of the effect of lockdown on anxiety and depression symptoms, January 1, 2020–May 11, 2021^a. ^aI² for heterogeneity for studies on anxiety symptoms = 94% (Q test p < 0.001). I² for heterogeneity for studies on depression symptoms = 98% (Q test p < 0.001)

Fig. 3

Funnel plots of the effect of lockdown on anxiety and depression symptoms, January 1, 2020–May 11, 2021^a. ^aThe graph on the left shows studies on anxiety symptoms, and that on the right shows studies on depression symptoms. The Trim and Fill adjusted pooled standardized mean difference for depression symptoms = 0.001 (95% CI: -0.04, 0.02)

Fig. 4

Forest plots of the effect of lockdown on unemployment and labor force participation, January 1, 2020–May 11, 2021^a. ^aI² for heterogeneity for studies on unemployment = 92% (Q test p < 0.001). I² for heterogeneity for studies on labor force participation = 0% (Q test p = 0.69)