ABSTRACT
Objective To assess the early vaccine administration coverage and vaccine effectiveness and outcome data across an integrated care system of eight CCGs leveraging a unique population-level care dataset Design Retrospective cohort study. Setting Individuals eligible for COVID 19 vaccination in North West London based on linked primary and secondary care data. Participants 2,183,939 individuals eligible for COVID 19 vaccination Results During the NWL vaccine programme study time period 5.88% of individuals declined and did not receive a vaccination. Black or black British individuals had the highest rate of declining a vaccine at 16.14% (4,337). There was a strong negative association between deprivation and rate of declining vaccination (r=-0.94, p<0.01) with 13.5% of individuals declining vaccination in the most deprived postcodes compared to 0.98% in the least deprived postcodes. In the first six days after vaccination 344 of 389587 individuals tested positive for COVID-19 (0.09%). The rate increased to 0.13% (525/389,243) between days 7 and 13, before then gradually falling week on week. At 28 days post vaccination there was a 74% (HR 0.26 (0.19-0.35)) and 78% (HR 0.22 (0.18-0.27)) reduction in risk of testing positive for COVID -19 for individuals that received the Oxford/Astrazeneca and Pfizer/BioNTech vaccines respectively, when compared with unvaccinated individuals. After vaccination very low rates of hospital admission were seen in individuals testing positive for COVID-19 (0.01% of all patients vaccinated). Conclusions This study provides further evidence that a single dose of either the Pfizer/BioNTech vaccine or the Oxford/Astrazeneca vaccine is effective at reducing the risk of testing positive for COVID-19 up to 60 days across all adult age groups, ethnic groups, and risk categories in an urban UK population. There was no difference in effectiveness up to 28 days between the Oxford/Astrazeneca and Pfizer/BioNtech vaccines. In those declining vaccination higher rates were seen in those living in the most deprived areas and in Black and Black British groups. There was no definitive evidence to suggest COVID-19 was transmitted as a result of vaccination hubs during vaccine the administration roll-out in NWL, and the risk of contracting COVID-19 and/or becoming hospitalised after vaccination has been demonstrated to be very low in the vaccinated population.
Subject(s)
COVID-19ABSTRACT
Background Hospitals in England have undergone considerable change to address the surge in demand imposed by the COVID-19 epidemic. The impact of this on emergency department (ED) attendances is unknown, especially for non-COVID-19 related emergencies.Methods We calibrated auto-regressive integrated moving average time-series models of ED attendances to Imperial College Healthcare NHS Trust (ICHNT) using historic (2015–2019) data. Forecasted trends were compared to present year ICHNT data for the period between March 12 (when England implemented the first COVID-19 public health measure) and May 31. We compared ICHTN trends with publicly available regional and national data. Lastly, we compared emergency admissions and in-hospital mortality at ICHNT during the present year to a historic 5-year average.Results ED attendances at ICHNT decreased by 35%, in keeping with the trend for ED attendances across all England regions, which fell by approximately 50%. For ICHNT, the decrease in attendances was mainly amongst those aged < 65 years and those arriving by their own means (e.g. personal or public transport). Increasing distance from postcode of residence to hospital was a significant predictor of reduced attendances. Non-COVID related emergency admissions to hospital after March 12 fell by 48%; there was an indication of a non-significant increase in non-COVID-19 crude mortality risk (RR 1.13, 95%CI 0.94–1.37, p = 0.19).Conclusions Our study finds strong evidence that emergency healthcare seeking has drastically changed across the population in England. At ICHNT, we find that a larger proportion arrived by ambulance and that hospitalisation outcomes of non-COVID patients did not differ from previous years. The extent to which these findings relate to ED avoidance behaviours compared to having sought alternative emergency health services outside of hospital remains unknown. National analyses and strategies to streamline emergency services in England going forward are urgently needed.