Article
Research
A scoping review of the impact of long-distance truck
drivers on the spread of COVID-19 infection
Thobile Malinga, Charles
Ambrose Otau Talisuna
Shey
Wiysonge,
Duduzile
Ndwandwe,
Joseph
Chukwudi
Okeibunor,
Corresponding author: Thobile Malinga, Cochrane South Africa, South African Medical Research Council, Cape Town,
South Africa. Thobile.Malinga@mrc.ac.za
Received: 27 Oct 2020 - Accepted: 08 Jan 2021 - Published: 12 Jan 2021
Keywords: Long-distance truck drivers, pandemic, prevention, coronavirus disease
Copyright: Thobile Malinga et al. Pan African Medical Journal (ISSN: 1937-8688). This is an Open Access article distributed
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Cite this article: Thobile Malinga et al. A scoping review of the impact of long-distance truck drivers on the spread of
COVID-19 infection. Pan African Medical Journal. 2021;38(27). 10.11604/pamj.2021.38.27.26691
Available online at: https://www.panafrican-med-journal.com//content/article/38/27/full
&
A scoping review of the impact of long-distance
truck drivers on the spread of COVID-19 infection
Thobile Malinga1,2,&, Charles Shey Wiysonge1,2,3,
Duduzile
Ndwandwe1,
Joseph
Chukwudi
4
4
Okeibunor , Ambrose Otau Talisuna
1
Cochrane South Africa, South African Medical
Research Council, Cape Town, South Africa,
2
Department of Global Health, Stellenbosch
University, Cape Town, South Africa, 3School of
Public Health and Family Medicine, University of
Cape Town, Cape Town, South Africa, 4World
Health Organization Regional Office for Africa,
Brazzaville, Congo
Corresponding author
Thobile Malinga, Cochrane South Africa, South
African Medical Research Council, Cape Town,
South Africa
Article
Abstract
Introduction: long-distance truck drivers have been
identified as a high-risk group for coronavirus
disease (COVID-19) infection. Thus, the aim of this
scoping review is to map out the existing evidence
on the impact of long-distance truck drivers on the
spread of COVID-19 and measures that countries
can implement to mitigate this route of spread in
the African region. Methods: we searched the
PubMed database and the website of the World
Health Organization (WHO) in March 2020 for
eligible studies. Results: the search strategy
identified 669 citations, of which six met the
inclusion criteria. The most frequently reported
interventions were maintaining hand hygiene,
social distance, testing truck drivers, regulation of
trade and transport e.g. only trucks with the food,
medical supplies, fuels, agricultural supplies will be
allowed to operate in interstate operations and
regulating and controlling trucks carrying essential
goods and services e.g. truck drivers are required to
declare their final destination and are urged to stop
only at designated points. Two studies from the
African region reported about border closures and
entry and exit screening, two studies from the US
reported about the threat for public safety and risks
and mitigation plans and 2 guidelines reported
about harmonisation and facilitation of cross
border in the context of the COVID-19 outbreak.
Conclusion: this review highlights the countries
response to mitigate the impact of the pandemic by
implementing measures to facilitate safe crossborder trade and adopting regional harmonization
of trucking regulations.
Introduction
COVID-19 confirmed cases have been reported
globally [1]. The first case in Africa was confirmed
in Egypt on February 14th, 2020 [2,3]. COVID-19 has
led to the introduction measures meant to prevent
the spread of the virus, including testing and
waiting for the test results for truck drivers.
According to [4] public health events can cause
serious crises and damage to the human population
if effective surveillance systems; and programmes
to prevent and respond promptly to health threats.
The recent West-African ebola outbreaks and the
zika virus have highlighted considerable room for
improvement in meeting the imperative to
research and rapidly develop effective strategies to
curb the spread of the virus [5]. It was difficult to
bring under control owing to high infectivity, weak
health systems, rampant fear and mistrust among
the affected population and fluid cross-border
movement of peoples [6]. Thus, screening
measures of truck drivers at the point of entry
including ports can be implemented to prevent
intercontinental transmission of disease by early
detection.
Long-distance truck drivers around the world have
been identified as a high-risk group for this
pandemic and are consequently the targets for
prevention and education-based intervention.
While most of these interventions have addressed
individual-level risk behaviour, more attention
needs to be paid to the structural barriers e.g. social
disruption due to COVID-19 pandemic of truck
drivers [7]. Fears that are associated with the
current global spread of the novel coronavirus
disease have trickled into almost every industry
including the trucking industry as well. Some
companies try their best to ensure that the drivers
are healthy, rested and fed during the COVID-19
outbreak, but this is not always the case. Concerns
like a lack of medical facilities for drivers who may
develop symptoms while on the road may fuel the
spread of the virus because truck drivers are part of
mobile populations which have been noted as a key
population at risk [8].
In some countries of the African region,
transporting of goods is essential for the economy
and the trucking industry play a major role. Due to
the transcontinental nature of the transport
industry, health plan of action to prioritize truck
drivers need complementary national healthcare
policies. Research has demonstrated that most
countries in the African region are aware of the
vulnerability of truck drivers to poor health
outcomes and the member states have developed
Thobile Malinga et al. PAMJ - 38(27). 12 Jan 2021. - Page numbers not for citation purposes.
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strategic plans to address such issues [9]. Each
country´s functional capacity to manage health
security issues is based on WHO International
Health Regulations (IHR) 2005 which states the
WHO recommendations in response to a Public
Health Emergency of International Concern (PHEIC)
may include screening measures at points of entry,
Monitoring and Evaluation Framework (MEF) and
on an indicator of vulnerability to emerging
epidemics [4]. Thus, following this the South African
Development Community (SADC) developed
guidelines on harmonisation and facilitation of
cross border transport operations across the region
during the COVID-19 pandemic as a measure to
curb the spread of the virus within the region [10].
However, further planning for efficient
implementation, scale-up and the ability to
maintain healthcare programmes for truck drivers
is stalled by knowledge gaps within this population
and the impact of existing healthcare services on
health outcomes [9]. Hence the need to conduct
this scoping review.
“driver” or “drivers” and “COVID-19” or “COVID” or
“corona” or “coronavirus” or “SARS-CoV-2” or
“SARS-CoV-2” and “pandemic influenza” or “H1N1”
or “MERS” or “SARS”. Research was conducted on
studies and reports published between 2014-2020.
A detailed search strategy is provided in Table 1.
The review strategy had been shaped using the
peer review of electronic search strategies (PRESS)
2015 guideline statement, which was helpful to
guide and improve the peer review of electronic
literature search strategies [13].
Methods
Extraction and charting the results: data extraction
forms were created for both primary studies and
reports and the coded into structured categories
according to: author(s); year of publication; country
of focus; and key message that relate to the review
question (Table 2). Figure 1 displays the flow chart
as to the database search and final article selection.
Data were then summarized using narrative
description to outline the characteristics of the
included studies.
The authors performed a scoping review of the
published and unpublished literature. We adhered
to the PRISMA ScR guidelines for reporting [11] of
scoping review, see the PRISMA flow diagram
(Figure 1).
Eligibility criteria: the studies were selected
according to population-concept-context (PCC)
framework recommended by Joanna Briggs
Institute [12] for scoping reviews. Participants:
truck drivers; concepts: health promotion; health
interventions; context: countries and borders
within the African region.
Search strategy: the authors searched scientific
databases such as PubMed and WHO website and
country level-reports (SADC), using a broad search
strategy including all fields and free text. The search
included the following word combinations: “long
distance” or “long distance” or “cross-border” or
“cross-border” or “international” or “regional” and
“truck” or “transport” or “transportation” or
Study selection: the lead author TM first examined
the titles and abstracts were and after discussion
with CW an agreement was reached to include all
publications and reports describing a healthcare
programme in the African region providing services
designed specifically for truck drivers. The full text
records of all the material selected for further
examination were assessed for inclusion. The
author TM confirmed the final list of selected
material with CW.
Results
Selection of sources of evidence: search results
yielded 669 articles in PubMed 3 from WHO
website. After removal of duplicates, 565 records
remained. Out of these, 115 titles were screened
for relevant studies, 21 abstracts were then
scanned for acceptable inclusion criteria. Finally, 6
full text articles were included in the review.
Several studies were excluded due to lack of focus
on the study topic, lack of reported issue on truck
drivers and no new evidence was demonstrated by
the studies.
Thobile Malinga et al. PAMJ - 38(27). 12 Jan 2021. - Page numbers not for citation purposes.
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Characteristics of sources of evidence: a total of 6
articles (2 guidelines, 2 commentaries and 2 journal
articles) were included in our final analysis. The
most frequently reported interventions were
maintaining hand hygiene, maintaining social
distance and testing truck drivers, regulation of
trade and transport and regulating and controlling
trucks carrying essential goods and services. Two
studies from the African region reported about
border closures and entry and exit screening, two
studies from the US reported about the threat for
public safety and risks and mitigation plans.
Synthesized results: the peer-reviewed literature
on the impact of long-distance truck drivers on the
spread of the virus and measures that countries can
implement to mitigate this route of spread of
COVID-19 is recent and it limited. Among the
included studies, 83% were published in the past 5
months of the current review (2020). Most of the
studies were mainly from the African region. Out of
the 6 included studies, 3 studies were focused on
low-income countries, 2 studies in high-income
countries and 1 in both low- and middle-income
countries. The included studies in the review have
used various types of study design: n=2 guidelines,
n=2 commentaries and n=2 journal articles (Table
1). However, it was difficult to identify the study
approach because the authors did not provide
enough details on their methodology.
One guideline addressed harmonisation and
facilitation of cross border transport operations
across the region during the COVID-19 pandemic
and the other document addressed the
management of ill travellers at points of entry
(international airports, seaports and ground
crossings) in the context of COVID-19. The member
states within the Southern African Development
Community (SADC) region have come up with
guidelines to deal with the impact of COVID-19 in
the African region. These includes: regulation of
trade and transport: stating that those trucks that
carry goods will be allowed to operate in interstate
operations to ensure continuity of supply chains
including and not limited to food, medical supplies,
fuel, humanitarian relief services and other goods
and products as may be agreed among member
states.
Regulating and controlling trucks carrying essential
goods and services: the member states should
ensure that national policies, regulations and
guidelines to ensure that: law enforcement officers
treat with leniency and recognize the extension of
validity
of
short-term
cross
border
permits/licenses, which have expired en-route due
to different administrative procedures in force
following the COVID-19 measures until the vehicles
can complete the journey. Second, guidelines
should recommend that vehicles only have 2-3
crew members per vehicle to facilitate smooth
border crossing in the region. Thirdly, if a driver or
crew member is showing signs for COVID-19, the
truck will be de-contaminated before it is allowed
to continue to its final destination and the driver or
crew member must be referred to a treatment
center at operator´s cost. Finally, truck owners
should make necessary arrangements for a backup
if the crew is quarantined while in transit and truck
drivers should declare their final destination and
urged to stop only at designated points along the
transport corridors [3,10].
Lockdown regulations on truck drivers and
communities: among the studies that reported
findings and outcomes related to lockdown
regulations on truck drivers and communities. They
made
no
specific
conclusion
regarding
interventions (for the impact of drivers for
prevention of COVID-19) but highlighted that with
disparities in the response to COVID-19 in many
African countries the authorities are trying to
isolate sources of infections. For example,
Tanzania´s neighbours, they perceived truck drivers
to be a source of new cases. As a result Kenya,
Uganda and Zambia have introduced border
closures and tighter preventive measures on truck
drivers´ movements [14]. Therefore, to counteract
the outcome tracing internal community infections
and contacts is of paramount importance and
reducing the time of getting the results for truck
drivers.
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Long-distance truck drivers and physical distancing,
provision of personal protective equipment,
screening programme and communities: two
studies explored key COVID-19 metrics that need to
be established for this population. Relationships
between long-haul trucker network attributes and
COVID-19 spread need to be delineated.
Furthermore, interactions between endemic health
disparities and COVID-19 vulnerability need to be
elucidated and policies and interventions need to
be identified and implemented [15,16] reported
that stopping all international, domestic passenger
air and intercity bus/train travel; create
administrative zones of about 1 million people;
stop all non-emergency cross-zonal travel except
for transportation of goods, deploy an informationdriven service value chain to control the spread of
the pandemic within a zone might assist to curb the
spread.
countries with weaker health systems is a major
public health concern [14]. Some countries remain
ill-equipped. Some are without the diagnostic
capacity for rapid testing for the virus, which might
critically increase the delay from the identification
of suspected cases to their confirmation and
isolation,
affecting
possible
disease
transmission [17]. World Health Organization
(WHO) is currently supporting countries to improve
their diagnostic capacity.
Discussion
This scoping review has demonstrated that in the
African region viruses like COVID-19 may be
transmitted by people who work along the roads
like truck drivers. Truck drivers have become a core
group for COVID-19 and they have generated
significant local transmission, which now threatens
a full-blown epidemic unless strict controls are put
in place [18]. For example, since these drivers
cannot have a single home, they establish a semipermanent home at every stop exposing everyone
who they come into contact with. During the
COVID-19 lockdown, the drivers are the ones
who´ve been carrying the food, the medical
supplies and every other essential item designated
under the regulations. Unlike petrol attendants,
farmworkers, supermarket cashiers and others who
get to go home at the end the day, truck drivers
spend days, if not weeks, away from their families
as they continue to serve the nation during this
crisis time. However, this could lead to a major virus
epidemic and researchers have started to study
ways by which the virus might continue to enter
countries and how it might spread. An observation
of long-distance truck drivers demonstrates that
there might be a relationship between highways
and the spread of COVID-19.
This scoping review used standard systematic
review methods to identify, select and synthesize
findings from 6 studies that reported impact of
long-distance truck drivers on the spread of the
virus and measures that countries can implement
to mitigate this route of spread. Early detection of
COVID-19 and prevention of onward transmission
are crucial challenges to all countries in the African
region [2]. Onward spread possibly occurring in
Limitations: our review presents several
limitations. Firstly, we aimed to map out the
evidence on the measures that countries can
implement to mitigate prioritizing truck drivers
based on available information. Owing to the
nature of the documents reviewed, we were unable
to assess the quality of methodology that was used.
Moreover, we focused on reports, studies and
guidelines available publicly. Due to the nature of
Entry and exit screening, contact tracing, laboratory
testing of suspected cases: the authors in this study
highlighted lessons learned from previous
pandemics like Ebola, H1N1, SARS that little
evidence is available about entry and exit screening
measure implementation and effectiveness at
ports and ground crossings. For preparedness
purposes and to be ready to respond to any
unexpected public health event, all countries
should have the capacities to implement entry and
exit screening at designated ports, airports and
ground crossings. Exit screening measures could be
prioritized compared to entry measures, based on
past temporary recommendations issued during
PHEIC [4].
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the documents reviewed, we were unable to assess
the quality of services provided in these
programmes. Lastly, is that new data are added
daily, the pandemic is dynamic. Data analysis
should be done on a continuous basis to obtain a
completer and more up-to-date picture.
Conclusion
As COVID-19 continue to spread globally including
the African region research should be considered to
assess the impact on all possible prevention
measures. This review illustrates a global picture of
the current academic literature on the impact of
long-distance truck drivers and the spread of
COVID-19. The inconsistency and the lack of strong
quality in the methodology of the included studies
are proof that more rigorous studies are needed to
demonstrate the positive and adverse impact of
long-distance truck drivers during the COVID-19
pandemic. Nevertheless, the existing evidence
from this review highlights that following the WHO
guidelines can assist to curb the spread of COVID19. Furthermore, these studies should look at how
do the infected individual´s age and other
characteristics of a case (i.e. patient) affect the risk
of transmitting the infection to others. Primary
studies to evaluate the effect of truck drivers and
the spread of COVD-19 are still needed. The most
promising intervention seems to be to educate the
drivers ineffective strategies like frequent
handwashing. Also, collaborative efforts among
trucking services and governments are important
to ensure that the proposed guidelines are adhered
to. Without these measures, truck drivers will be
left behind. Screening should be part of the
government´s recommendations in certain points
of entry for specific periods. Furthermore,
screening for COVID-19 in the most affected African
countries could assist to identify cases. Future
research should also include economic evaluations
as well as methods to determine facilitators and
barriers to programme participation and
continuation.
What is known about this topic
Very few data are available regarding the
impact of long-distance truck drivers on the
spread of the virus and measures that
countries can implement to mitigate this
route of spread;
Truck drivers drive long distances, exposing
themselves to a more extensive social
network, primarily urban and likely crowded
places such as ports where the probability of
contact with infected person may be
increased;
Some countries in the region remain illequipped. Some are without the diagnostic
capacity for rapid testing for the virus, which
might critically increase the delay from the
identification of suspected cases to their
confirmation and isolation, affecting
possible disease transmission.
What this study adds
For preparedness purposes and to be ready
to respond to any unexpected public health
event, all countries should have the
capacities to implement entry and exit
screening at designated ports, airports and
ground crossings;
Public health prevention measures that take
into account regional integration of efforts
are required to ensure success for the
COVID-19 programs for truck drivers.
Competing interests
The authors declare no competing interests.
Authors' contributions
CSW was responsible for the full conceptualization;
TM collected the data and created the first draft in
consultation with CSW in all the stages; ND, JO and
AT critically reviewed the manuscript and
contributed substantially for its improvement. All
the authors have read and agreed to the final
manuscript.
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Tables and figure
Table 1: search strategy
Table 2: summary of evidence for included studies
for addressing the impact of long-distance truck
drivers on the spread of COVID-19 infection
Figure 1: flow diagram showing the seach and
selection of studies for the review
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Table 1: search strategy
Search string
#1
Long distance or long-distance or cross-border or cross border or international or regional
#2
Truck or transport or transportation or driver or drivers
#3
#1 and #2
#4
COVID-19 or COVID or corona or coronavirus or SARS-CoV-2 or SARS-CoV 2
#5
Pandemic influenza or H1N1 or MERS or SARS
#6
#4 and #5
#7
#3 and #6
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Table 2: summary of evidence for included studies for addressing the impact of long-distance truck drivers on the
spread of COVID-19 infection
Author
Type of
Region of focus
Key message
(year)
document
The author made no specific conclusion regarding interventions (for impact
of drivers for prevention of COVID-19) but highlighted that with disparities
in the response to COVID-19 in many African countries the authorities are
Nakkazi
East Africa
Commentary trying to isolate sources of infections; for example, Tanzania's neighbors,
(2020)
they perceived truck drivers to be a source of new cases, as a result, Kenya,
Uganda and Zambia have introduced border closures and tighter
preventive measures on truck drivers' movements
As with any plan, there is a need to be cognizant of its risks and challenges;
every administrative zone will encounter risks and develop mitigations
Baveja
Journal
plans that are most appropriate for its situation; the authors strongly
US
(2020)
article
recommend setting up best-practice sharing platforms that will help
disseminate effective ideas amongst communities
Targeted research and prevention‐oriented action steps are urgently
needed to curb the likelihood of the development of this pandemic, a
network of health problems, ones that share common social underpinnings
and cause an increased public health burden on a community (poses an
Lemke
US
Commentary imminent, significant and widespread threat for public health and safety),
(2020)
especially as mandated physical distancing policies heterogeneously
expire, the American economy gradually reopens and freight volumes
increase-along with US long‐haul truck drivers' vulnerability to acquiring
and transmitting COVID‐19
Highlights lessons learned from previous pandemics like Ebola, H1N1, SARS
that little evidence is available about entry and exit screening measure
implementation and effectiveness at ports and ground crossings; for
West Africa,
preparedness purposes and to be ready to respond to any unexpected
Mouchtouri Canada,
Journal
public health event, all countries should have the capacities to implement
Singapore,
(2019)
article
entry and exit screening at designated ports, airports and ground
Australia
crossings; exit screening measures could be prioritized compared to entry
measures, based on past temporary recommendations issued during Public
Health Emergency of International Concern (PHEIC)
The member states and other key stakeholders and partners should:
review national transport related policies, regulations and response
measures and identify inconsistencies; based on the review, select best
Fernandez
practices and propose to the member states harmonized policies,
SADC region Guideline
(2020)
regulations and measures; put in place a mechanism to enable member
states to share information on COVID-19 response policies, regulations and
guidelines, best practices and experiences in the implementations of the
various measures
Points of entry should adhere to the following guidance: wear a tightly
fitted medical mask that covers the nose and mouth when entering all the
Global
time when they are dealing with people including truck drivers clean their
WHO (2020)
Guideline
including Africa
hands with alcohol-based hand rub or soap and water after handling any
equipment or documents
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Figure 1: flow diagram showing the seach and selection of studies for the review
Thobile Malinga et al. PAMJ - 38(27). 12 Jan 2021. - Page numbers not for citation purposes.
10