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Objectives: During the COVID-19 pandemic, rapid and heterogeneous changes were made to maternity care. Identification of changes that may reduce maternal health inequalities is a national priority. The aim of this project was to use data collected about care and outcomes to identify NHS Trusts in the UK where inequalities in outcomes reduced during the pandemic and explore through interviews how the changes that occurred may have led to a reduction in inequalities., Methods: A Women's Reference Group of public advisors guided the project. Analysis of Hospital Episode Statistics Admitted Patient Care data of 128 organisations in England identified "positive deviant" organisations that reduced inequalities, using maternal and perinatal composite adverse outcome indicators. Positive deviant organisations were identified for investigation, alongside comparators. Senior clinicians, heads of midwifery and representatives of women giving birth were interviewed. Reflexive thematic analysis was employed., Results: The change in the inequality gap for the maternal indicator ranged from a reduction of -0.24 to an increase of 0.30 per 1000 births between the pre-pandemic and pandemic period. For the perinatal composite indicator, the change in inequality gap ranged from -0.47 to 0.67 per 1000 births. Nine Trusts were identified as positive deviants and 10 as comparators. We conducted 20 interviews from six positive deviant and four comparator organisations. Positive deviants reported that necessary shifts in roles led to productive and novel use of expert staff; comparators reported senior staff 'stepping in' where needed and no benefits of this. They reported proactivity and quick reactions, increased team working, and rapid implementation of new ideas. Comparators found constant changes overwhelming, and no increase in team working. No specific differences in care processes were identified., Conclusions: Harnessing proactivity, flexibility, staffing resource, and increased team working proves vital in reducing health inequalities., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Seasonal infectious diseases can cause demand and supply pressures that reduce the ability of healthcare systems to provide high-quality care. This may generate negative spillover effects on the health outcomes of patients seeking medical help for unrelated reasons. Separating these indirect burdens from the direct consequences for infected patients is usually impossible due to a lack of suitable data and an absence of population testing. However, this paper finds robust empirical evidence of excess mortality among non-COVID-19 patients in an integrated public healthcare system: the English National Health Service (NHS). Analysing the forecast error in the NHS' model for predicted mortality, we find at least one additional excess death among patients who sought medical help for reasons unrelated to COVID-19 for every 42 COVID-19-related deaths in the population. We identify COVID-19 pressures as a key driver of non-COVID-19 excess mortality in NHS hospitals during the pandemic, and characterize the hospital populations and medical conditions that were disproportionately affected. Our findings have substantive relevance in shaping our understanding of the wider burden of COVID-19, and other seasonal diseases more generally, and can contribute to debates on optimal public health policy., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier B.V.)

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Background: Through the extensive use of public media, the government of England was heavily involved in encouraging and instructing people on how to manage their life during coronavirus disease 2019 (COVID-19). This model of health emergency governance replicates the practice of 'calculative technologies' and 'bio-politics' embedded in population management. Previous research on COVID-19 governance both in the United Kingdom and beyond provides varied revelations on broader 'technologies of government' and bio-politics by numerous governments. However, rarely have any studies explicitly and distinctively highlighted the unique 'calculative technologies' mobilised by governments within their bio-politically designed "technologies of government" to compel the populations to manage their lives under their COVID-19 guidance. The paper therefor examines how the UK government deployed "calculative technologies," as part of its strategies of health governance and governmentality during the first wave of COVID-19 in England. Methods: This study uses document analysis as its data collection method. Its review includes documents, press releases, social media disclosures and health guidance issued by the UK government from March to December, 2020. The data are analysed employing the Foucault's governmentality and bio-political scholarship. Results: The paper's findings reveal the UK government's use of integrated calculative technologies of self-governance in the form of risk calculations and metrices/statistics (eg, death tolls, infection rates), performance management (eg, two metre social distancing, and hand washing for twenty seconds) and discipline and control (eg, fourteen days selfisolation), in addition to a more conventional top-down, managerial decision-making process adopted in the past. By these newly initiated "calculative technologies," the government has "bio-politically" governed the behaviours and lifestyles of vulnerable community members, health workers and general public at a distance, inculcating selfmanagement and individualisation of responsibility. Conclusion: The newly adopted calculative technologies used by the UK government created a multi-faceted discourse of obligations, entitlements and scale of engagement, and facilitated directions about what people should do to protect themselves and others from the spread of the virus. Overall, the overtly and idiosyncratically used calculative technologies resemble a unique 'art of government' and produce a set of 'bio-political' interventions enforcing the populations to manage their own wellbeing and governing them at a distance during COVID-19. [ABSTRACT FROM AUTHOR]

Background: Community-based volunteering supports outbreak management by extending reach into at-risk communities. This paper examines the application of a 'community champions' model in England, UK, during the COVID-19 pandemic. Evidence pre-pandemic shows that community champion interventions tap into social networks to strengthen connections with disadvantaged communities. During the pandemic, the UK government set up a COVID community champions funding award scheme for local authorities to develop local programmes that addressed emerging inequalities. The study aim was to identify transferable learning on community engagement in the pandemic by undertaking a secondary qualitative synthesis of practice-based case studies of local COVID community champion programmes. Methods: A systematic staged approach for synthesis of practice-based case studies was used. In total, 16 COVID community champion case studies, which were written by practitioners involved in local programme implementation and published by the Local Government Association, were included. Case studies covered aims, programme development and delivery, examples of activities and a discussion of learning. Framework qualitative analysis methods were used to code and organise data prior to cross case analysis. The final stage produced an overarching thematic framework that best represented descriptive and interpretive themes. Results: The results provide an overview of common features of COVID community champion programmes and emergent learning. All local programmes aimed to reduce health inequalities by involving at-risk communities in local prevention efforts, adapting the approach to local priorities. Two levels of community engagement were volunteer mobilisation and subsequent community-based outreach activities. Elements of capacity building, such as training and creation of networks, were common. The synthesis of practice-based learning found that stronger relationships with communities were regarded as a key mechanism to support more equitable prevention strategies. Other learning themes related to champion roles, community engagement strategies and programme implementation. Conclusions: By focusing on how community champion approaches were applied by local authorities in England during the COVID-19 pandemic, this study contributes to knowledge on volunteer mobilisation as a mechanism to improve public health communication and outreach. Notwithstanding the limitations of experiential evidence, the synthesis of practice-based learning highlights potentially transferable community engagement strategies for health protection and health improvement. [ABSTRACT FROM AUTHOR]

COVID-19 presents a unique and significant challenge to healthcare systems across the globe. Dental workforce redeployment, in England, during the response to Coronavirus (COVID-19), is the first reported national effort to redeploy a professional body into new clinical environments. The policy decision to facilitate redeployment of the dental workforce, in March 2020, by the Office of the Chief Dental Officer (OCDO), increased flexibility within workforce systems and allowed increasing demand on healthcare services to be managed safely and effectively. This paper outlines how this policy change was achieved via a multi-professional approach, mapping competencies of the dental workforce to high-priority areas of healthcare need. The dental workforce has a varied and often specialised skill set, offering expertise in infection prevention and control, airway management and often, behaviour management. These skills can be an important contribution to tackling a pandemic where expertise in these areas is vital. This increase in workforce supply allows healthcare systems to improve their surge response capabilities. Additionally, redeployment presents an opportunity to create greater and sustained collaboration between the medical and dental professions, leading to greater understanding of the contribution of oral health to wider medical wellbeing., Competing Interests: Declaration of Competing Interest None., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Purpose: This paper considers the accounting and accountability practices of the UK government's response to COVID-19 for England, focussing on the first wave of the pandemic in 2020. Design/methodology/approach: Based on a close reading of the news media and official reports from government departments, Parliament select committees and the National Audit Office, among others, this paper frames the UK government's uses of accounting and accountability in its response to COVID-19. This is by using the categories of "apparatuses of security", Foucault's schematic of government for economising on the uses of state power. Findings: The paper shows that an important role for accounting is in the process of enabling the government to gauge the extent of the crisis and produce calculations to underpin its response, what Foucault called "normalisation". This role was unlike statistics and economics. The government relied most on monthly statistical reporting and budgeting flexibilities. By contrast, the multi-year Spending Review and financial reporting were not timely enough. That said, financial reporting fed into financial sustainability projections and enabled audit that could provide potential accountability regarding regularity, probity, value for money and fairness. The authors' findings suggest that, conceptually, accountability should be added to the object–subject element of Foucault's apparatuses of security because of its significance for governments' ability to pursue crisis objectives that require popular assent. Practical implications: In view of the ongoing uncertainty, with the crisis extending over longer budget and financial reporting periods, a Spending Review is becoming ever more necessary for better planning, without limiting, however, the budget flexibilities that have proven so useful for rapid government responses. Moreover, the government should continue its accounting reforms post COVID-19 so that improved accountability and audit can contribute to enhanced future financial resilience. Originality/value: This is the first paper to apply Foucault's notion of apparatuses of security to an analysis of government accounting and accountability practices. [ABSTRACT FROM AUTHOR]

In this paper, we use a UK case study to explore how the COVID-19 pandemic affected the mental health (emotional, psychological, social wellbeing) of farmers. We outline the drivers of poor farming mental health, the manifold impacts of the pandemic at a time of policy and environmental change, and identify lessons that can be learned to develop resilience in farming communities against future shocks. We undertook a survey answered by 207 farmers across the UK, focusing on drivers of poor mental health and the effect of the COVID-19 pandemic. We also conducted 22 in-depth interviews with individuals in England, Scotland and Wales who provide mental health support to farmers. These explored how and why the COVID-19 pandemic affected the mental health of farmers. These interviews were supplemented by 93 survey responses from a similar group of support providers (UK-wide). We found that the pandemic exacerbated underlying drivers of poor mental health and wellbeing in farming communities. 67% of farmers surveyed reported feeling more stressed, 63% felt more anxious, 38% felt more depressed, and 12% felt more suicidal. The primary drivers of poor mental health identified by farmers during the pandemic included decreased social contact and loneliness, issues with the general public on private land, and moving online for social events. Support providers also highlighted relationship and financial issues, illness, and government inspections as drivers of poor mental health. Some farmers, conversely, outlined positive impacts of the pandemic. The COVID-19 pandemic is just one of many potential stressors associated with poor farming mental health and its impacts are likely to be long-lasting and delayed. Multiple stressors affecting farmers at the same time can create a tipping point. Therefore, there is a need for long-term support and ongoing evaluation of the drivers of poor mental health in farming families. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to present data about access to health and social care services during the COVID-19 pandemic for adults with learning disabilities across England, Northern Ireland, Scotland and Wales. Design/methodology/approach: Data were collected directly from 621 adults with learning disabilities and through separate proxy reports by family carers and paid support staff of another 378 adults with learning disabilities. The data were collected between December 2020 and February 2021 and concerned the use of health and social care services since the start of the first COVID-19 national lockdown in March 2020. Findings: Access to and use of health and social care services significantly reduced for adults with learning disabilities across the UK during the COVID-19 pandemic between March 2020 and February 2021, with many people not receiving any services at all during that period. Similar patterns were seen across England, Northern Ireland, Scotland and Wales. However, data suggest some variations between countries for some services. Practical implications: Future pandemic planning must ensure that access to these essential services is not completely lost for adults with learning disabilities and their family carers, as it was in some cases during the COVID-19 pandemic in 2020. Originality/value: This is the largest study about the impact of the COVID-19 pandemic on health and social care services for adults with learning disabilities in the UK. The authors primarily collected data directly from adults with learning disabilities, and worked with partner organisations of people with learning disabilities throughout the study. [ABSTRACT FROM AUTHOR]

• Systematic mass testing in closed settings provides information on infection rates. • Test positivity was 11.6%, with only one-quarter reporting symptoms. • The prison wing handling new admissions reported the second-lowest positivity rate. • Testing uptake was higher in residents than in staff members. • Mass testing is a valuable tool to bring outbreaks under control quickly. The aim of this paper was to describe the results of mass asymptomatic testing for COVID-19 in a male prison in England following the declaration of an outbreak. It provides novel data on the implementation of a mass testing regime within a prison during the pandemic. The paper is an observational evaluation of the mass testing conducted for 6 months following the declaration of a COVID-19 outbreak within a prison. It investigated the incidence of positive cases in both staff and residents using polymerase chain reaction testing. Data from October 2020 until March 2021 was included. A total of 2170 tests were performed by 851 residents and 182 staff members; uptake was 48.3% for people living in prison and 30.4% for staff. Overall test positivity was 11.6% (14.3% for residents, 3.0% for staff), with around one-quarter of these reporting symptoms. The prison wing handling new admissions reported the second-lowest positivity rate (9.4%) of the eight wings. Mass testing for COVID-19 over a short space of time can lead to rapid identification of additional cases, particularly asymptomatic cases. Testing that relies on residents and staff reporting symptoms will underestimate the true extent of transmission and will likely lead to a prolonged outbreak. [ABSTRACT FROM AUTHOR]

Social care Personal Assistants (PAs) are directly employed by individuals to assist with activities of daily living such as help or support with personal care, shopping, household tasks and community participation. This option is encouraged by UK public funding. In England, disabled people's support organisations initially offered assistance with such arrangements, although numbers doing this have declined. The Covid‐19 pandemic provided the opportunity to ask those remaining organisations providing support for PA employers about their activities during this time and the questions being posed to them by PA employers. This paper reports data from 15 interviews undertaken March–July 2021 with disability support organisation representatives. We identified one overarching theme 'Working to prevent and challenge marginalisation of PA employers', with three related subthemes: (1) Advocating for the voice of a forgotten group; (2) Needing to be proactive and (3) Adapting to new tasks and ways of working. Participant accounts focused on representing the needs of disabled people to the authorities and providing concise, timely and accurate information to PA employers, particularly around the use of public funds during Covid‐19. Remote working amplified the digital‐divide, resulting in these organisations working hard to ensure PA employers received important information about their support options. Befriending services and Covid‐hubs were established by some organisations to reduce isolation and risks of poor mental health amongst PA employers. Many of the challenges facing PA employers existed pre‐pandemic but were perceived to have been heightened during it, reflecting the value of and need for the work of these local support organisations. Our findings suggest areas where effective contingency planning drawn from closer collaboration between disability support organisations and central and local government might usefully be focussed. The potential for specific services or organisations to be commissioned to provide such support is discussed. [ABSTRACT FROM AUTHOR]

Elevated urban Nitrogen Dioxide (NO 2 ) is a consequence of road traffic and other fossil-fuel combustion sources, and the road transport sector provides a significant contribution to UK NO 2 emissions. The inhalation of traffic-related air pollution, including NO 2 , can cause a range of problems to human health. Due to their developing organs, children are particularly susceptible to the negative effects of air pollution inhalation. Accordingly, schools and associated travel behaviours present an important area of study for the reduction of child exposure to these harmful pollutants. COVID-19 reached the UK in late January 2020. On the 23rd of March that year, the UK government announced a nationwide stay-at-home order, or lockdown, banning all non-essential travel and contact with people outside of their own homes. The lockdown was accompanied by the closure of schools, public facilities, amenities, businesses and places of worship. The current study aims to assess the significance of nationwide NO 2 reductions at schools in England as a consequence of the lockdown in order to highlight the benefits of associated behavioural changes within the context of schools in England and potential child exposure. NO 2 data were collected from all AURN (Automatic Urban and Rural Network) monitoring sites within 500 m of nurseries, primary schools, secondary schools and colleges in England. A significant reduction of mean NO 2 concentrations was observed in the first month of the UK lockdown at background (-35.13%) and traffic (-40.82%) sites. Whilst lockdown restrictions are undoubtedly unsustainable, the study results demonstrate the possible reductions of NO 2 at schools in England and potential reductions of child exposure that are achievable when public behaviours shift towards active travel, work from home policies and generally lower use of polluting vehicles., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Introduction: Delays in cancer diagnosis arose from the commencement of non-pharmaceutical interventions (NPI) introduced in the UK in March 2020 in response to the COVID-19 pandemic. Our earlier work predicted this will lead to approximately 3620 avoidable deaths for four major tumour types (breast, bowel, lung, and oesophageal cancer) in the next 5 years. Here, using national population-based modelling, we estimate the health and economic losses resulting from these avoidable cancer deaths. We also compare these with the impact of an equivalent number of COVID-19 deaths to understand the welfare consequences of the different health conditions., Methods: We estimate health losses using quality-adjusted life years (QALYs) and lost economic productivity using the human capital (HC) approach. The analysis uses linked English National Health Service (NHS) cancer registration and hospital administrative datasets for patients aged 15-84 years, diagnosed with breast, colorectal, and oesophageal cancer between 1st Jan to 31st Dec 2010, with follow-up data until 31st Dec 2014, and diagnosed with lung cancer between 1st Jan to 31st Dec 31 2012, with follow-up data until 31st Dec 2015. Productivity losses are based on the estimation of excess additional deaths due to cancer at 1, 3 and 5 years for the four cancer types, which were derived from a previous analysis using this dataset. A total of 500 random samples drawn from the total number of COVID-19 deaths reported by the Office for National Statistics, stratified by gender, were used to estimate productivity losses for an equivalent number of deaths (n = 3620) due to SARS-CoV-2 infection., Results: We collected data for 32,583 patients with breast cancer, 24,975 with colorectal cancer, 6744 with oesophageal cancer, and 29,305 with lung cancer. We estimate that across the four site-specific cancers combined in England alone, additional excess cancer deaths would amount to a loss of 32,700 QALYs (95% CI 31,300-34,100) and productivity losses of £103.8million GBP (73.2-132.2) in the next five years. For breast cancer, we estimate a loss of 4100 QALYS (3900-4400) and productivity losses of £23.2 m (18.2-28.6); for colorectal cancer, 15,000 QALYS (14,100-16,000) lost and productivity losses of £35.7 m (22.4-48.7); for lung cancer 10,900 QALYS (9,900-11,700) lost and productivity losses of £38.3 m (14.0-59.9) for lung cancer; and for oesophageal cancer, 2700 QALYS (2300-3,100) lost and productivity losses of £6.6 m (-6 to -17.6). In comparison, the equivalent number of COVID-19 deaths caused approximately 21,450 QALYs lost, as well as productivity losses amounting to £76.4 m (73.5-79.2)., Conclusion: Premature cancer deaths resulting from diagnostic delays during the first wave of the COVID-19 pandemic in the UK will result in significant economic losses. On a per-capita basis, this impact is, in fact, greater than that of deaths directly attributable to COVID-19. These results emphasise the importance of robust evaluation of the trade-offs of the wider health, welfare and economic effects of NPI to support both resource allocation and the prioritisation of time-critical health services directly impacted in a pandemic, such as cancer care., Competing Interests: Conflict of interest statement The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

A skilled workforce is essential for producing high quality construction work, efficiently and effectively. This paper is formulated to improve the understanding and knowledge surrounding the skill shortage currently being faced within the UK, and the significant impact it is having on quality management. It surrounds around each main area, and the impacts of recent years: Brexit, Covid-19 and ageing workforce. A mixed method approach was applied to collect data from the quantitative and qualitative sources. The quantitative survey data was collected through snowball sampling from the 130 construction professionals working the UK construction industry. Moreover, a case study has been conducted on a large-scale construction project located in the Northeast of England where the outcome of these issues can be seen in all aspects of the work. Training and development are the fundamental issues highlighted during the literature review and then subsequently expressed by participants of the surveys. In addition, the moderation analysis also provides the important role of training and development in reducing the negative impacts of COVID-19 and Brexit towards quality management. However, it was also revealed that the training and development are not useful for the aging workforce in combating the skilled shortage challenges towards quality management system in the construction industry. This research will allow the industry to understand the need for a skilled workforce and how it benefits the quality management elements of a construction project. [ABSTRACT FROM AUTHOR]

This paper examines the mental health impacts of poor quality private-rented housing in the north of England during the UK's first COVID-19 lockdown. The paper draws on data collected from semi-structured telephone interviews with 40 renters in the private-rented sector. We use the Power Threat Meaning Framework to highlight how substandard housing was a social and material vulnerability which, underpinned by powerlessness, resulted in threats that created and exacerbated the mental-ill health of precarious private renters. The paper suggests the pandemic and increased time spent in unhealthy places of residence can create stresses at a time of broader structural fragility, and calls for the greater engagement and integration of health practitioners in the future development of housing policy at all levels. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To explore the experiences of nursing students in England who had worked through the first wave and transitioned to qualification in the ongoing pandemic. Background: Experiences of health professionals and student nurses during the pandemic are now well documented, but the transition of students to qualification is less well understood. In Summer 2020, we interviewed 16 student nurses who had worked as health care assistants on paid extended placements as part of the COVID‐19 response in the East of England, finding surprisingly positive experiences, including perceived heightened preparedness for qualification. A year later, we re‐interviewed 12 participants from the original study to hear about transitioning to qualification during the ongoing pandemic. This study provides novel insights into their experiences. Design: A qualitative study design was used. Methods: Twelve newly qualified nurses who had participated in the original study took part in qualitative, online interviews where they shared their experiences of working and transitioning to qualification during the ongoing pandemic since we spoke to them a year earlier. The data was analysed using thematic analysis. COREQ guidelines were used in developing and reporting this study. Results: Three themes were identified. Constant change: in the clinical environment and arising out of the transition to newly qualified nurse, mental health and well‐being and reflecting on the past to learn for the future. Conclusions: Participants experienced a unique transition to qualification. The perceived heightened preparedness for qualification that participants who had worked as students during the first wave of the pandemic had become a reality, ameliorating some of the known effects of transition. However, increased expectations and added responsibilities in extremely busy, fluctuating clinical environments with minimal support add weight to calls for mandatory preceptorship programmes. While heightened resilience was evident, provision of ongoing mental health and well‐being support is strongly recommended. Relevance to Clinical Practice: We need a partnership approach with nurse educators and practice colleagues which ensures preparation for qualified practice is appropriate. If we do not effectively prepare students for qualified nurse posts, patient care will almost certainly be compromised. [ABSTRACT FROM AUTHOR]

In England (UK), at the start of the COVID-19 pandemic the public were required to reduce their physical contacts to slow the spread of COVID-19. We investigated the factors associated with children having: 1) close contact with family members from outside their household ('non-adherent behaviour'); and 2) low well-being (Revised Child Anxiety and Depression Scale). We conducted an online cross-sectional survey, completed at any location of the participant's choice between 8 and 11 June 2020 in parents (n = 2,010) who were aged eighteen years or over and had a school-aged child (4–18 years old). Parents reported that 15% (n = 309) of children had non-adherent contact and that 26% (n = 519) had low well-being. We used a series of binary logistic regressions to investigate associations between outcomes and child and parent characteristics. Children had higher odds of having non-household contact when they had special educational needs [adjusted odds ratio, 2.19 (95% CI, 1.47 to 3.27)], lower well-being [2.65 (95% CI, 2.03 to 3.46)], were vulnerable to COVID-19 [2.17 (95% CI, 1.45 to 3.25)], lived with someone who was over 70 years old [2.56 (95% CI, 1.55 to 4.24)] and their parent had low well-being [1.94 (95% CI, 1.45 to 2.58)]. Children had higher odds of lower well-being when they had special educational needs [4.13 (95% CI, 2.90 to 5.87)], were vulnerable to COVID-19 [3.06 (95% CI, 2.15 to 4.36)], lived with someone else who was vulnerable to COVID-19 [2.08 (95% CI, 1.64 to 2.64)], or lived with someone who was over 70 years old [2.41 (95% CI, 1.51 to 3.83)]. Many children came into contact with non-household family members, mainly for childcare. Factors relating to COVID-19, children's well-being and education were also important. If school closures are needed in future, addressing these issues may help reduce contact. [ABSTRACT FROM AUTHOR]

Background: Care home staff working during the COVID‐19 pandemic experienced higher levels of stress and increased workloads. People from diverse ethnic backgrounds were disproportionately affected by the COVID‐19 pandemic. This study explored the identity experiences of care home staff from diverse ethnic backgrounds in the context of working during the COVID‐19 pandemic. Methods: Fourteen semistructured interviews were conducted between May 2021 and April 2022 with ethnic minority care home staff in England, who worked during the pandemic. Participants were recruited using convenience and theoretical sampling. Interviews were conducted via telephone or online platforms. A social constructivist grounded theory methodology was utilised in analysing the data. Findings: Participants described five key processes which facilitated or hindered the impact that their experiences had on their identity: dealing with uncertainty and transitioning into a COVID‐19 world; difficult emotions; experiences of discrimination and racism; the response from the care home and societal systems; and the personal vs collective responsibility. When participants' physical and psychological needs went unmet by support structures within the care home and/or society, they experienced a sense of injustice, lack of control and being unvalued or discriminated against by others. Conclusions: This study highlights the importance of recognising the unique needs of staff from diverse ethnic backgrounds working in care homes and adapting working practices to improve impact on identity, job satisfaction and staff retention. Patient and Public Involvement: One care home worker was involved in developing the topic guide and helping to interpret the findings. [ABSTRACT FROM AUTHOR]

Patients with cancer are at increased risk of hospitalisation and mortality following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. However, the SARS-CoV-2 phenotype evolution in patients with cancer since 2020 has not previously been described. We therefore evaluated SARS-CoV-2 on a UK populationscale from 01/11/2020-31/08/2022, assessing case-outcome rates of hospital assessment(s), intensive care admission and mortality. We observed that the SARS-CoV-2 disease phenotype has become less severe in patients with cancer and the non-cancer population. Case-hospitalisation rates for patients with cancer dropped from 30.58% in early 2021 to 7.45% in 2022 while case-mortality rates decreased from 20.53% to 3.25%. However, the risk of hospitalisation and mortality remains 2.10x and 2.54x higher in patients with cancer, respectively. Overall, the SARS-CoV-2 disease phenotype is less severe in 2022 compared to 2020 but patients with cancer remain at higher risk than the non-cancer population. Patients with cancer must therefore be empowered to live more normal lives, to see loved ones and families, while also being safeguarded with expanded measures to reduce the risk of transmission. [ABSTRACT FROM AUTHOR]

Background: Men and gender-diverse people who have sex with men are disproportionately affected by health conditions associated with increased risk of severe illness due to COVID-19 infection. Methods: An online cross-sectional survey of men and gender-diverse people who have sex with men in the UK recruited via social networking and dating applications from 22 November-12 December 2021. Eligible participants included self-identifying men, transgender women, or gender-diverse individuals assigned male at birth (AMAB), aged ≥ 16, who were UK residents, and self-reported having had sex with an individual AMAB in the last year. We calculated self-reported COVID-19 test-positivity, proportion reporting long COVID, and COVID-19 vaccination uptake anytime from pandemic start to survey completion (November/December 2021). Logistic regression was used to assess sociodemographic, clinical, and behavioural characteristics associated with SARS-CoV-2 (COVID-19) test positivity and complete vaccination (≥ 2 vaccine doses). Results: Among 1,039 participants (88.1% white, median age 41 years [interquartile range: 31-51]), 18.6% (95% CI: 16.3%-21.1%) reported COVID-19 test positivity, 8.3% (95% CI: 6.7%-10.1%) long COVID, and 94.5% (95% CI: 93.3%-96.1%) complete COVID-19 vaccination through late 2021. In multivariable models, COVID-19 test positivity was associated with UK country of residence (aOR: 2.22 [95% CI: 1.26-3.92], England vs outside England) and employment (aOR: 1.55 [95% CI: 1.01-2.38], current employment vs not employed). Complete COVID-19 vaccination was associated with age (aOR: 1.04 [95% CI: 1.01-1.06], per increasing year), gender (aOR: 0.26 [95% CI: 0.09-0.72], gender minority vs cisgender), education (aOR: 2.11 [95% CI: 1.12-3.98], degree-level or higher vs below degree-level), employment (aOR: 2.07 [95% CI: 1.08-3.94], current employment vs not employed), relationship status (aOR: 0.50 [95% CI: 0.25-1.00], single vs in a relationship), COVID-19 infection history (aOR: 0.47 [95% CI: 0.25-0.88], test positivity or self-perceived infection vs no history), known HPV vaccination (aOR: 3.32 [95% CI: 1.43-7.75]), and low self-worth (aOR: 0.29 [95% CI: 0.15-0.54]). Conclusions: In this community sample, COVID-19 vaccine uptake was high overall, though lower among younger age-groups, gender minorities, and those with poorer well-being. Efforts are needed to limit COVID-19 related exacerbation of health inequalities in groups who already experience a greater burden of poor health relative to other men who have sex with men. [ABSTRACT FROM AUTHOR]

Purpose: Myopia prevalence has increased in the UK at age 10‐16y, but little is known about younger children. We hypothesise that if the 'myopia epidemic' is affecting young children, then there will be increasing rates of bilateral reduced unaided vision (V) at vision screenings of children 4–5 years of age. Methods: Retrospective anonymised data from computerised vision screening at age 4–5 years were analysed from serial cross‐sectional data. Refractive error is not assessed in UK vision screening, so vision was investigated. Data were only included from schools that screened every year from 2015/16 to 2021/22. The criterion used was unaided monocular logMAR (automated letter‐by‐letter scoring) vision >0.20 in both the right and left eyes, so as to maximise the chances of detecting bilateral, moderate myopia rather than amblyopia. Results: Anonymised raw data were obtained for 359,634 screening episodes from 2075 schools. Once schools were excluded where data were not available for every year and data were cleaned, the final database comprised 110,076 episodes. The proportion (percentage and 95% CI) failing the criterion from 2015/16 to 2021/22 were 7.6 (7.2–8.0), 8.5 (8.1–8.9), 7.5 (7.1–7.9), 7.8 (7.4–8.2), 8.7 (8.1–9.2), 8.5 (7.9–9.0) and 9.3 (8.8–9.7), respectively. The slope of the regression line showed a trend for increasing rates of reduced bilateral unaided vision, consistent with increasing frequency of myopia (p = 0.06). A decreasing linear trendline was noted for children 'Under Professional Care'. Conclusions: For children 4–5 years of age, there were signs of reduced vision over the last 7 years in England. Consideration of the most likely causes support the hypothesis of increasing myopia. The increase in screening failures highlights the importance of eye care in this young population. [ABSTRACT FROM AUTHOR]

Despite undeniable hardship, the onset of the COVID-19 pandemic also saw an outpour of community solidarity and mutual aid towards those in need. This study explored why people participated in mutual aid during the pandemic as well as the factors that contributed to continued involvement and/or its decline. We conducted remote interviews with 17 people in South-east England who had been involved in volunteering and local community mutual aid support groups during the first UK lockdown from March to May 2020. Using thematic analysis, we identified two themes: 1) The emergence of social groups and their psychosocial effects, and 2) Enduring connections and barriers to continued participation. Participants often reported an emergent shared identity, preferring the localised nature of these groups and the associated mutual nature of support. They also reported intentions to continue providing such support, should the need arise again, and any barriers to continued involvement in mutual aid were better explained by structural and systemic issues, rather than individual motivational factors. [ABSTRACT FROM AUTHOR]

Background Concerns have been raised that angiotensin-converting enzyme-inhibitors (ACE-I) and angiotensin receptor blockers (ARBs) might facilitate transmission of severe acute respiratory syndrome coronavirus 2 leading to more severe coronavirus disease (COVID-19) disease and an increased risk of mortality. We aimed to investigate the association between ACE-I/ARB treatment and risk of death amongst people with COVID-19 in the first 6 months of the pandemic. Methods We identified a cohort of adults diagnosed with either confirmed or probable COVID-19 (from 1 January to 21 June 2020) using computerized medical records from the Oxford-Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) primary care database. This comprised 465 general practices in England, United Kingdom with a nationally representative population of 3.7 million people. We constructed mixed-effects logistic regression models to quantify the association between ACE-I/ARBs and all-cause mortality among people with COVID-19, adjusted for sociodemographic factors, comorbidities, concurrent medication, smoking status, practice clustering, and household number. Results There were 9,586 COVID-19 cases in the sample and 1,463 (15.3%) died during the study period between 1 January 2020 and 21 June 2020. In adjusted analysis ACE-I and ARBs were not associated with all-cause mortality (adjusted odds ratio [OR] 1.02, 95% confidence interval [CI] 0.85–1.21 and OR 0.84, 95% CI 0.67–1.07, respectively). Conclusion Use of ACE-I/ARB, which are commonly used drugs, did not alter the odds of all-cause mortality amongst people diagnosed with COVID-19. Our findings should inform patient and prescriber decisions concerning continued use of these medications during the pandemic. [ABSTRACT FROM AUTHOR]

Introduction: Studies show that the COVID-19 pandemic disproportionately affected people with diabetes and those from disadvantaged backgrounds. During the first 6 months of the UK lockdown, > 6.6 M glycated haemoglobin (HbA1c) tests were missed. We now report variability in the recovery of HbA1c testing, and its association with diabetes control and demographic characteristics. Methods: In a service evaluation, we examined HbA1c testing across ten UK sites (representing 9.9% of England's population) from January 2019 to December 2021. We compared monthly requests from April 2020 to those in the equivalent 2019 months. We examined effects of (i) HbA1c level, (ii) between-practice variability, and (iii) practice demographics. Results: In April 2020, monthly requests dropped to 7.9–18.1% of 2019 volumes. By July 2020, testing had recovered to 61.7–86.9% of 2019 levels. During April–June 2020, we observed a 5.1-fold variation in the reduction of HbA1c testing between general practices (12.4–63.8% of 2019 levels). There was evidence of limited prioritization of testing for patients with HbA1c > 86 mmol/mol during April–June 2020 (4.6% of total tests vs. 2.6% during 2019). Testing in areas with the highest social disadvantage was lower during the first lockdown (April–June 2020; trend test p < 0.001) and two subsequent periods (July–September and October–December 2020; both p < 0.001). By February 2021, testing in the highest deprivation group had a cumulative fall in testing of 34.9% of 2019 levels versus 24.6% in those in the lowest group. Conclusion: Our findings highlight that the pandemic response had a major impact on diabetes monitoring and screening. Despite limited test prioritization in the > 86 mmol/mol group, this failed to acknowledge that those in the 59–86 mmol/mol group require consistent monitoring to achieve the best outcomes. Our findings provide additional evidence that those from poorer backgrounds were disproportionately disadvantaged. Healthcare services should redress this health inequality. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic has profoundly affected UK primary care, and as a result the route to cancer diagnosis for many patients. Aim: To explore how the pandemic affected primary care practice, in particular cancer suspicion, referral, and diagnosis, and how this experience evolved as the pandemic progressed. Design and setting: Seventeen qualitative interviews were carried out remotely with primary care staff. Method: Staff from practices in England that expressed an interest in trialling an electronic safety-netting tool were invited to participate. Remote, semi-structured interviews were conducted from September 2020 to March 2021. Data analysis followed a thematic analysis and mind-mapping approach. Results: The first lockdown was described as providing time to make adjustments to allow remote and minimal-contact consultations but caused concerns over undetected cancers. These concerns were realised in summer and autumn 2020 as the participants began to see higher rates of late-stage cancer presentation. During the second and third lockdowns patients seemed more willing to consult. This combined with usual winter pressures, demands of the vaccine programme, and surging levels of COVID-19 meant that the third lockdown was the most difficult. New ways of working were seen as positive when they streamlined services but also unsafe if they prevented GPs from accessing all relevant information and resulted in delayed cancer diagnoses. Conclusion: The post-pandemic recovery of cancer care is dependent on the recovery of primary care. The COVID-19 pandemic has highlighted and exacerbated vulnerabilities in primary care but has also provided new ways of working that may help the recovery. [ABSTRACT FROM AUTHOR]

Background: We looked at changes in the prevalence of increasing and higher risk drinkers reporting a reduction attempt motivated by temporary abstinence and changes in prevalence of use of the official app accompanying Dry January between 2020 vs 2021, following the onset of the COVID-19 pandemic. We also explored potential shifts in the sociodemographic composition of both groups.Methods: We analysed data from: i) 1863 increasing and higher risk drinkers (defined as ≥ 8 on the AUDIT) responding to a nationally representative survey of adults in England in January and February 2020 and 2021, and ii) 104,598 users of the 'Try Dry' app, the official aid to those participating in Dry January 2020 and 2021 in the UK. We used logistic regression to examine shifts in the prevalence of increasing and higher risk drinkers reporting a reduction attempt motivated by temporary abstinence and explored whether there were shifts in the characteristics of this group in terms of AUDIT score, number of last year reduction attempts, smoking status, living alone, living with children, reducing alcohol consumption due to future health motives, age, sex, and occupational social grade between 2020 and 2021. We used t-tests and chi-squared tests to compare the prevalence of users of the 'Try Dry' app in 2020 and 2021 and examine whether the two groups differed in terms of age and sex.Results: The proportion of increasing and higher risk drinkers reporting a reduction attempt motivated by temporary abstinence increased from 4% in 2020 to 8% in 2021 (OR = 2.07, 95% CI = 1.38-3.11, p < .001) with no changes detected in sociodemographic composition. The number of Try Dry app users in 2021 increased by 34.8% relative to 2020. App users in 2021 were two years older on average [p < .001, d = .02], with a 2% increase in the proportion of female app users [p < .001, vs. < .01].Conclusions: Higher participation in Dry January 2021 relative to 2020 indicates increased engagement with a period of temporary abstinence following the COVID-19 related lockdowns in England and the UK, which is positive in the wider context of increasing alcohol consumption throughout the pandemic. [ABSTRACT FROM AUTHOR]

Meals on Wheels (MoWs), a service offered by local authorities in England, deliver meals to older, housebound and/or vulnerable adults, who might otherwise not be able to acquire and prepare their own meals. Research suggests that MoWs provide benefits beyond nutrition. Little is known about the actual interactions between service providers and clients, particularly during the COVID‐19 pandemic. The aim of this small‐scale, formative study was to explore MoWs service providers' experiences and their perceptions around the benefits and challenges faced by the service, and understand how these experiences changed during the first UK national lockdown. Semi‐structured interviews were conducted in September 2020 with 18 service providers of MoWs (drivers who deliver the meals, service coordinators and managers) in two local authorities in England, and analysed thematically. Participants indicated that benefits of the service encompassed those to clients (e.g. welfare checks, encouraging independence and identifying and addressing isolation and loneliness), employees (e.g. sense of pride, rewarding relationships with clients) and the wider community (e.g. reducing pressures on families), and described MoWs as the 'fourth emergency service' (e.g. being the first responders to emergency situations). Participants identified several challenges faced by the MoWs service, including organisational challenges (e.g. funding cuts and closures, lack of appropriate publicity to raise awareness of the service) and restrictions on time spent with clients. The pandemic and lockdown resulted in increased demand on resources, concerns about client and staff wellbeing and uncertainty about how the service will cope if lockdowns continue. These findings provide important insights regarding the wide benefits of MoWs and the challenges the service faces, which can be used as the formative research base to guide future interventions and policies to protect vulnerable adults, not only during the COVID‐19 pandemic, but beyond. [ABSTRACT FROM AUTHOR]

In this study, we explore how participants articulate experiences of emotions during Covid-19 lockdown in the UK. We posit that emotions fulfil experiential and interpersonal functions, which are construed and conveyed through language choices. An online narrative survey was carried out. About 88 responses were analysed. Participants were from England and Wales. The mean age was 48.9 years old (SD = 62). A mixed-method approach was used. This combined quantitative Corpus Linguistics analysis and qualitative Interpretative Phenomenological Analysis with linguistic analysis. The findings show similarities to the public health and medical literature that highlight negative emotions, such as fear, distrust and anger in participants. However, we also found positive emotions not considered elsewhere, including happiness, relaxation, safety, optimism for the future and connectedness arising from the thematic IPA analysis. Emotions were construed using language explicitly labelling emotions and language implicitly signalling emotions. Our study highlights implications for managing risk behaviours associated with transmission in public health practices such as social distancing, as indicated by negative emotions. We also bring to light implications with perceived benefits of engaging in protective behaviours and social support central to public health measures, as suggested by the communication of positive emotions. [ABSTRACT FROM AUTHOR]

Background: Recent studies indicate that vitamin D supplementation may decrease respiratory tract infections, but the association between vitamin D and COVID-19 is still unclear. Objective: To explore the association between vitamin D status and infections, hospitalisation, and mortality due to COVID-19. Methods: We used UK Biobank, a nationwide cohort of 500,000 individuals aged between 40 and 69 years at recruitment between 2006 and 2010. We included people with at least one serum vitamin D test, living in England with linked primary care and inpatient records. The primary exposure was serum vitamin D status measured at recruitment, defined as deficiency at <25 nmol/L, insufficiency at 25–49 nmol/L and sufficiency at ≥ 50 nmol/L. Secondary exposures were self-reported or prescribed vitamin D supplements. The primary outcome was laboratory-confirmed or clinically diagnosed SARS-CoV-2 infections. The secondary outcomes included hospitalisation and mortality due to COVID-19. We used multivariable Cox regression models stratified by summertime months and non-summertime months, adjusting for demographic factors and underlying comorbidities. Results: We included 307,512 participants (54.9% female, 55.9% over 70 years old) in our analysis. During summertime months, weak evidence existed that the vitamin D deficiency group had a lower hazard of being diagnosed with COVID-19 (hazard ratio [HR] = 0.86, 95% confidence interval [CI] = 0.77–0.95). During non-summertime, the vitamin D deficiency group had a higher hazard of COVID-19 compared with the vitamin D sufficient group (HR = 1.14, 95% CI = 1.01–1.30). No evidence was found that vitamin D deficiency or insufficiency was associated with either hospitalisation or mortality due to COVID-19 in any time strata. Conclusion: We found no evidence of an association between historical vitamin D status and hospitalisation or mortality due to COVID-19, along with inconsistent results for any association between vitamin D and diagnosis of COVID-19. However, studies using more recent vitamin D measurements and systematic COVID-19 testing are needed. [ABSTRACT FROM AUTHOR]

Background: During the first wave of the COVID-19 pandemic in the UK, south London had the highest number of COVID-19 patients admitted to critical care. At one hospital, staff being redeployed to critical care were invited to attend an orientation to critical care workshop. Aim: To carry out a service evaluation of the training outcomes from rapidly redeployed staff who completed the workshop during the first wave of the COVID-19 pandemic (March–July 2020). Methods: Two stages were used, the first was a post-workshop evaluation questionnaire completed immediately after the training, with the second involving a single centre e-survey questionnaire two months later. Findings: In total 131 health professionals attended the workshop, and 124 (95%) postcourse evaluations were completed. Some 116 staff were contacted for the e-survey, with a response rate of 34% (n=40). Overall, the training was well evaluated. Of the 40 respondents, 70% (n=28) had volunteered, but only just over half (n=21, 52%) went on to work in critical care. Conclusion: This article describes the organisational response of one NHS acute hospital to the unprecedented challenges that arose from the COVID-19 pandemic. The service evaluation identified the importance of a pedagogical approach, which not only delivered clinical content, but also allayed anxiety for health professionals preparing to work in a new environment. [ABSTRACT FROM AUTHOR]

Background: During the coronavirus disease 2019 (COVID-19) pandemic, support staff working with people with learning disabilities experienced a range of stressors directly related to the effects of the pandemic on themselves and on service users. Supporting staff well-being is crucial given their essential role in the lives of people with learning disabilities. Aim: To investigate the experiences, during the COVID-19 pandemic, of support staff working in residential and supported-living services for people with learning disabilities and understand the stressors staff encountered, the ways in which they managed stress and the support mechanisms they found useful. Method: A qualitative descriptive approach was used and individual semi-structured interviews were conducted with 14 support staff working in residential or supported-living services for people with learning disabilities in the south of England. Findings: The COVID-19 pandemic caused additional stress for staff, including information overload, challenges in providing person-centred, holistic support, and feelings of unfairness or being let down. However, staff derived benefits from timely, practical and non-judgemental support from managers and peers, and from celebrating their own and service users' achievements. Conclusion: A greater focus on non-judgemental listening by managers, celebration of staff's and service users' achievements and awareness of the potential overwhelming effects of email communication could reduce the stress levels support staff are exposed to. [ABSTRACT FROM AUTHOR]

The newly evolved coronavirus, SARS‐CoV‐2, which has precipitated a global COVID‐19 pandemic among the human population, has been shown to be associated with disease in captive wild animals. Bats (Chiroptera) have been shown to be susceptible to experimental infection and therefore may be at risk from disease when in contact with infected people. Numerous conservation fieldwork activities are undertaken across the United Kingdom bringing potentially infected people into close proximity with bats. In this study, we analysed the risks of disease from SARS‐CoV‐2 to free‐living bat species in England through fieldworkers undertaking conservation activities and ecological survey work, using a qualitative, transparent method devised for assessing threats of disease to free‐living wild animals. The probability of exposure of bats to SARS‐CoV‐2 through fieldwork activities was estimated to range from negligible to high, depending on the proximity between bats and people during the activity. The likelihood of infection after exposure was estimated to be high and the probability of dissemination of the virus through bat populations medium. The likelihood of clinical disease occurring in infected bats was low, and therefore, the ecological, economic and environmental consequences were predicted to be low. The overall risk estimation was low, and therefore, mitigation measures are advisable. There is uncertainty in the pathogenicity of SARS‐CoV‐2 in bats and therefore in the risk estimation. Disease risk management measures are suggested, including the use of personal protective equipment, good hand hygiene and following the existing government advice. The disease risk analysis should be updated as information on the epidemiology of SARS‐CoV‐2 and related viruses in bats improves. The re‐analysis may be informed by health surveillance of free‐living bats. [ABSTRACT FROM AUTHOR]

Objectives: The Scientific Pandemic Insights group on Behaviours (SPI‐B) as part of England's Scientific Advisory Group on Emergencies (SAGE), were commissioned by the UK Cabinet Office to identify strategies to embed infection control behaviours to minimize Covid‐19 transmission in the long term. Methods: With minimal direct evidence available, three sources of information were used to develop a set of proposals: (1) a scoping review of literature on sustaining behaviour change, (2) a review of key principles used in risk and safety management, and (3) prior reports and reviews on behaviour change from SPI‐B. The information was collated and refined through discussion with SPI‐B and SAGE colleagues to finalize the proposals. Results: Embedding infection control behaviours in the long‐term will require changes to the financial, social, and physical infrastructure so that people in all sections of society have the capability, opportunity, and motivation needed to underpin those behaviours. This will involve building Covid‐safe educational programmes, regulating to ensure minimum standards of safety in public spaces and workspaces, using communications and social marketing to develop a Covid‐safe culture and identity, and providing resources so that all sections of society can build Covid‐safe behaviours into their daily lives. Conclusions: Embedding 'Covid‐safe' behaviours into people's everyday routines will require a co‐ordinated programme to shape the financial, physical, and social infrastructure in the United Kingdom. Education, regulation, communications, and social marketing, and provision of resources will be required to ensure that all sections of society have the capability, opportunity, and motivation to enact the behaviours long term. [ABSTRACT FROM AUTHOR]

Background Seroprevalence studies are essential to understand the epidemiology of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Various technologies, including laboratory assays and point-of-care self-tests, are available for antibody testing. The interpretation of seroprevalence studies requires comparative data on the performance of antibody tests. Methods In June 2020, current and former members of the United Kingdom police forces and fire service performed a self-test lateral flow immunoassay (LFIA), had a nurse-performed LFIA, and provided a venous blood sample for enzyme-linked immunosorbent assay (ELISA). We present the prevalence of antibodies to SARS-CoV-2 and the acceptability and usability of self-test LFIAs, and we determine the sensitivity and specificity of LFIAs compared with laboratory ELISA. Results In this cohort of 5189 current and former members of the police service and 263 members of the fire service, 7.4% (396 of 5348; 95% confidence interval [CI], 6.7–8.1) were antibody positive. Seroprevalence was 8.9% (95% CI, 6.9–11.4) in those under 40 years, 11.5% (95% CI, 8.8–15.0) in those of nonwhite ethnicity, and 7.8% (95% CI, 7.1–8.7) in those currently working. Self-test LFIA had an acceptability of 97.7% and a usability of 90.0%. There was substantial agreement between within-participant LFIA results (kappa 0.80; 95% CI, 0.77–0.83). The LFIAs had a similar performance: compared with ELISA, sensitivity was 82.1% (95% CI, 77.7–86.0) self-test and 76.4% (95% CI, 71.9–80.5) nurse-performed with specificity of 97.8% (95% CI, 97.3–98.2) and 98.5% (95% CI, 98.1–98.8), respectively. Conclusions A greater proportion of this nonhealthcare key worker cohort showed evidence of previous infection with SARS-CoV-2 than the general population at 6.0% (95% CI, 5.8–6.1) after the first wave in England. The high acceptability and usability reported by participants and similar performance of self-test and nurse-performed LFIAs indicate that the self-test LFIA is fit for purpose for home testing in occupational and community prevalence studies. [ABSTRACT FROM AUTHOR]

Viral reproduction of SARS-CoV-2 provides opportunities for the acquisition of advantageous mutations, altering viral transmissibility, disease severity, and/or allowing escape from natural or vaccine-derived immunity. We use three mathematical models: a parsimonious deterministic model with homogeneous mixing; an age-structured model; and a stochastic importation model to investigate the effect of potential variants of concern (VOCs). Calibrating to the situation in England in May 2021, we find epidemiological trajectories for putative VOCs are wide-ranging and dependent on their transmissibility, immune escape capability, and the introduction timing of a postulated VOC-targeted vaccine. We demonstrate that a VOC with a substantial transmission advantage over resident variants, or with immune escape properties, can generate a wave of infections and hospitalisations comparable to the winter 2020-2021 wave. Moreover, a variant that is less transmissible, but shows partial immune-escape could provoke a wave of infection that would not be revealed until control measures are further relaxed. Understanding the potential impacts of new variants of SARS-CoV-2 is important for pandemic planning. Here, the authors develop a model incorporating hypothetical new variants with varying transmissibility and immune evasion properties, and use it to project possible future epidemic waves in the UK. [ABSTRACT FROM AUTHOR]

Background: COVID-19 has led to big changes in UK primary care, including rapid digitalisation, with unknown impact on migrant groups.Aim: To understand the pandemic's impact on recently-arrived migrants and their access to primary health care, and implications for vaccine roll-out.Design and Setting: Qualitative study involving semi-structured interviews with primary care professionals (PCPs) and migrants in urban, suburban, and rural settings across England.Method: Sixty-four PCPs and administrative staff, and 17 recently-arrived migrants were recruited using purposive, convenience, and snowball sampling. In-depth, semi-structured interviews were conducted by telephone. Data were analysed iteratively, informed by thematic analysis.Results: PCPs and migrants concurred that digitalisation and virtual consultations have amplified existing inequalities in access to health care for many migrants, due to a lack of digital literacy and access to technology, compounded by language barriers. PCPs were concerned that virtual consultations resulted in difficulties building trust and risked missing safeguarding cues. Both PCPs and migrants highlighted challenges around registering and accessing health care due to physical closure of surgeries, as well as indirect discrimination, language and communication barriers, and a lack of access to targeted and tailored COVID-19 information or interventions. Migrants reported a range of specific beliefs, from acceptance to mistrust, around COVID-19 and potential COVID-19 vaccines, often influenced by misinformation. Innovative opportunities were suggested, including translated digital health advice using text templates and YouTube; these merit further exploration.Conclusion: Pandemic-related changes to primary care delivery may become permanent; some migrant groups are at risk of digital exclusion and may need targeted additional support to access services. Solutions are needed to address vaccine hesitancy in marginalised groups to ensure equitable COVID-19 vaccine uptake. [ABSTRACT FROM AUTHOR]

Objectives: The Covid-19 pandemic is hitting societies hard, and people living in disadvantaged circumstances are among the most affected. We investigate the combined effects of the Covid-19 crisis and living in a deprived neighbourhood on two dimensions of subjective well-being: hedonic (i.e. mental health) and evaluative (i.e. life satisfaction) subjective well-being. Methods: We use longitudinal data from the Understanding Society UK panel. We combine data gathered in the main survey between 2015 and 2019 with very recent data from the Covid-19 online survey between April and July 2020. Leveraging a sample of nearly 9,600 English individuals, we first run a set of cross-sectional OLS regressions to analyse changes over time in the relationship between neighbourhood deprivation and subjective well-being. Then, as our main model of interest, we use a fixed effect difference-in-differences model to provide more robust evidence. Results: Since the beginning of the crisis, both levels of hedonic and evaluative well-being have decreased as a result of the pandemic and lockdown. However, for those living in more deprived neighbourhoods the level of hedonic well-being decreased more than for those living in better areas. We found no such difference for evaluative well-being. Conclusion: Our results highlight the importance of reducing neighbourhood inequalities as the spatial clustering of disadvantages has increased by the pandemic. [ABSTRACT FROM AUTHOR]

By mid-May 2020, cases of COVID-19 in the UK had been declining for over a month; a multi-phase emergence from lockdown was planned, including a scheduled partial reopening of schools on 1 June 2020. Although evidence suggests that children generally display mild symptoms, the size of the school-age population means the total impact of reopening schools is unclear. Here,we presentwork frommid-May 2020 that focused on the imminent opening of schools and consider what these results imply for future policy. We compared eight strategies for reopening primary and secondary schools in England. Modifying a transmission model fitted to UK SARS-CoV-2 data, we assessed how reopening schools affects contact patterns, anticipated secondary infections and the relative change in the reproduction number, R. We determined the associated public health impact and its sensitivity to changes in social distancing within the wider community. We predicted that reopening schools with half-sized classes or focused on younger children was unlikely to push R above one. Older children generally have more social contacts, so reopening secondary schools results in more cases than reopening primary schools,while reopening both could have pushed R above one in some regions. Reductions in community social distancing were found to outweigh and exacerbate any impacts of reopening. In particular, opening schools when the reproduction number R is already above one generates the largest increase in cases. Our work indicates that while any school reopening will result in increasedmixing and infection amongst children and thewider population, reopening schools alone in June 2020was unlikely to push R above one. Ultimately, reopening decisions are a difficult trade-off between epidemiological consequences and the emotional, educational and developmental needs of children. Into the future, there are difficult questions aboutwhat controls can be instigated such that schools can remain open if cases increase. This article is part of the theme issue 'Modelling that shaped the early COVID-19 pandemic response in the UK'. [ABSTRACT FROM AUTHOR]