Article Notes
- Rubber and plastic bullets
- Beanbag rounds
- Shot pellets
- Baton rounds
- Arrest of individuals engaged in unlawful behaviour, such as throwing rocks and;
- Crowd dispersal in riot situations that threaten public safety."
- Physical distancing
- Face masks
- Eye protection
- Small study size; note the wide confidence interval in absolute difference of percentage COVID infection, ranging from 50% relative decrease to 15% increase in infection rate.
- Self-reporting by subjects.
- Poor-compliance with hydroxychloroquine; around 1 in 5 did not complete course.
This systematic review out of Berkeley investigated data on death, injury and disability resulting from crowd control projectiles:
The researchers looked at published data from a 27 year period in the US, UK/N Ireland, Israel, Palestine, Switzerland, Turkey, Kashmir and Nepal.
The study was part of a larger effort from Physicians for Human Rights and the International Network of Civil Liberties Organizations.
What did they find?
Analysing 26 articles (mainly cohort studies) including 1,984 injured people, they identified 53 (3%) deaths and 300 (15%) permanently disabled. Half of total deaths and 83% of disabilities were due to head or neck strikes.
More than half (56%) of the deaths were from penetrative injuries, and 27% from chest or abdominal trauma.
The majority of permanent disability was vision loss, or abdominal injuries resulting in splenectomy or colostomy.
71% of survived injuries were severe, mostly to skin or extremities.
"Given their inherent inaccuracy, potential for misuse and associated health consequences of severe injury, disability and death, KIPs do not appear to be appropriate weapons for use in crowd-control settings."
Take-home
Although colloquially called 'non-lethal weapons', it would be more accurate to label kinetic impact projectiles (KIPs) as less-lethal weapons given the high risk of severe injury, permanent disability or even death.
"We identified only two basic contexts in which CCWs should be used in crowd-control settings:
Compounding issue...
Several articles highlighted the effect on morbidity of delays in accessing medical care due to police action and civil unrest.
"There is an urgent need to establish international guidelines on the use of CCWs to prevent unnecessary injury, disability and death, particularly in the use of operational models that avoid the use of weapons."
This important WHO-funded review and meta-analysis from Canada's COVID-19 SURGE group (Systematic Urgent Review Group Effort) looked at the effect of three non-pharmacological interventions on coronavirus transmission:
Why is this important?
The speed of both the global spread of SARS-CoV-2 and national responses has lead to a bundled-approach to public health interventions for which the evidence-base is still catching up. This review provides reassurance that the core recommendations are likely beneficial.
What did they do?
Reflecting the lack of data, the review group analysed research covering not just SARS-CoV-2, but also SARS and MERS, capturing 172 observational studies with over 25,000 patients in both community and healthcare settings.
What did they find?
Perhaps unsurprisingly (though reassuring!) physical distancing > 1 meter was associated with lower transmission risk (risk difference 95% CI -11.5 to -7.5%) with increasing protection as distance increased beyond 2 meters.
Face-masks were also associated with reduced transmission (risk difference 95% CI -14.3% to -15.9%, though with low certainty), as was eye protection (risk difference 95% CI -12.5% to -7.7%).
N95 masks were even more strongly associated with risk reduction, as was mask use in a health-care setting vs non-health-care. Both N95 and multi-layer surgical masks were more protective than single-layer masks.
Bottom-line?
Simple protective behavioural changes, namely physical distancing, face-mask use and eye protection, are associated with a significant risk reduction in coronavirus transmission.
“...recognize, as an aspect of health worker safety, the precautionary principle that reasonable action to reduce risk, such as the use of a fitted N95 respirator, need not await scientific certainty”.
Campbell (2006) SARS Commission final report
Keep in mind...
Most of the 172 studies reported on bundled interventions (ie. PPE and distancing) so multi-factor analysis was required to tease out the individual contributions to risk reduction. Randomised trials are still pending...
Withdrawn by the authors because of their inability to confirm validity of data from Surgisphere used as the basis for this study:
“Because all the authors were not granted access to the raw data and the raw data could not be made available to a third-party auditor, we are unable to validate the primary data sources underlying our article.”
Although the findings are broadly consistent with existing low-quality observational and randomised trials, once again there are trial issues that cast uncertainty:
It is unfortunate that, perhaps in their haste, the researchers did not design a more robust trial.