COVID-19 Pandemic​

Changes in Pattern of Adherence to NPIs During the COVID-19 Pandemic​

To the Editor: During the COVID-19 pandemic, non pharmaceutical interventions (NPIs) have been the frontline defense against its spread. As we approach a complete unlock, circumstances seem ideal to have a revision of adherence to NPIs. Usage of NPIs, namely face mask, social distancing, and hand rub among the adults accompanying the children to the OPD in an exclusive pediatric hospital on 15th February 2021, was assessed. The results were compared with a similar study from October 2020 [1]. Among the 300 participants, an overall decrease in adherence to NPIs was observed. Compliance to social distancing decreased from 86% to around 45% and usage of hand rub reduced from 86% to 24%. But a significant increase in adherence to face masks was observed (74% to 99%). 

The overall decrease in usage of NPIs could be attributed to “pandemic fatigue” [2]. Another reason could be complacency following flattening of India’s COVID-19 curve. The higher usage of masks could be due to better understanding of the disease and strict regulations demanding compulsory wearing of masks in public spaces. But the significant rise in mask usage and relative decrease in adherence to other NPIs could be due to a misconception that face masks are more effective. Similar trend of increase in usage of face masks but a decreased adherence to social distancing and other NPIs was observed by Crane et al. [3]. Analysis of this behavior is needed to understand this trend. 

A combination of NPIs has been proven to be more effective in preventing spread of COVID-19 [4], rather than face mask alone. Governments should mandate strategies to reinvigorate public support for NPIs [2]. Despite vaccination, experts recommend continued adherence to NPIs. With the looming question of a second wave outbreak, it is vital that the public remains vigilant and maintains complete adherence to NPIs. 


1. Clinton M, Sankar J, Ramesh V, et al. Use of proper personal pro-

tective measures among parents of children attending outpatient de-

partment — an observational study. Indian J Pediatr. 2021.

2. World Health Organization. Regional office for Europe 2020.

Pandemic fatigue: reinvigorating the public to prevent COVID-19:

policy considerations for member states in the WHO European re-

gion. World Health Organization. Regional Office for Europe.

License: CC BY-NC-SA 3.0 IGO. Accessed on 25 Feb 2020.

3. Crane MA, Shermock KM, Omer SB, Romley JA. Change in report-

ed adherence to nonpharmaceutical interventions during the COVID-

19 pandemic, April–November 2020. JAMA. 2021.

4. Bo Y, Guo C, Lin C, et al. Effectiveness of non-pharmaceutical

interventions on COVID-19 transmission in 190 countries from 23

January to 13 April 2020. Int J Infect Dis. 2021;102:247–53.

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