Category: Coronavirus

COVID-19, seasonal influenza and measles: potential triple burden and the role of flu and MMR vaccines

Policy interventions aimed at reducing person-to-person transmission of SARS-CoV-2 (such as hand hygiene, physical distancing and wearing face coverings) were implemented globally to minimise healthcare burden, and to allow more time for an effective treatment and successful vaccine. After months of ‘lockdown’, many countries started to ease these measures recently only to see a surge in COVID-19 cases and deaths. During the winter of 2020–2021, we face the prospect of a dual burden of a COVID-19 pandemic and a seasonal influenza epidemic. However, what’s not being currently discussed is that the burden on healthcare could be further compounded by a potential surge of measles and rubella cases. This is due to: (1) a declining trend in Measles-Mumps-Rubella vaccine coverage accompanied by an increasing trend in Measles-Mumps-Rubella cases since 2016; and (2) disruption and suspension of Measles-Mumps-Rubella vaccination campaigns in 23 countries to cope with the COVID-19 pandemic. Our article was published in the Journal of the Royal Society of Medicine.


Associations of Social Isolation with Anxiety and Depression During the Early COVID-19 Pandemic: A Survey of Older Adults in London

The COVID-19 pandemic is imposing a profound negative impact on the health and wellbeing of societies and individuals, worldwide. One concern is the effect of social isolation as a result of social distancing on the mental health of vulnerable populations, including older people. Our findings were published in the journal Frontiers in Psychiatry.

Within six weeks of lockdown, we initiated the CHARIOT COVID-19 Rapid Response Study, a bespoke survey of cognitively healthy older people living in London, to investigate the impact of COVID-19 and associated social isolation on mental and physical wellbeing. The sample was drawn from CHARIOT, a register of people over 50 who have consented to be contacted for aging related research. A total of 7,127 men and women (mean age=70.7 [SD=7.4]) participated in the baseline survey, May–July 2020. Participants were asked about changes to the 14 components of the Hospital Anxiety Depression scale (HADS) after lockdown was introduced in the UK, on 23rd March. A total of 12.8% of participants reported feeling worse on the depression components of HADS (7.8% men and 17.3% women) and 12.3% reported feeling worse on the anxiety components (7.8% men and 16.5% women). Fewer participants reported feeling improved (1.5% for depression and 4.9% for anxiety).

Women, younger participants, those single/widowed/divorced, reporting poor sleep, feelings of loneliness and who reported living alone were more likely to indicate feeling worse on both the depression and/or anxiety components of the HADS. There was a significant negative association between subjective loneliness and worsened components of both depression (OR 17.24, 95% CI 13.20, 22.50) and anxiety (OR 10.85, 95% CI 8.39, 14.03). Results may inform targeted interventions and help guide policy recommendations in reducing the effects of social isolation related to the pandemic, and beyond, on the mental health of older people.


The failure of England’s Test and Trace system means we will be in and out of lockdowns for some time

Whether we will come of the 4-week lockdown on schedule will depend on how low the government’s Covid-19 strategy brings the R-value for the country. The R value is the average number of people that each new case of Covid-19 infects. If the R value for England is less than one, the daily number of cases will start to fall; and if the R value is greater than one, the daily number of cases will continue to increase. Once the R value is below one, and the daily number of cases start to fall, the number of people being admitted to hospital and the number of deaths will also start to fall.

There is though a lag before the number of hospital admissions and deaths begin to fall. This is because it can take 1-2 weeks from becoming infected before a person is unwell enough to need hospital treatment. There is then as further period of time before death. Hence, case numbers start to fall first, followed by the number of people admitted to hospital and then finally, the number of people dying from Covid=19.

The “nightmare scenario” that we will face is that the new lockdown measures are not strict enough or people do not comply with them, meaning that the R value stays above one and the numbers of cases, hospital admissions and deaths do not fall. This will mean continuing restrictions after the 4-week lockdown period ends. Even if the number of Covid-19 cases does fall to a more manageable level by the end of the lockdown, there will still be ongoing restrictions on social activities, resulting in Christmas 2020 being very different from a normal Christmas.

It’s also possible that we will see future waves of Covid-19 infection after lockdown measures are relaxed – as we saw earlier in the year – meaning that we may get further lockdowns followed by periods of relaxation of lockdown measures. Unfortunately, ever since the start of the pandemic, England’s Test and Trace system has not worked well enough to suppress local outbreaks promptly and keep the number of cases low – as we have seen in countries such as New Zealand, Taiwan and South Korea.

Hence, this cycle of lockdowns and restrictions of activities, followed by some loosening of these restrictions, may not end until we have a safe and effective vaccine that can finally bring Covid-19 under control in England and across the rest of the world. The encouraging news is that the early results about the safety and effectiveness of the new vaccines being developed for Covid-19 are very positive; and we may be able to launch a large-scale vaccine programme in the United Kingdom very soon. This vaccine programme is going to be complex and challenging to deliver but the NHS does have the expertise to do this.

Excess mortality: the gold standard in measuring the impact of COVID-19 worldwide?

Our new paper published in the Journal of the Royal Society of Medicine discusses excess mortality during the Covid-19 pandemic. The scale of the COVID-19 pandemic has forced policy-makers to operate with limited evidence for the relative success of different control measures.  Excess mortality is one key outcome measure. The highest excess mortality per million population is seen in Spain, followed by England and Wales. The majority of these excess deaths are caused by COVID-19, but a significant proportion are not directly related to COVID-19. In measuring the impact of COVID-19, mortality is however only one of many important outcomes. Even in ‘mild’ cases not requiring hospitalisation, symptoms can be long-lasting, and heart and lung complications are common, affecting quality of life and ability to work. Beyond the effects on health, the pandemic has disrupted all aspects of society – many countries have experienced record economic recessions, while school closures affect children’s educational attainment.

The impact of COVID-19 on academic primary care and public health

The COVID-19 pandemic has had a dramatic effect on people’s lives globally. For academics working in fields such as primary care and public health, the pandemic led to major changes in professional roles as I discuss in an article published in the JRSM. Universities across the United Kingdom closed their campuses in March 2020 and switched to remote working. Staff began to work from home and teaching of students moved online. University staff rapidly had to put in place systems for teaching, monitoring and assessing students remotely. For many universities, these changes will be in place until the end of 2020, with no return to a more normal mode of working until January 2021 at the earliest.


COVID-19 presents opportunities and threats to transport and health

The ‘lockdown’ of the United Kingdom on 23 March had pronounced impacts on travel patterns as we discussed in our recent JRSM paper. As many millions of people moved to either working at home or were furloughed from their jobs, there were large decreases in trips to workplaces alongside even steeper decreases in recreational journeys. Transport is an often overlooked influence on the health of populations and health inequalities, affecting physical activity, road traffic incidents and air pollution, in addition to being a major contributor to climate change. There is ongoing uncertainty around the longer-term trajectory of COVID-19, including risks of a second wave, meaning that the medium-term changes to transport and society are hard to predict. Nevertheless, the current easing of the lockdown in England presents both opportunities and threats to the health impacts of transport.


The primary care response to COVID-19 in England’s National Health Service

In a recent article, I discuss the primary care response to Covid-19 in England. The first case of COVID-19 in England was identified at the end of January 2020. Cases increased during February, and by early March, it became apparent that England faced a large COVID-19 epidemic. This led to the Department of Health and Social Care and NHS England (the bodies that respectively fund and manage the NHS in England) to recommend radical changes to the provision of NHS primary care services.
For most general practices, these changes began to be implemented in the week beginning 16 March 2020. As a first step, general practices switched from the traditional model of face-to-face service provision to one where all patients were initially assessed through a telephone or a video call. Patients were encouraged to register for online booking of these appointments if they had not already done this.
All patients requesting advice spoke first to a health professional, usually general practitioners. The aim was to deal with as many queries as possible by telephone or a video call. Patients who required a face-to-face appointment were booked to be seen in later that day. This ensured that patients were largely managed on the same day they sought medical advice. These changes have resulted in around three-quarters of patients being managed remotely compared to the same time last year when only one-quarter were, with the total volume of primary care activity falling by about 25%.
We have seen rapid changes in primary care in England, but challenges remain, particularly if the number of people with COVID-19 infection increases rapidly and starts to overwhelm the health system, or if second and subsequent waves of infection occur. Other challenges include providing medical care for people who are self-isolating at home because of their age or because of underlying medical problems that increase their risk of complications and death if they contract a COVID-19 infection. There are also problems that will arise from the cutting back of many specialist hospital services, which will have negative effects on health outcomes if restrictions in health services remain in place for a prolonged period.
Overall, primary care in England has responded well to the COVID-19 pandemic, making radical changes to how primary care services are delivered in a very short period of time. Key to allowing this to happen is the commitment by the UK government to support general practices financially to prevent the loss of income that has occurred to primary care practices in countries such as the USA. However, the future will remain challenging for primary care teams in England until such time as a vaccine or effective drug treatment can be found for COVID-19.
Read the full article in the Journal of the Royal Society of Medicine.

Health inequalities: the hidden cost of COVID-19

My article in the Journal of the Royal Society of Medicine discusses the wider impact of COVID-19 on health systems and the potential for changes to health services to increase health inequalities. We report a 44% decrease in emergency department attendances in England in March 2020. We must not overlook the importance of good infection control for outsourced NHS staff such as cleaners, security guards and caterers. They can acquire COVID-19, thereby putting themselves at risk, and transmit COVID-19 to patients and other NHS staff.
Read the full article in the Journal of the Royal Society Medicine.

Protecting healthcare workers during the COVID-19 pandemic

My editorial in the British Journal of General Practice discusses how we can protect healthcare workers during the Covid-19 pandemic. Some of the key steps we can take include:
1. Maximise remote working
2. Implement good infection control
3. Use PPE effectively.
4. Risk assessment for staff based on age and medical history
Too many health and care workers have died and we must take urgent action to protect them. When we protect staff, we also protect patients because we reduce the risk of hospital acquired infection.
Read the full article in the British Journal of General Practice.

Protecting older people from COVID-19: should the United Kingdom start at age 60?

National and global spread of COVID-19 is accelerating. To reduce COVID-19-related hospitalisations, intensive care unit admissions and deaths, we recommend that those aged between 60 and 69 years are particularly stringent when implementing public health measures such as social distancing and personal hygiene. In the absence of government guidance, people in this group can make their own informed decisions on how to minimise their risks of COVID-19 infection. This can include using precautionary measures to reduce the risk of infection in a similar manner to that recommended by the UK government for people aged 70 years and over.

Read the article in the Journal of the Royal Society of Medicine.