Table 1 Open in new tab (Part 1):...

Table 1

(Part 1): Personal practices as preventive measure—risk; behavioural change; health co-benefits; enabling and limiting factors and strength of evidence

	Engage in regular handwashing	Wear face mask	Avoid touching the face
Risk	COVID-19 is transmittable through respiratory fluid droplets⁴^,¹⁹ Droplets can persist on hands and other surfaces²⁰ Droplets may be transferred if hands are not disinfected	Respiratory droplets from other individuals and hand-to-face contacts can result in droplet intake through the nose and mouth⁴^,²¹^,²² Viruses have the potential to survive in the respiratory tract.²³ The virus may also enter through ocular means, although studies focusing specifically on COVID-19 are limited²⁴ COVID-19 has an incubation period of as long as 19 days²⁵; asymptomatic or mildly symptomatic individuals may spread the virus through coughing or sneezing In 2010, WHO stated that where there is improper mask usage, risk may increase²⁶	Recent research has suggested that nasal carriage²⁷ and ocular entry²⁴ are key alternative routes to oral entry into the respiratory tract for COVID-19 It has been demonstrated that COVID-19 can be detected on surfaces of plastic, stainless steel, copper and cardboard for up to 72 hours²⁰ after contamination. Hand-to-face contact following contact of public surfaces may pose a risk
Behavioural change	Wash hands with soap²⁵^,^28–34 for a minimum of 20 seconds using a step-by-step guideline such as the WHO healthcare-based 11-step guideline³⁵ Wash hands before eating, after bathroom usage, after mask removal, etc. Practice alternative handwashing routines as long as they maintain the core principle of ensuring that the entire surface area of the hands is scrubbed³⁶ Ensure commonly missed areas are washed, such as the thumbs and fingertips^37–40	Wear surgical face masks²⁵^,³³^,³⁴^,^41–44 to create a physical barrier preventing the spread or intake of the virus-containing respiratory droplet (which are released by coughing or sneezing) through facial openings⁴⁵ Wear face masks to minimize the touching of the nose and mouth as these can serve as transmission routes for COVID-19²¹^,⁴⁶^,²²^,⁴ Use face masks correctly to ensure the best overall effectiveness, including one-time usage; limiting usage to 1 day and avoid touching the surface to minimize risk of self-contamination⁴⁷^,⁴⁸	Avoid touching the face to minimize the risk of COVID-19 contact through the body’s main entry points for transmittable conditions^32–34^,⁴¹^,⁴⁹: the mouth, the eyes and the nose Exercise increased awareness of this unwanted practice to minimize the risk of infection, as self-touching of the face may be spontaneous⁵⁰^,⁵¹
Co-benefit(s)	Prevention of other contact transmissible diseases such as influenza,⁵²^,⁵³ to some extent, diarrhoea⁵⁴^,⁵⁵ and eye infections⁵⁶ Potential for reduced infection transmission in community and household⁵⁷	Protection against other microbes transmitted by respiratory droplets through the nose, mouth or eyes²⁴^,²⁷ Protection from air pollutants and other air particles,⁵⁸^,⁵⁹ which could cause other respiratory conditions⁶⁰ such as asthma and lung cancer⁶¹^,⁶²	Minimizes contracting diseases with similar transmission pathways such as influenza⁴⁹^,⁶³ Reduce risk of transferring bacterial pathogens found on hands⁶⁴
Enabling factor(s)	Availability and affordability of sufficient running water, soap, and alcohol-based rubs	Access to effective face masks Information about the correct use of face masks, including proper disposal Information about when to wear facemasks Socio-cultural acceptance and habit on wearing face masks (global East vs. West)	Effectiveness may be limited for infants, children and others who do not have sufficient conscious control of body movement
Limiting factor(s) and/or alternative(s)	Alcohol-based formulas as an alternative; efficacy in killing enveloped viruses has been demonstrated⁶⁵ Use of ash and mud as an alternative in areas where there is no access to soap or alcohol-based rubs. Although these carry potential antimicrobial properties,⁶⁶ their efficacy in counteracting viral infections is not well-evidenced⁶⁷ Sharing and reusing water or water containers, in areas lacking running water, elevate the risk of transmission through droplets.	For those who cannot access surgical face masks, due to affordability, availability or otherwise, homemade masks⁶⁹ accompanied with the same hygienic measures can be considered⁷⁰	Where face touching is necessary or difficult to control, for example in infants or children, handwashing will be a more effective prevention measure
Strength of evidence	Published evidence showed handwashing is a core community prevention measure for COVID-19 transmission Handwashing communities display lower risks of developing transmittable diseases when compared to their non-handwashing counterparts, in both rural⁶⁶ and urban populations⁷¹ The measure is recommended by multiple governing bodies, including the WHO⁴¹ and CDC⁴² Studies from Severe Acute Respiratory Syndrome (SARS), although not conclusive, are suggestive of handwashing as an effective measure⁷² 20 seconds may be considered a minimum duration given that time reductions, for example to 5 seconds,⁷³ have been demonstrated as less effective Soap and alcohol-based rubs are well evidenced in their capability to interact with and degrade enveloped viruses⁴³^,⁶⁵ Evidence of ash or mud-based alternatives as antimicrobials is limited; no concrete evidence with respect to efficacy against COVID-19 or other viral infections was identified	Multiple extensive studies on the similar SARS coronavirus concluded that there is evidence of effective transmission risk reduction^28–30^,⁷⁴ Success of Hong Kong and Taiwan’s high compliance to mask-wearing practices⁷⁵ has been potentially reflected in the low rate of locally infected cases of COVID-19,⁷⁶ with both communities having reported periods of no new infections despite initial surges⁷⁷ Used in conjunction with other practices such as social distancing, a model simulation demonstrated community-wide benefits of mask-wearing⁷⁸	Such measures have been recommended for influenza in the past³¹ There is strong evidence of viral infections entering through the facial entry points and has been demonstrated for COVID-19,²⁷^,²⁴ although evidence for the impact of face touching in disease transmission was not found The stability of COVID-19 virus on certain surfaces has been evidenced. Similarly, previous studies have demonstrated the stability of other coronaviruses such as SARS, on such surfaces⁷⁹
Risk	COVID-19 is transmittable through droplets¹⁹ and has the potential to remain stable on surfaces up to 72 hours.²⁰ Open coughing, sneezing, and talking may directly or indirectly transmit COVID-19.⁴⁹ Research suggests that such pathogen-bearing droplets can travel up to 7–8 m⁸⁰	There is a high possibility of COVID-19 transmission through saliva droplets⁸¹^,⁸² in instances where public utensils are not sufficiently disinfected⁸³^,⁸⁴	There is growing evidence of COVID-19 being present in stool after clearance through the respiratory tract⁸⁵^,⁸⁶ Virus particles present in stool can be transmitted through toilet plume generated after flushing,⁸⁷^,⁸⁸ especially if the toilet is unclosed
Behavioural change	Cough/sneeze into tissue paper that is disposed immediately Replace mask after a major sneeze Cough or sneeze into elbow or shirt if mask or tissue is unavailable⁸⁹ These practices²⁵^,³⁰^,³⁴^,^41–43 minimize droplet landings on the hands, which are most likely to come into contact with oneself and other surfaces. Hands should be disinfected after coughing or sneezing	Avoid food consumption with public utensils, or utensils that have not been confirmed to be disinfected Use personal utensils³⁴^,⁹⁰^,⁹¹ that have been appropriately disinfected for food consumption	Cover toilets prior to flushing, both at home and in public Avoid public toilets during such a pandemic, especially those with toilets lacking lids⁹²
Co-benefit(s)	Minimizing risk of other droplet-transmittable diseases⁴⁹	Prevention of other diseases that are transmitted through saliva⁶³	Improved household hygiene and protection from pathogens present in stool, such as bacterial or norovirus infections causing gastroenteritis⁸⁸
Enabling factor(s)	Access to masks and tissue Adequate mobility and reaction to raise elbow or tissue to the face	Access to personal reusable or single-use utensils	Access to a toilet with a functional lid
Limiting factor(s) and/or alternative(s)	People with limited mobility, such as the elderly,⁹³^,⁹⁴ may not be able to react in time. The alternative is to maximize mask wearing as a permanent physical barrier	May not be applicable to contexts where eating with hands is the tradition. Handwashing should be the primary preventive measure in these contexts Where personal utensils are not available, single-use utensils can be considered, although there are environmental implications of disposable utensils⁹⁵^,⁹⁶	Another study has suggested that due to space between the lid and the toilet bowl, shutting the lid may not impede emissions entirely⁹⁷ For households lacking lidded toilets, other protective measures include regular cleaning; wearing a face mask during toilet usage and avoiding sharing toilets
Strength of evidence	There is strong evidence supporting the transmission of COVID-19 through respiratory droplets, which can be expelled in sneezing and coughing³²^,⁹⁸^,⁹⁹ Some evidence indicates that wearing a mask redirects coughed particles to a less harmful direction⁴⁴—similar outcome may be inferred for tissue or elbow blockage, although it may not be as effective There is lacking evidence on how each of the behavioural changes contribute to risk reduction for COVID-19 specifically	There is no specific evidence of COVID-19 transmitting through public cutlery Limited evidence suggesting restaurants or caterers fail to properly disinfect their reusable cutlery	Although this has not been directly confirmed, there is growing evidence that COVID-19 may be present in stool There is evidence that toilet plumes ascend when toilets remain open This measure has been suggested by authorities in places such as Hong Kong³³

	Engage in regular handwashing	Wear face mask	Avoid touching the face
Risk	COVID-19 is transmittable through respiratory fluid droplets⁴^,¹⁹ Droplets can persist on hands and other surfaces²⁰ Droplets may be transferred if hands are not disinfected	Respiratory droplets from other individuals and hand-to-face contacts can result in droplet intake through the nose and mouth⁴^,²¹^,²² Viruses have the potential to survive in the respiratory tract.²³ The virus may also enter through ocular means, although studies focusing specifically on COVID-19 are limited²⁴ COVID-19 has an incubation period of as long as 19 days²⁵; asymptomatic or mildly symptomatic individuals may spread the virus through coughing or sneezing In 2010, WHO stated that where there is improper mask usage, risk may increase²⁶	Recent research has suggested that nasal carriage²⁷ and ocular entry²⁴ are key alternative routes to oral entry into the respiratory tract for COVID-19 It has been demonstrated that COVID-19 can be detected on surfaces of plastic, stainless steel, copper and cardboard for up to 72 hours²⁰ after contamination. Hand-to-face contact following contact of public surfaces may pose a risk
Behavioural change	Wash hands with soap²⁵^,^28–34 for a minimum of 20 seconds using a step-by-step guideline such as the WHO healthcare-based 11-step guideline³⁵ Wash hands before eating, after bathroom usage, after mask removal, etc. Practice alternative handwashing routines as long as they maintain the core principle of ensuring that the entire surface area of the hands is scrubbed³⁶ Ensure commonly missed areas are washed, such as the thumbs and fingertips^37–40	Wear surgical face masks²⁵^,³³^,³⁴^,^41–44 to create a physical barrier preventing the spread or intake of the virus-containing respiratory droplet (which are released by coughing or sneezing) through facial openings⁴⁵ Wear face masks to minimize the touching of the nose and mouth as these can serve as transmission routes for COVID-19²¹^,⁴⁶^,²²^,⁴ Use face masks correctly to ensure the best overall effectiveness, including one-time usage; limiting usage to 1 day and avoid touching the surface to minimize risk of self-contamination⁴⁷^,⁴⁸	Avoid touching the face to minimize the risk of COVID-19 contact through the body’s main entry points for transmittable conditions^32–34^,⁴¹^,⁴⁹: the mouth, the eyes and the nose Exercise increased awareness of this unwanted practice to minimize the risk of infection, as self-touching of the face may be spontaneous⁵⁰^,⁵¹
Co-benefit(s)	Prevention of other contact transmissible diseases such as influenza,⁵²^,⁵³ to some extent, diarrhoea⁵⁴^,⁵⁵ and eye infections⁵⁶ Potential for reduced infection transmission in community and household⁵⁷	Protection against other microbes transmitted by respiratory droplets through the nose, mouth or eyes²⁴^,²⁷ Protection from air pollutants and other air particles,⁵⁸^,⁵⁹ which could cause other respiratory conditions⁶⁰ such as asthma and lung cancer⁶¹^,⁶²	Minimizes contracting diseases with similar transmission pathways such as influenza⁴⁹^,⁶³ Reduce risk of transferring bacterial pathogens found on hands⁶⁴
Enabling factor(s)	Availability and affordability of sufficient running water, soap, and alcohol-based rubs	Access to effective face masks Information about the correct use of face masks, including proper disposal Information about when to wear facemasks Socio-cultural acceptance and habit on wearing face masks (global East vs. West)	Effectiveness may be limited for infants, children and others who do not have sufficient conscious control of body movement
Limiting factor(s) and/or alternative(s)	Alcohol-based formulas as an alternative; efficacy in killing enveloped viruses has been demonstrated⁶⁵ Use of ash and mud as an alternative in areas where there is no access to soap or alcohol-based rubs. Although these carry potential antimicrobial properties,⁶⁶ their efficacy in counteracting viral infections is not well-evidenced⁶⁷ Sharing and reusing water or water containers, in areas lacking running water, elevate the risk of transmission through droplets.	For those who cannot access surgical face masks, due to affordability, availability or otherwise, homemade masks⁶⁹ accompanied with the same hygienic measures can be considered⁷⁰	Where face touching is necessary or difficult to control, for example in infants or children, handwashing will be a more effective prevention measure
Strength of evidence	Published evidence showed handwashing is a core community prevention measure for COVID-19 transmission Handwashing communities display lower risks of developing transmittable diseases when compared to their non-handwashing counterparts, in both rural⁶⁶ and urban populations⁷¹ The measure is recommended by multiple governing bodies, including the WHO⁴¹ and CDC⁴² Studies from Severe Acute Respiratory Syndrome (SARS), although not conclusive, are suggestive of handwashing as an effective measure⁷² 20 seconds may be considered a minimum duration given that time reductions, for example to 5 seconds,⁷³ have been demonstrated as less effective Soap and alcohol-based rubs are well evidenced in their capability to interact with and degrade enveloped viruses⁴³^,⁶⁵ Evidence of ash or mud-based alternatives as antimicrobials is limited; no concrete evidence with respect to efficacy against COVID-19 or other viral infections was identified	Multiple extensive studies on the similar SARS coronavirus concluded that there is evidence of effective transmission risk reduction^28–30^,⁷⁴ Success of Hong Kong and Taiwan’s high compliance to mask-wearing practices⁷⁵ has been potentially reflected in the low rate of locally infected cases of COVID-19,⁷⁶ with both communities having reported periods of no new infections despite initial surges⁷⁷ Used in conjunction with other practices such as social distancing, a model simulation demonstrated community-wide benefits of mask-wearing⁷⁸	Such measures have been recommended for influenza in the past³¹ There is strong evidence of viral infections entering through the facial entry points and has been demonstrated for COVID-19,²⁷^,²⁴ although evidence for the impact of face touching in disease transmission was not found The stability of COVID-19 virus on certain surfaces has been evidenced. Similarly, previous studies have demonstrated the stability of other coronaviruses such as SARS, on such surfaces⁷⁹
Risk	COVID-19 is transmittable through droplets¹⁹ and has the potential to remain stable on surfaces up to 72 hours.²⁰ Open coughing, sneezing, and talking may directly or indirectly transmit COVID-19.⁴⁹ Research suggests that such pathogen-bearing droplets can travel up to 7–8 m⁸⁰	There is a high possibility of COVID-19 transmission through saliva droplets⁸¹^,⁸² in instances where public utensils are not sufficiently disinfected⁸³^,⁸⁴	There is growing evidence of COVID-19 being present in stool after clearance through the respiratory tract⁸⁵^,⁸⁶ Virus particles present in stool can be transmitted through toilet plume generated after flushing,⁸⁷^,⁸⁸ especially if the toilet is unclosed
Behavioural change	Cough/sneeze into tissue paper that is disposed immediately Replace mask after a major sneeze Cough or sneeze into elbow or shirt if mask or tissue is unavailable⁸⁹ These practices²⁵^,³⁰^,³⁴^,^41–43 minimize droplet landings on the hands, which are most likely to come into contact with oneself and other surfaces. Hands should be disinfected after coughing or sneezing	Avoid food consumption with public utensils, or utensils that have not been confirmed to be disinfected Use personal utensils³⁴^,⁹⁰^,⁹¹ that have been appropriately disinfected for food consumption	Cover toilets prior to flushing, both at home and in public Avoid public toilets during such a pandemic, especially those with toilets lacking lids⁹²
Co-benefit(s)	Minimizing risk of other droplet-transmittable diseases⁴⁹	Prevention of other diseases that are transmitted through saliva⁶³	Improved household hygiene and protection from pathogens present in stool, such as bacterial or norovirus infections causing gastroenteritis⁸⁸
Enabling factor(s)	Access to masks and tissue Adequate mobility and reaction to raise elbow or tissue to the face	Access to personal reusable or single-use utensils	Access to a toilet with a functional lid
Limiting factor(s) and/or alternative(s)	People with limited mobility, such as the elderly,⁹³^,⁹⁴ may not be able to react in time. The alternative is to maximize mask wearing as a permanent physical barrier	May not be applicable to contexts where eating with hands is the tradition. Handwashing should be the primary preventive measure in these contexts Where personal utensils are not available, single-use utensils can be considered, although there are environmental implications of disposable utensils⁹⁵^,⁹⁶	Another study has suggested that due to space between the lid and the toilet bowl, shutting the lid may not impede emissions entirely⁹⁷ For households lacking lidded toilets, other protective measures include regular cleaning; wearing a face mask during toilet usage and avoiding sharing toilets
Strength of evidence	There is strong evidence supporting the transmission of COVID-19 through respiratory droplets, which can be expelled in sneezing and coughing³²^,⁹⁸^,⁹⁹ Some evidence indicates that wearing a mask redirects coughed particles to a less harmful direction⁴⁴—similar outcome may be inferred for tissue or elbow blockage, although it may not be as effective There is lacking evidence on how each of the behavioural changes contribute to risk reduction for COVID-19 specifically	There is no specific evidence of COVID-19 transmitting through public cutlery Limited evidence suggesting restaurants or caterers fail to properly disinfect their reusable cutlery	Although this has not been directly confirmed, there is growing evidence that COVID-19 may be present in stool There is evidence that toilet plumes ascend when toilets remain open This measure has been suggested by authorities in places such as Hong Kong³³

Table 1

Open in new tab

(Part 1): Personal practices as preventive measure—risk; behavioural change; health co-benefits; enabling and limiting factors and strength of evidence

	Engage in regular handwashing	Wear face mask	Avoid touching the face
Risk	COVID-19 is transmittable through respiratory fluid droplets⁴^,¹⁹ Droplets can persist on hands and other surfaces²⁰ Droplets may be transferred if hands are not disinfected	Respiratory droplets from other individuals and hand-to-face contacts can result in droplet intake through the nose and mouth⁴^,²¹^,²² Viruses have the potential to survive in the respiratory tract.²³ The virus may also enter through ocular means, although studies focusing specifically on COVID-19 are limited²⁴ COVID-19 has an incubation period of as long as 19 days²⁵; asymptomatic or mildly symptomatic individuals may spread the virus through coughing or sneezing In 2010, WHO stated that where there is improper mask usage, risk may increase²⁶	Recent research has suggested that nasal carriage²⁷ and ocular entry²⁴ are key alternative routes to oral entry into the respiratory tract for COVID-19 It has been demonstrated that COVID-19 can be detected on surfaces of plastic, stainless steel, copper and cardboard for up to 72 hours²⁰ after contamination. Hand-to-face contact following contact of public surfaces may pose a risk
Behavioural change	Wash hands with soap²⁵^,^28–34 for a minimum of 20 seconds using a step-by-step guideline such as the WHO healthcare-based 11-step guideline³⁵ Wash hands before eating, after bathroom usage, after mask removal, etc. Practice alternative handwashing routines as long as they maintain the core principle of ensuring that the entire surface area of the hands is scrubbed³⁶ Ensure commonly missed areas are washed, such as the thumbs and fingertips^37–40	Wear surgical face masks²⁵^,³³^,³⁴^,^41–44 to create a physical barrier preventing the spread or intake of the virus-containing respiratory droplet (which are released by coughing or sneezing) through facial openings⁴⁵ Wear face masks to minimize the touching of the nose and mouth as these can serve as transmission routes for COVID-19²¹^,⁴⁶^,²²^,⁴ Use face masks correctly to ensure the best overall effectiveness, including one-time usage; limiting usage to 1 day and avoid touching the surface to minimize risk of self-contamination⁴⁷^,⁴⁸	Avoid touching the face to minimize the risk of COVID-19 contact through the body’s main entry points for transmittable conditions^32–34^,⁴¹^,⁴⁹: the mouth, the eyes and the nose Exercise increased awareness of this unwanted practice to minimize the risk of infection, as self-touching of the face may be spontaneous⁵⁰^,⁵¹
Co-benefit(s)	Prevention of other contact transmissible diseases such as influenza,⁵²^,⁵³ to some extent, diarrhoea⁵⁴^,⁵⁵ and eye infections⁵⁶ Potential for reduced infection transmission in community and household⁵⁷	Protection against other microbes transmitted by respiratory droplets through the nose, mouth or eyes²⁴^,²⁷ Protection from air pollutants and other air particles,⁵⁸^,⁵⁹ which could cause other respiratory conditions⁶⁰ such as asthma and lung cancer⁶¹^,⁶²	Minimizes contracting diseases with similar transmission pathways such as influenza⁴⁹^,⁶³ Reduce risk of transferring bacterial pathogens found on hands⁶⁴
Enabling factor(s)	Availability and affordability of sufficient running water, soap, and alcohol-based rubs	Access to effective face masks Information about the correct use of face masks, including proper disposal Information about when to wear facemasks Socio-cultural acceptance and habit on wearing face masks (global East vs. West)	Effectiveness may be limited for infants, children and others who do not have sufficient conscious control of body movement
Limiting factor(s) and/or alternative(s)	Alcohol-based formulas as an alternative; efficacy in killing enveloped viruses has been demonstrated⁶⁵ Use of ash and mud as an alternative in areas where there is no access to soap or alcohol-based rubs. Although these carry potential antimicrobial properties,⁶⁶ their efficacy in counteracting viral infections is not well-evidenced⁶⁷ Sharing and reusing water or water containers, in areas lacking running water, elevate the risk of transmission through droplets.	For those who cannot access surgical face masks, due to affordability, availability or otherwise, homemade masks⁶⁹ accompanied with the same hygienic measures can be considered⁷⁰	Where face touching is necessary or difficult to control, for example in infants or children, handwashing will be a more effective prevention measure
Strength of evidence	Published evidence showed handwashing is a core community prevention measure for COVID-19 transmission Handwashing communities display lower risks of developing transmittable diseases when compared to their non-handwashing counterparts, in both rural⁶⁶ and urban populations⁷¹ The measure is recommended by multiple governing bodies, including the WHO⁴¹ and CDC⁴² Studies from Severe Acute Respiratory Syndrome (SARS), although not conclusive, are suggestive of handwashing as an effective measure⁷² 20 seconds may be considered a minimum duration given that time reductions, for example to 5 seconds,⁷³ have been demonstrated as less effective Soap and alcohol-based rubs are well evidenced in their capability to interact with and degrade enveloped viruses⁴³^,⁶⁵ Evidence of ash or mud-based alternatives as antimicrobials is limited; no concrete evidence with respect to efficacy against COVID-19 or other viral infections was identified	Multiple extensive studies on the similar SARS coronavirus concluded that there is evidence of effective transmission risk reduction^28–30^,⁷⁴ Success of Hong Kong and Taiwan’s high compliance to mask-wearing practices⁷⁵ has been potentially reflected in the low rate of locally infected cases of COVID-19,⁷⁶ with both communities having reported periods of no new infections despite initial surges⁷⁷ Used in conjunction with other practices such as social distancing, a model simulation demonstrated community-wide benefits of mask-wearing⁷⁸	Such measures have been recommended for influenza in the past³¹ There is strong evidence of viral infections entering through the facial entry points and has been demonstrated for COVID-19,²⁷^,²⁴ although evidence for the impact of face touching in disease transmission was not found The stability of COVID-19 virus on certain surfaces has been evidenced. Similarly, previous studies have demonstrated the stability of other coronaviruses such as SARS, on such surfaces⁷⁹
Risk	COVID-19 is transmittable through droplets¹⁹ and has the potential to remain stable on surfaces up to 72 hours.²⁰ Open coughing, sneezing, and talking may directly or indirectly transmit COVID-19.⁴⁹ Research suggests that such pathogen-bearing droplets can travel up to 7–8 m⁸⁰	There is a high possibility of COVID-19 transmission through saliva droplets⁸¹^,⁸² in instances where public utensils are not sufficiently disinfected⁸³^,⁸⁴	There is growing evidence of COVID-19 being present in stool after clearance through the respiratory tract⁸⁵^,⁸⁶ Virus particles present in stool can be transmitted through toilet plume generated after flushing,⁸⁷^,⁸⁸ especially if the toilet is unclosed
Behavioural change	Cough/sneeze into tissue paper that is disposed immediately Replace mask after a major sneeze Cough or sneeze into elbow or shirt if mask or tissue is unavailable⁸⁹ These practices²⁵^,³⁰^,³⁴^,^41–43 minimize droplet landings on the hands, which are most likely to come into contact with oneself and other surfaces. Hands should be disinfected after coughing or sneezing	Avoid food consumption with public utensils, or utensils that have not been confirmed to be disinfected Use personal utensils³⁴^,⁹⁰^,⁹¹ that have been appropriately disinfected for food consumption	Cover toilets prior to flushing, both at home and in public Avoid public toilets during such a pandemic, especially those with toilets lacking lids⁹²
Co-benefit(s)	Minimizing risk of other droplet-transmittable diseases⁴⁹	Prevention of other diseases that are transmitted through saliva⁶³	Improved household hygiene and protection from pathogens present in stool, such as bacterial or norovirus infections causing gastroenteritis⁸⁸
Enabling factor(s)	Access to masks and tissue Adequate mobility and reaction to raise elbow or tissue to the face	Access to personal reusable or single-use utensils	Access to a toilet with a functional lid
Limiting factor(s) and/or alternative(s)	People with limited mobility, such as the elderly,⁹³^,⁹⁴ may not be able to react in time. The alternative is to maximize mask wearing as a permanent physical barrier	May not be applicable to contexts where eating with hands is the tradition. Handwashing should be the primary preventive measure in these contexts Where personal utensils are not available, single-use utensils can be considered, although there are environmental implications of disposable utensils⁹⁵^,⁹⁶	Another study has suggested that due to space between the lid and the toilet bowl, shutting the lid may not impede emissions entirely⁹⁷ For households lacking lidded toilets, other protective measures include regular cleaning; wearing a face mask during toilet usage and avoiding sharing toilets
Strength of evidence	There is strong evidence supporting the transmission of COVID-19 through respiratory droplets, which can be expelled in sneezing and coughing³²^,⁹⁸^,⁹⁹ Some evidence indicates that wearing a mask redirects coughed particles to a less harmful direction⁴⁴—similar outcome may be inferred for tissue or elbow blockage, although it may not be as effective There is lacking evidence on how each of the behavioural changes contribute to risk reduction for COVID-19 specifically	There is no specific evidence of COVID-19 transmitting through public cutlery Limited evidence suggesting restaurants or caterers fail to properly disinfect their reusable cutlery	Although this has not been directly confirmed, there is growing evidence that COVID-19 may be present in stool There is evidence that toilet plumes ascend when toilets remain open This measure has been suggested by authorities in places such as Hong Kong³³

	Engage in regular handwashing	Wear face mask	Avoid touching the face
Risk	COVID-19 is transmittable through respiratory fluid droplets⁴^,¹⁹ Droplets can persist on hands and other surfaces²⁰ Droplets may be transferred if hands are not disinfected	Respiratory droplets from other individuals and hand-to-face contacts can result in droplet intake through the nose and mouth⁴^,²¹^,²² Viruses have the potential to survive in the respiratory tract.²³ The virus may also enter through ocular means, although studies focusing specifically on COVID-19 are limited²⁴ COVID-19 has an incubation period of as long as 19 days²⁵; asymptomatic or mildly symptomatic individuals may spread the virus through coughing or sneezing In 2010, WHO stated that where there is improper mask usage, risk may increase²⁶	Recent research has suggested that nasal carriage²⁷ and ocular entry²⁴ are key alternative routes to oral entry into the respiratory tract for COVID-19 It has been demonstrated that COVID-19 can be detected on surfaces of plastic, stainless steel, copper and cardboard for up to 72 hours²⁰ after contamination. Hand-to-face contact following contact of public surfaces may pose a risk
Behavioural change	Wash hands with soap²⁵^,^28–34 for a minimum of 20 seconds using a step-by-step guideline such as the WHO healthcare-based 11-step guideline³⁵ Wash hands before eating, after bathroom usage, after mask removal, etc. Practice alternative handwashing routines as long as they maintain the core principle of ensuring that the entire surface area of the hands is scrubbed³⁶ Ensure commonly missed areas are washed, such as the thumbs and fingertips^37–40	Wear surgical face masks²⁵^,³³^,³⁴^,^41–44 to create a physical barrier preventing the spread or intake of the virus-containing respiratory droplet (which are released by coughing or sneezing) through facial openings⁴⁵ Wear face masks to minimize the touching of the nose and mouth as these can serve as transmission routes for COVID-19²¹^,⁴⁶^,²²^,⁴ Use face masks correctly to ensure the best overall effectiveness, including one-time usage; limiting usage to 1 day and avoid touching the surface to minimize risk of self-contamination⁴⁷^,⁴⁸	Avoid touching the face to minimize the risk of COVID-19 contact through the body’s main entry points for transmittable conditions^32–34^,⁴¹^,⁴⁹: the mouth, the eyes and the nose Exercise increased awareness of this unwanted practice to minimize the risk of infection, as self-touching of the face may be spontaneous⁵⁰^,⁵¹
Co-benefit(s)	Prevention of other contact transmissible diseases such as influenza,⁵²^,⁵³ to some extent, diarrhoea⁵⁴^,⁵⁵ and eye infections⁵⁶ Potential for reduced infection transmission in community and household⁵⁷	Protection against other microbes transmitted by respiratory droplets through the nose, mouth or eyes²⁴^,²⁷ Protection from air pollutants and other air particles,⁵⁸^,⁵⁹ which could cause other respiratory conditions⁶⁰ such as asthma and lung cancer⁶¹^,⁶²	Minimizes contracting diseases with similar transmission pathways such as influenza⁴⁹^,⁶³ Reduce risk of transferring bacterial pathogens found on hands⁶⁴
Enabling factor(s)	Availability and affordability of sufficient running water, soap, and alcohol-based rubs	Access to effective face masks Information about the correct use of face masks, including proper disposal Information about when to wear facemasks Socio-cultural acceptance and habit on wearing face masks (global East vs. West)	Effectiveness may be limited for infants, children and others who do not have sufficient conscious control of body movement
Limiting factor(s) and/or alternative(s)	Alcohol-based formulas as an alternative; efficacy in killing enveloped viruses has been demonstrated⁶⁵ Use of ash and mud as an alternative in areas where there is no access to soap or alcohol-based rubs. Although these carry potential antimicrobial properties,⁶⁶ their efficacy in counteracting viral infections is not well-evidenced⁶⁷ Sharing and reusing water or water containers, in areas lacking running water, elevate the risk of transmission through droplets.	For those who cannot access surgical face masks, due to affordability, availability or otherwise, homemade masks⁶⁹ accompanied with the same hygienic measures can be considered⁷⁰	Where face touching is necessary or difficult to control, for example in infants or children, handwashing will be a more effective prevention measure
Strength of evidence	Published evidence showed handwashing is a core community prevention measure for COVID-19 transmission Handwashing communities display lower risks of developing transmittable diseases when compared to their non-handwashing counterparts, in both rural⁶⁶ and urban populations⁷¹ The measure is recommended by multiple governing bodies, including the WHO⁴¹ and CDC⁴² Studies from Severe Acute Respiratory Syndrome (SARS), although not conclusive, are suggestive of handwashing as an effective measure⁷² 20 seconds may be considered a minimum duration given that time reductions, for example to 5 seconds,⁷³ have been demonstrated as less effective Soap and alcohol-based rubs are well evidenced in their capability to interact with and degrade enveloped viruses⁴³^,⁶⁵ Evidence of ash or mud-based alternatives as antimicrobials is limited; no concrete evidence with respect to efficacy against COVID-19 or other viral infections was identified	Multiple extensive studies on the similar SARS coronavirus concluded that there is evidence of effective transmission risk reduction^28–30^,⁷⁴ Success of Hong Kong and Taiwan’s high compliance to mask-wearing practices⁷⁵ has been potentially reflected in the low rate of locally infected cases of COVID-19,⁷⁶ with both communities having reported periods of no new infections despite initial surges⁷⁷ Used in conjunction with other practices such as social distancing, a model simulation demonstrated community-wide benefits of mask-wearing⁷⁸	Such measures have been recommended for influenza in the past³¹ There is strong evidence of viral infections entering through the facial entry points and has been demonstrated for COVID-19,²⁷^,²⁴ although evidence for the impact of face touching in disease transmission was not found The stability of COVID-19 virus on certain surfaces has been evidenced. Similarly, previous studies have demonstrated the stability of other coronaviruses such as SARS, on such surfaces⁷⁹
Risk	COVID-19 is transmittable through droplets¹⁹ and has the potential to remain stable on surfaces up to 72 hours.²⁰ Open coughing, sneezing, and talking may directly or indirectly transmit COVID-19.⁴⁹ Research suggests that such pathogen-bearing droplets can travel up to 7–8 m⁸⁰	There is a high possibility of COVID-19 transmission through saliva droplets⁸¹^,⁸² in instances where public utensils are not sufficiently disinfected⁸³^,⁸⁴	There is growing evidence of COVID-19 being present in stool after clearance through the respiratory tract⁸⁵^,⁸⁶ Virus particles present in stool can be transmitted through toilet plume generated after flushing,⁸⁷^,⁸⁸ especially if the toilet is unclosed
Behavioural change	Cough/sneeze into tissue paper that is disposed immediately Replace mask after a major sneeze Cough or sneeze into elbow or shirt if mask or tissue is unavailable⁸⁹ These practices²⁵^,³⁰^,³⁴^,^41–43 minimize droplet landings on the hands, which are most likely to come into contact with oneself and other surfaces. Hands should be disinfected after coughing or sneezing	Avoid food consumption with public utensils, or utensils that have not been confirmed to be disinfected Use personal utensils³⁴^,⁹⁰^,⁹¹ that have been appropriately disinfected for food consumption	Cover toilets prior to flushing, both at home and in public Avoid public toilets during such a pandemic, especially those with toilets lacking lids⁹²
Co-benefit(s)	Minimizing risk of other droplet-transmittable diseases⁴⁹	Prevention of other diseases that are transmitted through saliva⁶³	Improved household hygiene and protection from pathogens present in stool, such as bacterial or norovirus infections causing gastroenteritis⁸⁸
Enabling factor(s)	Access to masks and tissue Adequate mobility and reaction to raise elbow or tissue to the face	Access to personal reusable or single-use utensils	Access to a toilet with a functional lid
Limiting factor(s) and/or alternative(s)	People with limited mobility, such as the elderly,⁹³^,⁹⁴ may not be able to react in time. The alternative is to maximize mask wearing as a permanent physical barrier	May not be applicable to contexts where eating with hands is the tradition. Handwashing should be the primary preventive measure in these contexts Where personal utensils are not available, single-use utensils can be considered, although there are environmental implications of disposable utensils⁹⁵^,⁹⁶	Another study has suggested that due to space between the lid and the toilet bowl, shutting the lid may not impede emissions entirely⁹⁷ For households lacking lidded toilets, other protective measures include regular cleaning; wearing a face mask during toilet usage and avoiding sharing toilets
Strength of evidence	There is strong evidence supporting the transmission of COVID-19 through respiratory droplets, which can be expelled in sneezing and coughing³²^,⁹⁸^,⁹⁹ Some evidence indicates that wearing a mask redirects coughed particles to a less harmful direction⁴⁴—similar outcome may be inferred for tissue or elbow blockage, although it may not be as effective There is lacking evidence on how each of the behavioural changes contribute to risk reduction for COVID-19 specifically	There is no specific evidence of COVID-19 transmitting through public cutlery Limited evidence suggesting restaurants or caterers fail to properly disinfect their reusable cutlery	Although this has not been directly confirmed, there is growing evidence that COVID-19 may be present in stool There is evidence that toilet plumes ascend when toilets remain open This measure has been suggested by authorities in places such as Hong Kong³³

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