Ethnic inequalities among NHS staff in England - workplace experiences during the COVID-19 pandemic (preprint)

ObjectivesTo determine how workplace experiences of NHS staff varied by ethnic group during the COVID-19 pandemic and examine how these experiences are associated with mental and physical health at the time of the study. MethodsAn online Inequalities Survey was conducted by the TIDES study (Tackling Inequalities and Discrimination Experiences in health Services) in collaboration with NHS CHECK. This Inequalities Survey collected measures relating to workplace experiences (such as personal protective equipment (PPE), risk assessments, redeployments, and discrimination) as well as mental health, and physical health from NHS staff working in the 18 trusts participating with the NHS CHECK study between February and October 2021 (N=4622). ResultsRegression analysis revealed that staff from Black and Mixed/Other ethnic groups had greater odds of experiencing workplace harassment (adjusted odds ratio (AOR) = 2.43 [1.56-3.78] and 2.38 [1.12-5.07], respectively) and discrimination (AOR = 4.36 [2.73-6.96], and 3.94 [1.67-9.33], respectively) compared to White British staff. Staff from black ethnic groups also had greater odds than White British staff of reporting PPE unavailability (AOR = 2.16 [1.16-4.00]). Such workplace experiences were associated with negative physical and mental health outcomes, though this association varied by ethnicity. Conversely, understanding employment rights around redeployment, being informed about, and having the ability to inform redeployment decisions were associated with lower odds of poor health outcomes. ConclusionsStructural changes to the way staff from ethnically minoritised groups are supported, and how their complaints are addressed by leaders within the NHS are urgently required to address racism and inequalities in the NHS. Policy implicationsMaintaining transparency and implementing effective mechanisms for addressing poor working conditions, harassment, and discrimination is crucial in the NHS. This can be achieved through appointing a designated staff member, establishing a tracking system, and training HR managers in identifying and handling reports of racial discrimination. Incorporating diversity and inclusion considerations into professional development activities and providing staff with opportunities to actively participate in decision-making can also benefit their health. The NHS Workforce Race Equality Standard may need to broaden its scope to assess race equality effectively.

Unexplained longitudinal variability in COVID-19 antibody status by Lateral Flow Immuno-Antibody testing (preprint)

BackgroundCOVID-19 antibody testing allows population studies to classify participants by previous SARS-CoV-2 infection status. Home lateral flow immune-antibody testing devices offer a very convenient way of doing this, but relatively little is known about how measurement and antibody variability will affect consistency in results over time. We examined consistency by looking at the outcome of two tests three months apart while COVID-19 infection rates were low (summer 2020 in the UK). MethodsThe KCL-Coronavirus Health and Experiences in Colleagues at Kings is an occupational cohort of staff and postgraduate research students. Lateral flow immune-antibody testing kits were sent to participants homes in late June 2020 and late September 2020. Participants also completed regular surveys that included asking about COVID-19 symptoms and whether they thought they had been infected. ResultsWe studied 1489 participants returned valid results in both June and September (59% of those sent kits). Lateral flow immune-antibody test was positive for 7.2% in June and 5.9% in September, with 3.9% positive in both. Being more symptomatic or suspecting infection increased the probability of ever being positive. Of those positive in June, 46% (49/107) were negative in September (seroreversion), and this was similar regardless of symptom characteristics, suspicion, and timing of possible infection. A possible outlier was those aged over 55 years, where only 3 of 13 (23%) had seroreversion. DiscussionThese results do not follow the pattern reported from studies specifically designed to monitor seropositivity, which have found greater consistency over time and the influence of presence, timing and severity of symptoms on seroreversion. We suggest several factors that may have contributed to this difference: our low bar in defining initial seropositivity (single test); a non-quantitative test known to have relatively low sensitivity; participants carrying out testing. We would encourage other studies to use these real-world performance characteristics alongside those from laboratory studies to plan and analyse any antibody testing.

The psychosocial impact of the COVID-19 pandemic on 4,378 UK healthcare workers and ancillary staff: initial baseline data from a cohort study collected during the first wave of the pandemic. (preprint)

Objectives This study reports preliminary findings on the prevalence of, and factors associated with, mental health and wellbeing outcomes of healthcare workers during the early months (April-June) of the COVID-19 pandemic in the UK. Methods Preliminary cross-sectional data were analysed from a cohort study (n=4,378). Clinical and non-clinical staff of three London-based NHS Trusts (UK), including acute and mental health Trusts, took part in an online baseline survey. The primary outcome measure used is the presence of probable common mental disorders (CMDs), measured by the General Health Questionnaire (GHQ-12). Secondary outcomes are probable anxiety (GAD-7), depression (PHQ-9), Post-Traumatic Stress Disorder (PTSD) (PCL-6), suicidal ideation (CIS-R), and alcohol use (AUDIT). Moral injury is measured using the Moray Injury Event Scale (MIES). Results Analyses showed substantial levels of CMDs (58.9%, 95%CI 58.1 to 60.8), and of PTSD (30.2%, 95%CI 28.1 to 32.5) with lower levels of depression (27.3%, 95%CI 25.3 to 29.4), anxiety (23.2%, 95%CI 21.3 to 25.3), and alcohol misuse (10.5%, 95%CI, 9.2 to 11.9). Women, younger staff, and nurses tended to have poorer outcomes than other staff, except for alcohol misuse. Higher reported exposure to moral injury (distress resulting from violation of one's moral code) was strongly associated with increased levels of CMDs, anxiety, depression, PTSD symptoms, and alcohol misuse. Conclusions Our findings suggest that mental health support for healthcare workers should consider those demographics and occupations at highest risk. Rigorous longitudinal data are needed in order to respond to the potential long-term mental health impacts of the pandemic.

Self-harm presentations to Emergency Departments and Place of Safety during the first wave of the UK COVID-19 pandemic: South London and Maudsley data on service use from February to June 2020. (preprint)

The lockdown and social distancing policy imposed due to the COVID-19 pandemic has had a substantial impact on both mental health service delivery, and the ways in which people are accessing these services. Previous reports from the South London and Maudsley NHS Trust (SLaM; a large mental health service provider for around 1.2m residents in South London) have highlighted increased use of virtual contacts by mental health teams, with dropping numbers of face-to-face contacts over the first wave of the pandemic. There has been concern that the impact of the COVID-19 pandemic would lead to higher mental health emergencies, particularly instances of self-harm. However, with people advised to stay at home during the first wave lockdown, it is as yet unclear whether this impacted mental health service presentations. Taking advantage of SLaMs Clinical Records Interactive Search (CRIS) data resource with daily updates of information from its electronic mental health records, this paper describes overall presentations to Emergency Department (ED) mental health liaison teams, and those with self-harm. The paper focussed on three periods: i) a pre-lockdown period 1st February to 15th March, ii) a lockdown period 16th March to 10th May and iii) a post-lockdown period 11th May to 28th June. In summary, all attendances to EDs for mental health support decreased during the lockdown period, including those with self-harm. All types of self-harm decreased during lockdown, with self-poisoning remaining the most common. Attendances to EDs for mental health support increased post-lockdown, although were only just approaching pre-lockdown levels by the end of June 2020.

Indicators of COVID-19 status in a cohort study of university staff and post-graduate research students, including results from home antibody testing (preprint)

BackgroundCohort studies of people with a history of COVID-19 infection and controls will be essential to understand the epidemiology of long-term effects. However, clinical diagnosis requires resources that are frequently restricted to the severely ill. Cohort studies may have to rely on surrogate indicators of COVID-19 illness. We describe the prevalence and overlap of five potential indicators: self-reported suspicion, self-reported core symptoms, symptom algorithm, self-reported routine test results, and home antibody testing. MethodsAn occupational cohort of staff and postgraduate students at a large London university who participated in surveys and antibody testing. Self-report items cover March to June 2020 and antibody test results from lateral flow IgG/IgM antibody test cassettes sent to participants in June 2020. ResultsValid antibody test results were returned for 1882 participants. Of the COVID-19 indicators, the highest prevalence was core symptoms (770 participants positive, 41%), followed by participant suspicion of infection (n=509, 27%), a symptom algorithm (n=297, 16%), study antibody positive test (n=124, 6.6%) and self-report of a positive external test (n=39, 2.1%). Study antibody positive result was rare in people who had no suspicion they had experienced COVID-19 (n=4, 0.7%) or did not experience core symptoms (n=10, 1.6%). When study antibody test results were compared with earlier external antibody results in those who had reported them, the study antibody results agreed in 88% cases (kappa= 0.636), with a lower proportion testing positive on this occasion (proportion with antibodies detected 15% in study test vs 24% in external testing). DiscussionOur results demonstrate that there is some agreement between different COVID indicators, but that they a more complete story when used together. Antibody testing may provide greater certainty and be one of the only ways to detect asymptomatic cases, but is likely to under-ascertain due to weak antibody responses to mild infection, which wane over time. Cohort studies will need to review how they deal with different and sometimes conflicting indicators of COVID-19 illness in order to study the long-term outcomes of COVID-19 infection and related impacts. What is already known on this subject?Research into the effects of COVID-19 in the community is needed to respond to the pandemic. Objective testing has not been widely available and accuracy may not be high when carried out in retrospect. Many cohort studies are considering how best to measure COVID-19 infection status. What this study adds?Antibody testing is feasible, but it is possible that sensitivity may be poor. Each indicator included added different aspects to the ascertainment of COVID-19 exposure. Using combinations of self-reported and objectively measured variables, it may be possible to tailor COVID-19 indicators to the situation.

Scientific publications and COVID-19 "research pivots" during the pandemic: An initial bibliometric analysis (preprint)

An examination is presented of scientific research publication trends during the global coronavirus (COVID-19) pandemic in 2020. After reviewing the timing of the emergence of the pandemic in 2020 and the growth of governmental responses, available secondary and sources are used to highlight impacts of COVID-19 on scientific research. A bibliometric analysis is then undertaken to analyze developments in COVID-19 related scientific publications through to October of 2020 by broad trends, fields, countries, and organizations. Two publication data sources are used: PubMed and the Web of Science. While there has been a massive absolute increase in PubMed and Web of Science papers directly focused on COVID-19 topics, especially in medical, biological science, and public health fields, this is still a relatively small proportion of publication outputs across all fields of science. Using Web of Science publication data, the paper examines the extent to which researchers across all fields of science have pivoted their research outputs to focus on topics related to COVID-19. A COVID-19 research pivot is defined as the extent to which the proportion of output in a particular research field has shifted to a focus on COVID-19 topics in 2020 (to date) compared with 2019. Significant variations are found by specific fields (identified by Web of Science Subject Categories). In a top quintile of fields, not only in medical specialties, biomedical sciences, and public health but also in subjects in social sciences and arts and humanities, there are relatively high to medium research pivots. In lower quintiles, including other subjects in science, social science, and arts and humanities, low to zero COVID-19 research pivoting is identified. Version NoteThis working paper is Version 1, completed on December 6, 2020. As further data becomes available, it may be updated.

Identification of potential coagulation pathway abnormalities in SARS-Cov-2 infection; insights from bioinformatics analysis (preprint)

Abnormal coagulation parameters have been explored in a significant number of severe COVID-19 patients, linked to poor prognosis and increased risk of organ failure. Here, to uncover the potential abnormalities in coagulation pathways, we analyzed the RNA-seq data (GEO147507) obtained from the treatment of three pulmonary epithelial cell lines with SARS-CoV-2. The significant differentially expressed genes (DEGs) were subjected to Enrichr database for KEGG pathway enrichment analysis and gene ontology (GO) functional annotation. The STRING database was used to generate PPI networks for identified DEGs. We found three upregulated procoagulant genes (SERPINE1, SERPINA5, and SERPINB2) belong to the serine protease inhibitor (serpin) superfamily that inhibit tissue plasminogen activator (t-PA) and urokinase plasminogen activator (u-PA) in the fibrinolysis process. In conclusion, we suggest the fibrinolysis process, especially the blockage of t-PA and u-PA inhibitors, a potential target for more study in treating coagulopathy in severe COVID-19 cases.

The King’s College London Coronavirus Health and Experiences of Colleagues at King’s Study (KCL CHECK) protocol paper: a platform for study of the effects of coronavirus pandemic on staff and postgraduate students (preprint)

Introduction We will use an occupational sample to study the impact of COVID-19 on current staff and postgraduate research students at a large UK university. The cohort study will address some of the key questions about COVID-19 for the international community, while also providing feedback to the employer and educator. Methods and analysis Participants were recruited via email to their University email address. Administrative records were available to compare the composition of volunteer participants to underlying staff and postgraduate student populations of the University. The study comprises a baseline survey, longitudinal follow-up surveys and a viral antibody study. Baseline information was collected in April 2020 including demographics, working situation, current stresses and worries, mental health and neurological symptoms. Personal experiences of COVID-19, indirect experiences and attitudes towards the pandemic were queried, as well as satisfaction with communication and support at work. Longitudinal surveys will assess changes in COVID-19 exposure and mental health. A viral antibody detection component is being planned and will also be longitudinal in nature. Ethics and dissemination Ethical approval has been gained from KCL’s Psychiatry, Nursing and Midwifery Research Ethics Committee (HR-19/20-18247). Participants were provided with information and agreed to a series of consent statements before enrolment. Data are kept on secure servers with access to personally identifiable information limited. Researchers may apply to have access to pseudonymised data. Findings will be disseminated internally to the University and participants, and externally through scientific publications.