The COVID-19 pandemic prompted governments worldwide to implement physical distancing measures to control transmission. While effective in curbing the spread, these measures, particularly nationwide lockdowns, incurred significant costs, especially for vulnerable populations already facing increased risks and susceptibility to adverse health outcomes. Existing systematic reviews examined the effectiveness of physical distancing, but a comprehensive understanding of its impact on vulnerable groups remained lacking. This scoping review aimed to address this gap by examining the negative impacts of physical distancing measures on vulnerable populations and identifying ringfencing measures designed to mitigate these impacts. The study's importance stems from the need to understand the unintended consequences of pandemic control measures and to ensure equitable responses that protect the most vulnerable members of society. The widespread implementation of these measures necessitates a deep understanding of their differential effects on various population groups to ensure equitable and effective pandemic management strategies. Ignoring the specific vulnerabilities of certain groups could result in significant long-term social and economic disparities.

The researchers conducted a comprehensive search across ten databases (PubMed, Scopus, Web of Science, ProQuest, ProQuest Coronavirus Research Database, Embase, ERIC, OVID, Cochrane reviews, and WHO's COVID-19 Global literature database), identifying 39,816 records. After removing duplicates and screening titles and abstracts, 265 studies were included in the review. These studies covered 49 countries across five continents and examined various vulnerable populations, with a focus on children/students and low-income populations. The review also incorporated 87 records identified through targeted systematic searches from 2021 onwards. The inclusion of studies from various geographical locations and methodologies strengthens the review's robustness and generalizability. The large number of studies included ensures a thorough and representative overview of the impact of physical distancing measures on vulnerable groups.

This scoping review employed a systematic approach to consolidate existing research on the impact of COVID-19 physical distancing measures on vulnerable populations. The study utilized a multi-stage search strategy across ten major databases. The search terms focused on 'COVID-19', 'physical distancing', and various vulnerable populations (e.g., older adults, children, low-income groups). Initial searches were conducted from March 2021 to April 2021, with an update in June 2022 to include new literature published after April 2021. The search yielded a substantial number of records (39,816). Duplicate records were removed, and titles and abstracts were screened to identify relevant studies based on predefined inclusion and exclusion criteria. Full-text articles were retrieved for detailed assessment, leading to the inclusion of 265 studies for the final synthesis. Data extraction followed a predefined template, with rigorous quality control measures implemented. Data analysis involved a detailed line-by-line examination of qualitative information, categorized by vulnerable population groups. This used a framework synthesis approach to account for study heterogeneity. The review questions focused on identifying physical distancing measures that negatively impacted vulnerable populations and analyzing any ringfencing measures implemented to protect those populations.

The review revealed significant negative impacts of physical distancing measures across various vulnerable groups. **Older People:** Physical distancing, while mitigating COVID-19 infection and death, increased the risk of cardiovascular, autoimmune, and neurocognitive diseases and worsened mental health outcomes due to social isolation. Effective strategies included technology use to maintain social connections and early detection/contact tracing in long-term care facilities. **Children/Students:** School closures led to learning disruptions, decreased social interaction, and significant learning disparities between socio-economic groups. Mitigation efforts included providing printed learning materials, education funds, and childcare support. **Low-Income Populations:** Lockdowns disproportionately impacted this group due to job/income loss, limited access to necessities (food, water, sanitation), and mental distress. Interventions focused on enhanced case detection, treatment, and provision of basic needs by governments and NGOs. **Migrant Workers:** Lockdowns resulted in job losses, income loss, food insecurity, and limited access to healthcare. Successful interventions included providing transport home and improving access to healthcare and public health information. **Prisoners:** Social isolation exacerbated mental health issues and even led to riots. Strategies included releasing some prisoners and implementing virtual visits. **People with Disabilities:** Reduced social connection and access to healthcare services were common challenges. Solutions included delivering distance learning and related services. **Sex Workers:** Access to testing and treatment for STIs was hampered. Community-based interventions played a crucial role in providing basic necessities and health services. **Victims of Domestic Violence:** Lockdowns increased domestic violence incidents, as victims struggled to access support services. Public information campaigns and support services were implemented to help mitigate this problem. **Refugees:** Overcrowded living conditions and limited access to services exacerbated existing vulnerabilities, prompting interventions like enhanced hygiene protocols and mental health services. **Ethnic Minorities:** Language barriers, overcrowding, and adverse employment conditions hampered adherence to physical distancing measures. Strategies included providing translated information and educational resources. **People from Sexual and Gender Minorities:** Access to essential medical services, including HIV testing and treatment, was disrupted, resulting in worsened mental health outcomes. Telehealth interventions and NGO support were vital in mitigating these negative impacts. The study also found that ring-fencing measures, while sometimes effective, were limited in scope and implementation across various countries.

The findings confirm the significant negative impacts of blanket physical distancing measures on vulnerable populations. The review highlights the disproportionate burden experienced by these groups due to pre-existing vulnerabilities. The effectiveness of ring-fencing measures varied significantly, illustrating the need for context-specific interventions. The study emphasizes the importance of equitable policy responses that consider the unique challenges faced by different vulnerable groups. Future research should focus on evaluating the long-term effects of these measures, developing more targeted interventions, and improving the design of ring-fencing measures to enhance social inclusion and reduce health disparities.

This scoping review provides a comprehensive overview of the negative impacts of COVID-19 physical distancing measures on vulnerable populations. The findings underscore the need for policymakers to consider the complex interplay of vulnerabilities when implementing pandemic control measures. Future research should focus on evaluating the effectiveness of context-specific ring-fencing interventions and developing strategies to promote health equity and social justice in the face of future pandemics. Furthermore, research on the long-term impacts of these measures on both physical and mental health is critical.

The review may have missed a small subset of studies due to variations in definitions of vulnerability and vulnerable populations. The review did not delve into jurisdictional differences in the impacts experienced by the vulnerable populations examined. These limitations provide opportunities for future research to further refine our understanding of the topic.