Indian researchers find the most cost-effective preventative measure that we can take against the coronavirus. The result is a data-driven case for hand hygiene that has arrived at an important time.
The pandemic has become the tale of two worlds. In countries with access to vaccines, mass vaccination campaigns have successfully brought down the number and severity of COVID-19 cases. Large swaths of America have reopened, bringing back mass gatherings like concerts and packed arenas for playoff games. People are even starting to refer to the pandemic in the past tense.
At the same time as much of the developed world ends or eases pandemic restrictions, large parts of the rest of the world are facing their most difficult months of the pandemic. Many jurisdictions will be waiting until at least next year before they can achieve widespread vaccination. In the absence of herd immunity, public health officials have tough choices to make. Their challenge is to protect the greatest number of people with limited resources. Their vexing situation makes studies like this one from India, published in the Elsevier Journal of Clinical Epidemiology and Global Health, all the more important. In this research paper, the authors study the cost-effectiveness of various protective measures that have been widely used during the COVID-19 pandemic.
Needed information, but under-researched
As India combats the spread of the especially contagious COVID-19 Delta variant, their analysis, first published in February of this year, is prescient. The risk of distributing resources towards an inefficient intervention could have dire consequences. As the authors note, “in resource-limited and large countries like India, disproportionate use PPEs by the population could lead to a mismatch in demand and supply and could lead to a shortage of PPEs for the needy, especially for healthcare workers.”1
At this stage in the pandemic, it is surprising that this was the first investigation into the various costs of popular interventions in their national context. The protective measures studied included the use of surgical mask with hand hygiene, surgical masks by itself, fit-tested N-95 respirator, non-fit tested N-95, and hand-hygiene.
A guide to making tough choices
After running the numbers to see how different interventions affected COVID-19 case numbers and lives saved compared to the cost of these interventions to the public purse, they found that hand hygiene was the most cost-effective.
“Based on the findings, we conclude that among the nonpharmacological interventions to be considered for preventing the spread of COVID-19, hand hygiene was cost-effective, and avoidance of the use of surgical masks and respirators by the general public could save resources. Therefore, we recommend the authorities at all levels to actively promote population-level hand hygiene practices.”2
Never waste an opportunity to educate
While more protection is better, using the interventions as effectively as possible is crucial. The authors analysis of the scientific literature found what many others have. Washing your hands for at least 20 seconds with soap and water or a hand sanitizer with at least 60% can “degrade most of the coronaviruses,” including SARS-CoV-2.3 The effectiveness of this approach is good news. The study does leave us with two concerns. The first is that the authors note that the scientific literature they analyzed was based in medical facilities, not in general population areas. The second is that, even within medical facilities, “improper use of PPEs even among medical care workers as well the general population leads to an increase in risk for COVID-19 and contributes to the transmission of pathogens.”4
Expanding hand hygiene infrastructure in public spaces is recommended by the World Health Organization, but even if officials lack the resource to invest heavily in new equipment they have an opportunity to improve health outcomes. The pandemic has drawn the public’s focus to hand hygiene practices like never before, and public health departments and government officials can continue to educate people on proper hand hygiene behaviour. It the single most effective and economical measure that they can encourage.
 Bagepally, Bhavani Shankara, et al. “Cost-Effectiveness of Surgical Mask, N-95 Respirator, Hand-Hygiene and Surgical Mask with Hand Hygiene in the Prevention of COVID-19: Cost Effectiveness Analysis from Indian Context.” Clinical Epidemiology and Global Health, vol. 10, 2021, p. 100703.
 Bagepally, Bhavani Shankara, et al. p. 100709
 Bagepally, Bhavani Shankara, et al. p. 100707
 Bagepally, Bhavani Shankara, et al. p. 100703