The impact of "freedom day" on COVID-19 health protective behaviour in England: An observational study of hand hygiene, face covering use and physical distancing in public spaces pre and post the relaxing of restrictions.

Objectives: To study the prevalence of COVID-19 health protective behaviours before and after rules eased in England on the 19th July 2021. Design: Observational study pre (12th-18th July) and post (26th July-1st August) 19th July, and a cross-sectional online survey (26th to 27th July). Setting: Observations occurred in supermarkets (n = 10), train stations (n = 10), bus stops (n = 10), a coach station (n = 1) and a London Underground station (n = 1). The survey recruited a nationally representative sample. Participants: All adults entering the observed locations during a one-hour period (n = 3819 pre- and n = 2948 post-19th July). In the online survey, 1472 respondents reported having been shopping for groceries/visited a pharmacy and 566 reported having used public transport or having been in a taxi/minicab in the last week. Main outcome measures: We observed whether people wore a face covering, maintained distance from others and cleaned their hands. We investigated self-reports of wearing a face covering while in shops or using public transport. Results: In most locations observed, the proportion of people wearing face coverings, cleaning the hands and maintaining physical distance declined post 19th July. Pre 19th July, 70.2% (95% CI 68.7 to 71.7%) of people were observed to be wearing a face covering versus 55.8% (54.2 to 57.9%) post 19th July. Equivalent rates for physical distancing were 40.9% (39.0 to 42.8%) versus 29.5% (27.4 to 31.7%), and for hand hygiene were 4.4% (3.8 to 5.1%) versus 3.9% (3.2 to 4.6%). Self-reports of "always" wearing face coverings were broadly similar to observed rates. Conclusions: Adherence to protective behaviours was sub-optimal and declined during the relaxation of restrictions, despite appeals to exercise caution. Self-reports of "always" wearing a face covering in specific locations appear valid.

Knowledge of Self-Isolation Rules in the UK for Those Who Have Symptoms of COVID-19: A Repeated Cross-Sectional Survey Study.

OBJECTIVES: To investigate knowledge of self-isolation rules and factors associated with knowledge. METHODS: Repeated cross-sectional online surveys (n ≈ 2000 UK adults) between 9 November 2020 and 16 February 2022 (78,573 responses from 51,881 participants). We computed a composite measure of knowledge of self-isolation rules and investigated associations between knowledge and survey wave, socio-demographic characteristics (age, gender, UK nation, index of multiple deprivation), trust in government, and participants' belief that they had received enough information about self-isolation. RESULTS: In total, 87.9% (95% CI 87.7% to 88.1%, n = 67,288/76,562) of participants knew that if they had symptoms of COVID-19 they should 'self-isolate'. However, only 62.8% (n = 48,058/76,562, 95% CI 62.4% to 63.1%) knew the main rules regarding what that meant. Younger people had less knowledge than older people, and men had less knowledge than women. Knowledge was lower in people living in England versus in Scotland, Wales, and Northern Ireland. The pattern of association between knowledge and trust in government was unclear. Knowledge was lower in people living in a more deprived area and those who did not believe they had enough information about self-isolation. Knowledge was lower in December 2020 to January 2021, compared with before and after this period. CONCLUSIONS: Approximately 63% of UK adults between November 2020 and February 2022 appeared to know the main rules regarding self-isolation if symptomatic with COVID-19. Knowledge was lower in younger than older people, men than women, those living in England compared with Scotland, Wales or Northern Ireland, and those living in more deprived areas.

Psychosocial factors affecting COVID-19 vaccine uptake in the UK: A prospective cohort study (CoVAccS - Wave 3).

Background: We investigated factors associated with COVID-19 vaccine uptake, future vaccination intentions, and changes in beliefs and attitudes over time. Methods: Prospective cohort study. 1500 participants completed an online survey in January 2021 (T1, start of vaccine rollout in the UK), of whom 1148 (response rate 76.5 %) completed another survey in October 2021 (T2, all UK adults offered two vaccine doses). Binary logistic regression analysis was used to investigate factors associated with subsequent vaccine uptake. Content analysis was used to investigate the main reasons behind future vaccine intentions (T2). Changes in beliefs and attitudes were investigated using analysis of variance. Findings: At T2, 90.0 % (95 % CI 88.2-91.7 %) of participants had received two doses of a COVID-19 vaccine, 2.2 % (95 % CI 1.3-3.0 %) had received one dose, and 7.4 % (95 % CI 5.9-8.9 %) had not been vaccinated. Uptake was associated with higher intention to be vaccinated at T1, greater perceived vaccination social norms, necessity of vaccination, and perceived safety of the vaccine. People who had initiated vaccination reported being likely to complete it, while those who had not yet received a vaccine reported being unlikely to be vaccinated in the future. At T2, participants perceived greater susceptibility to, but lower severity of, COVID-19 (p < 0.001) than at T1. Perceived safety and adequacy of vaccine information were higher (p < 0.001). Interpretation: Targeting modifiable beliefs about the safety and effectiveness of vaccination may increase uptake.

Observed and self-reported COVID-19 health protection behaviours on a university campus and the impact of a single simple intervention.

During the COVID-19 pandemic, most data on adherence to health protective behaviours were collected via a self-report. We quantified the discrepancy between self-report data and discretely observed behaviour in a sample of university staff and students. We assessed the prevalence of cleaning hands, wearing a face-covering and maintaining distance from others. We also tested whether additional signage reminding people that these behaviours were mandatory improved observed adherence. Prevalence estimates based on self-report were higher than those based on observations. Signage was associated with improvements for observed behaviours (all χ2 ≥ 6.0, P < 0.05). We caution that self-reported data can produce misleading adherence rates.

A qualitative study about how families coped with managing their well-being, children's physical activity and education during the COVID-19 school closures in England.

In 2020, schools in England closed for six months due to COVID-19, resulting in children being home-schooled. There is limited understanding about the impacts of this on children's mental and physical health and their education. Therefore, we explored how families coped with managing these issues during the school closures. We conducted 30 qualitative interviews with parents of children aged 18 years and under (who would usually be in school) between 16 and 21 April 2020. We identified three themes and eight sub-themes that impacted how families coped whilst schools were closed. We found that family dynamics, circumstances, and resources (Theme 1), changes in entertainment activities and physical movement (Theme 2) and worries about the COVID-19 pandemic (Theme 3) impacted how well families were able to cope. A key barrier to coping was struggles with home-schooling (e.g., lack of resources and support from the school). However, parents being more involved in their children's personal development and education were considered a benefit to home-schooling. Managing the lack of entertainment activities and in-person interactions, and additional health worries about loved ones catching COVID-19 were challenges for families. Parents reported adverse behaviour changes in their children, although overall, they reported they were coping well. However, pre-existing social and educational inequalities are at risk of exacerbation. Families with more resources (e.g., parental supervision, access to green space, technology to facilitate home-schooling and no special educational needs) were better able to cope when schools were closed. On balance, however, families appeared to be able to adapt to the schools being closed. We suggest that policy should focus on supporting families to mitigate the widening health and educational gap between families with more and less resources.

Parents' intention to vaccinate their child for COVID-19: A mixed-methods study (CoVAccS-wave 3).

AIM: To investigate UK parents' vaccination intention at a time when COVID-19 vaccination was available to some children. METHODS: Data reported are from the second wave of a prospective cohort study. We conducted a mixed-methods study using an online survey of 270 UK parents (conducted 4-15 October 2021). At this time, vaccination was available to 16- and 17-year-olds and had become available to 12- to 15-year-olds two weeks prior. We asked participants whose child had not yet been vaccinated how likely they were to vaccinate their child for COVID-19. Linear regression analyses were used to investigate factors associated with intention (quantitative component). Parents were also asked for their main reasons behind vaccination intention. Open-ended responses were analysed using content analysis (qualitative component). RESULTS: Parental vaccination intention was mixed (likely: 39.3%, 95% CI 32.8%, 45.7%; uncertain: 33.9%, 95% CI 27.7%, 40.2%; unlikely: 26.8%, 95% CI 20.9%, 32.6%). Intention was associated with: parental COVID-19 vaccination status; greater perceived necessity and social norms regarding COVID-19 vaccination; greater COVID-19 threat appraisal; and lower vaccine safety and novelty concerns. In those who intended to vaccinate their child, the main reasons for doing so were to protect the child and others. In those who did not intend to vaccinate their child, the main reason was safety concerns. CONCLUSIONS: Parent COVID-19 vaccination status and psychological factors explained a large percentage of the variance in vaccination intention for one's child. Further study is needed to see whether parents' intention to vaccinate their child is affected by fluctuating infection rates, more children being vaccinated, and the UK's reliance on vaccination as a strategy to live with COVID-19.

Daily use of lateral flow devices by contacts of confirmed COVID-19 cases to enable exemption from isolation compared with standard self-isolation to reduce onward transmission of SARS-CoV-2 in England: a randomised, controlled, non-inferiority trial.

BACKGROUND: In the UK, during the study period (April to July, 2021), all contacts of people with COVID-19 were required to self-isolate for 10 days, which had adverse impacts on individuals and society. Avoiding the need to self-isolate for those who remain uninfected would be beneficial. We investigated whether daily use of lateral flow devices (LFDs) to test for SARS-CoV-2, with removal of self-isolation for 24 h if negative, could be a safe alternative to self-isolation as a means to minimise onward transmission of the virus. METHODS: We conducted a randomised, controlled, non-inferiority trial in adult contacts identified by COVID-19 contact tracing in England. Consenting participants were randomly assigned to self-isolation (single PCR test, 10-day isolation) or daily contact testing (DCT; seven LFD tests, two PCR tests, no isolation if negative on LFD); participants from a single household were assigned to the same group. Participants were prospectively followed up, with the effect of each intervention on onward transmission established from routinely collected NHS Test and Trace contact tracing data for participants who tested PCR-positive for SARS-CoV-2 during the study period and tertiary cases arising from their contacts (ie, secondary contacts). The primary outcome of the study was the attack rate, the percentage of secondary contacts (close contacts of SARS-CoV-2-positive study participants) who became COVID-19 cases (tertiary cases) in each group. Attack rates were derived from Bernoulli regression models using Huber-White (robust) sandwich estimator clustered standard errors. Attack rates were adjusted for household exposure, vaccination status, and ability to work from home. The non-inferiority margin was 1·9%. The primary analysis was a modified intention-to-treat analysis excluding those who actively withdrew from the study as data from these participants were no longer held. This study is registered with the Research Registry (number 6809). Data collection is complete; analysis is ongoing. FINDINGS: Between April 29 and July 28, 2021, 54 923 eligible individuals were enrolled in the study, with final group allocations (following withdrawals) of 26 123 (52·6%) participants in the DCT group and 23 500 (47·4%) in the self-isolation group. Overall, 4694 participants tested positive for SARS-CoV-2 by PCR (secondary cases), 2364 (10·1%) in the self-isolation group and 2330 (8·9%) in the DCT group. Adjusted attack rates (among secondary contacts) were 7·5% in the self-isolation group and 6·3% in the DCT group (difference of -1·2% [95% CI -2·3 to -0·2]; significantly lower than the non-inferiority margin of 1·9%). INTERPRETATION: DCT with 24 h exemption from self-isolation for essential activities appears to be non-inferior to self-isolation. This study, which provided evidence for the UK Government's daily lateral flow testing policy for vaccinated contacts of COVID-19 cases, indicated that daily testing with LFDs could allow individuals to reduce the risk of onward transmission while minimising the adverse effects of self-isolation. Although contacts in England are no longer required to isolate, the findings will be relevant for future policy decisions around COVID-19 or other communicable infections. FUNDING: UK Government Department of Health and Social Care.

Exploring the impact of shielding advice on the wellbeing of individuals identified as clinically extremely vulnerable amid the COVID-19 pandemic: a mixed-methods evaluation.

BACKGROUND: The national shielding programme was introduced by UK Government at the beginning of the COVID-19 pandemic, with individuals identified as clinically extremely vulnerable (CEV) offered advice and support to stay at home and avoid all non-essential contact. This study aimed to explore the impact and responses of "shielding" on the health and wellbeing of CEV individuals in Southwest England during the first COVID-19 lockdown. METHODS: A two-stage mixed methods study, including a structured survey (7 August-23 October 2020) and semi-structured telephone interviews (26 August-30 September 2020) with a sample of individuals who had been identified as CEV and advised to "shield" by Bristol, North Somerset & South Gloucestershire (BNSSG) Clinical Commissioning Group (CCG). RESULTS: The survey was completed by 203 people (57% female, 54% > 69 years, 94% White British, 64% retired) in Southwest England identified as CEV by BNSSG CCG. Thirteen survey respondents participated in follow-up interviews (53% female, 40% > 69 years, 100% White British, 61% retired). Receipt of 'official' communication from NHS England or General Practitioner (GP) was considered by participants as the legitimate start of shielding. 80% of survey responders felt they received all relevant advice needed to shield, yet interviewees criticised the timing of advice and often sought supplementary information. Shielding behaviours were nuanced, adapted to suit personal circumstances, and waned over time. Few interviewees received community support, although food boxes and informal social support were obtained by some. Worrying about COVID-19 was common for survey responders (90%). Since shielding had begun, physical and mental health reportedly worsened for 35% and 42% of survey responders respectively. 21% of survey responders scored ≥ 10 on the PHQ-9 questionnaire indicating possible depression and 15% scored ≥ 10 on the GAD-7 questionnaire indicating possible anxiety. CONCLUSIONS: This research highlights the difficulties in providing generic messaging that is applicable and appropriate given the diversity of individuals identified as CEV and the importance of sharing tailored and timely advice to inform shielding decisions. Providing messages that reinforce self-determined action and assistance from support services could reduce the negative impact of shielding on mental health and feelings of social isolation.

Psychological factors associated with reporting side effects following COVID-19 vaccination: A prospective cohort study (CoVAccS - Wave 3).

OBJECTIVE: To investigate symptom reporting following the first and second COVID-19 vaccine doses, attribution of symptoms to the vaccine, and factors associated with symptom reporting. METHODS: Prospective cohort study (T1: 13-15 January 2021, T2: 4-15 October 2021). Participants were aged 18 years or older, living in the UK. Personal, clinical, and psychological factors were investigated at T1. Symptoms were reported at T2. We used logistic regression analyses to investigate associations. RESULTS: After the first COVID-19 vaccine dose, 74.1% (95% CI 71.4% to 76.7%, n = 762/1028) of participants reported at least one injection-site symptom, while 65.0% (95% CI 62.0% to 67.9%, n = 669/1029) reported at least one other (non-injection-site) symptom. Symptom reporting was associated with being a woman and younger. After the second dose, 52.9% (95% CI 49.8% to 56.0%, n = 532/1005) of participants reported at least one injection-site symptom and 43.7% (95% CI 40.7% to 46.8%, n = 440/1006) reported at least one other (non-injection-site) symptom. Symptom reporting was associated with having reported symptoms after the first dose, having an illness that put one at higher risk of COVID-19 (non-injection-site symptoms only), and not believing that one had enough information about COVID-19 to make an informed decision about vaccination (injection-site symptoms only). CONCLUSIONS: Women and younger people were more likely to report symptoms from vaccination. People who had reported symptoms from previous doses were also more likely to report symptoms subsequently, although symptom reporting following the second vaccine was lower than following the first vaccine. Few psychological factors were associated with symptom reporting.

How has the emergence of the Omicron SARS-CoV-2 variant of concern influenced worry, perceived risk and behaviour in the UK? A series of cross-sectional surveys.

OBJECTIVES: To investigate changes in beliefs and behaviours following news of the Omicron variant and changes to guidance understanding of Omicron-related guidance, and factors associated with engaging with protective behaviours. DESIGN: Series of cross-sectional surveys (1 November to 16 December 2021, five waves of data collection). SETTING: Online. PARTICIPANTS: People living in England, aged 16 years or over (n=1622-1902 per wave). PRIMARY AND SECONDARY OUTCOME MEASURES: Levels of worry and perceived risk, and engagement with key behaviours (out-of-home activities, risky social mixing, wearing a face covering and testing uptake). RESULTS: Degree of worry and perceived risk of COVID-19 (to oneself and people in the UK) fluctuated over time, increasing slightly around the time of the announcement about Omicron (p<0.001). Understanding of rules in England was varied, ranging between 10.3% and 91.9%, with people overestimating the stringency of the new rules. Rates of wearing a face covering and testing increased over time (p<0.001). Meeting up with people from another household decreased around the time of the announcement of Omicron (29 November to 1 December), but then returned to previous levels (p=0.002). Associations with protective behaviours were investigated using regression analyses. There was no evidence for significant associations between out-of-home activity and worry or perceived risk (COVID-19 generally or Omicron-specific, p≥0.004; Bonferroni adjustment p<0.002 applied). Engaging in highest risk social mixing and always wearing a face covering were associated with worry and perceived risk about COVID-19 (p≤0.001). Always wearing a face covering in shops was associated with having heard more about Omicron (p<0.001). CONCLUSIONS: Almost 2 years into the COVID-19 outbreak, the emergence of a novel variant of concern only slightly influenced worry and perceived risk. The main protective behaviour (wearing a face covering) promoted by new guidance showed significant re-uptake, but other protective behaviours showed little or no change.

The acceptability of testing contacts of confirmed COVID-19 cases using serial, self-administered lateral flow devices as an alternative to self-isolation.

Introduction. Evidence suggests that although people modify their behaviours, full adherence to self-isolation guidance in England may be suboptimal, which may have a detrimental impact on COVID-19 transmission rates.Hypothesis. Testing asymptomatic contacts of confirmed COVID-19 cases for the presence of SARS-CoV-2 could reduce onward transmission by improving case ascertainment and lessen the impact of self-isolation on un-infected individuals.Aim. This study investigated the feasibility and acceptability of implementing a 'test to enable approach' as part of England's tracing strategy.Methodology. Contacts of confirmed COVID-19 cases were offered serial testing as an alternative to self-isolation using daily self-performed lateral flow device (LFD) tests for the first 7 days post-exposure. Asymptomatic participants with a negative LFD result were given 24 h of freedom from self-isolation between each test. A self-collected confirmatory PCR test was performed on testing positive or at the end of the LFD testing period.Results. Of 1760 contacts, 882 consented to daily testing, of whom 812 individuals were within 48 h of exposure and were sent LFD testing packs. Of those who declined to participate, 39.1% stated they had already accessed PCR testing. Of the 812 who were sent LFD packs, 570 (70.2%) reported one or more LFD results; 102 (17.9%) tested positive. Concordance between reported LFD result and a supplied LFD image was 97.1%. In total, 82.8% of PCR-positive samples and 99.6% of PCR-negative samples were correctly detected by LFD. The proportion of secondary cases from contacts of those who participated in the study and tested positive (6.3%; 95% CI: 3.4-11.1%) was comparable to a comparator group who self-isolated (7.6%; 95% CI: 7.3-7.8%).Conclusion. This study shows a high acceptability, compliance and positivity rates when using self-administered LFDs among contacts of confirmed COVID-19 cases. Offering routine testing as a structured part of the contact tracing process is likely to be an effective method of case ascertainment.

A systematic review of observational methods used to quantify personal protective behaviours among members of the public during the COVID-19 pandemic, and the concordance between observational and self-report measures in infectious disease health protection.

OBJECTIVES: To assess the quantity and quality of studies using an observational measure of behaviour during the COVID-19 pandemic, and to narratively describe the association between self-report and observational data for behaviours relevant to controlling an infectious disease outbreak. DESIGN: Systematic review and narrative synthesis of observational studies. DATA SOURCES: We searched Medline, Embase, PsychInfo, Publons, Scopus and the UK Health Security Agency behavioural science LitRep database from inception to 17th September 2021 for relevant studies. STUDY SELECTION: We included studies which collected observational data of at least one of three health protective behaviours (hand hygiene, face covering use and maintaining physical distance from others ('social distancing') during the COVID-19 pandemic. Studies where observational data were compared to self-report data in relation to any infectious disease were also included. DATA EXTRACTION AND SYNTHESIS: We evaluated the quality of studies using the NIH quality assessment scale for observational studies, extracted data on sample size, setting and adherence to health protective behaviours, and synthesized results narratively. RESULTS: Of 27,279 published papers on COVID-19 relevant health protective behaviours that included one or more terms relating to hand hygiene, face covering and social distancing, we identified 48 studies that included an objective observational measure. Of these, 35 assessed face covering use, 17 assessed hand hygiene behaviour and seven assessed physical distancing. The general quality of these studies was good. When expanding the search to all infectious diseases, we included 21 studies that compared observational versus self-report data. These almost exclusively studied hand hygiene. The difference in outcomes was striking, with self-report over-estimating observed adherence by up to a factor of five in some settings. In only four papers did self-report match observational data in any domains. CONCLUSIONS: Despite their importance in controlling the pandemic, we found remarkably few studies assessing protective behaviours by observation, rather than self-report, though these studies tended to be of reasonably good quality. Observed adherence tends to be substantially lower than estimates obtained via self-report. Accurate assessment of levels of personal protective behaviour, and evaluation of interventions to increase this, would benefit from the use of observational methods.

A systematic review of observational methods used to quantify personal protective behaviours among members of the public during the COVID-19 pandemic, and the concordance between observational and self-report measures in infectious disease health protection

To assess the quantity and quality of studies using an observational measure of behaviour during the COVID-19 pandemic, and to narratively describe the association between self-report and observational data for behaviours relevant to controlling an infectious disease outbreak. Systematic review and narrative synthesis of observational studies. We searched Medline, Embase, PsychInfo, Publons, Scopus and the UK Health Security Agency behavioural science LitRep database from inception to 17th September 2021 for relevant studies. We included studies which collected observational data of at least one of three health protective behaviours (hand hygiene, face covering use and maintaining physical distance from others (‘social distancing’) during the COVID-19 pandemic. Studies where observational data were compared to self-report data in relation to any infectious disease were also included. We evaluated the quality of studies using the NIH quality assessment scale for observational studies, extracted data on sample size, setting and adherence to health protective behaviours, and synthesized results narratively. Of 27,279 published papers on COVID-19 relevant health protective behaviours that included one or more terms relating to hand hygiene, face covering and social distancing, we identified 48 studies that included an objective observational measure. Of these, 35 assessed face covering use, 17 assessed hand hygiene behaviour and seven assessed physical distancing. The general quality of these studies was good. When expanding the search to all infectious diseases, we included 21 studies that compared observational versus self-report data. These almost exclusively studied hand hygiene. The difference in outcomes was striking, with self-report over-estimating observed adherence by up to a factor of five in some settings. In only four papers did self-report match observational data in any domains. Despite their importance in controlling the pandemic, we found remarkably few studies assessing protective behaviours by observation, rather than self-report, though these studies tended to be of reasonably good quality. Observed adherence tends to be substantially lower than estimates obtained via self-report. Accurate assessment of levels of personal protective behaviour, and evaluation of interventions to increase this, would benefit from the use of observational methods.

A qualitative process analysis of daily contact testing as an alternative to self-isolation following close contact with a confirmed carrier of SARS-CoV-2.

BACKGROUND: In July 2021, a randomised controlled trial was conducted to compare the effect on SARS-CoV-2 transmission of seven days of Daily Contact Testing (DCT) using Lateral Flow Test (LFT) and two Polymerase Chain Reaction (PCR) tests as an alternative to 10 days of standard self-isolation with one PCR, following close contact with a SARS-CoV-2 carrier. In this qualitative study, we used a nested process evaluation to aid interpretation of the trial and provide insight into factors influencing use of tests, understanding of test results, and how tests were used to inform behavioural decisions. METHODS: Interviews were conducted with 60 participants (42 randomised to DCT and 18 randomised to self-isolation) who had been in close contact with a confirmed SARS-CoV-2 carrier and had consented to take part in the trial. RESULTS: Data were organised into three overarching themes: (1) assessing the risks and benefits of DCT (2) use of testing during the study period and (3) future use of testing. Attitudes toward DCT as an alternative to self-isolation and behaviour during the testing period appeared to be informed by an assessment of the associated risks and benefits. Participants reported how important it was for them to avoid isolation, how necessary self-isolation was considered to be, and the ability of LFTs to detect infection. Behaviour during the testing period was modified to reduce risks and harms as much as possible. Testing was considered a potential compromise, reducing both risk of transmission and the negative impact of self-isolation, and was regarded as a way to return to normal. CONCLUSION: Participants in this study viewed DCT as a sensible, feasible, and welcome means of avoiding unnecessary self-isolation. Although negative LFTs provided reassurance, most people still restricted their activity as recommended. DCT was also highly valued by those in vulnerable households as a means of providing reassurance of the absence of infection and as an important means of detecting infection and prompting self-isolation when necessary.

Do people with symptoms of an infectious illness follow advice to stay at home? Evidence from a series of cross-sectional surveys about presenteeism in the UK.

OBJECTIVES: To assess the percentage of people in the UK with cough, fever or loss of taste or smell who have not had a positive COVID-19 test result who had been to work, to shops, socialised or provided care to a vulnerable person in the 10 days after developing symptoms. To investigate whether these rates differed according to the type of symptom, what the participant thought the cause of their symptoms was and whether they had taken a COVID-19 test. DESIGN: Four online cross-sectional surveys using non-probability quota sampling method (n=8547). SETTING: Data were collected across the UK from 20 September to 3 November 2021, via a market research company. PARTICIPANTS: Aged over 16 years living in the UK. PRIMARY OUTCOME MEASURES: Out-of-home activity. RESULTS: 498 participants reported one or more symptoms and had not had a positive COVID-19 test result. Within that group, about half of employed participants had attended work while symptomatic (51.2%-56.3% depending on the symptom, 95% CIs 42.2% to 65.6%). Rates of other contact behaviours ranged from 31.4% (caring for a vulnerable person after developing a cough: 95% CI 24.3% to 38.4%) to 61.5% (shopping for groceries or pharmacy after developing a cough: 95% CI 54.1% to 68.9%). There were no differences according to type of symptom experienced or what the participant felt might be the cause. People who had taken a COVID-19 test were less likely to go out shopping for non-essentials than people who had not taken a test. CONCLUSION: Many people in the UK with symptoms of an infectious disease were not following government advice to stay at home if they believed they had an infectious illness. Reducing these rates may require a shift in our national attitude to the acceptability of people attending work with infectious illnesses.

Psychological wellbeing in the English population during the COVID-19 pandemic: A series of cross-sectional surveys.

Psychological distress has been elevated during the COVID-19 pandemic. However, few studies published to date have investigated distress after the first wave of infections (Spring - Summer 2020). We investigated distress and wellbeing between April 2020 and April 2022 in England through a series of cross-sectional online surveys. People aged 16 years or over living in the UK were eligible for the surveys; for this study we selected only those living in England due to differences in restrictions between UK nations. Distress was measured using the PHQ4 (n = 60,921 responses), while wellbeing was measured using the Short Warwick-Edinburgh Mental Wellbeing Scale (n = 61,152 responses). Throughout, approximately 50%-60% of women and 40%-50% of men reported distress, higher than the 25%-30% of women, and 20%-25% of men reported in normative data. Wellbeing was also worse than population norms, with women reporting lower wellbeing than men. Rates of distress in the English population have been consistently high throughout the pandemic. Patterns of distress have broadly mirrored the pattern of restrictions and case numbers, but there are notable exceptions which indicate that other factors may play a part in population mental health.

Patterns of social mixing in England changed in line with restrictions during the COVID-19 pandemic (September 2020 to April 2022).

Social mixing contributes to the transmission of SARS-CoV-2. We developed a composite measure for risky social mixing, investigating changes during the pandemic and factors associated with risky mixing. Forty-five waves of online cross-sectional surveys were used (n = 78,917 responses; 14 September 2020 to 13 April 2022). We investigated socio-demographic, contextual and psychological factors associated with engaging in highest risk social mixing in England at seven timepoints. Patterns of social mixing varied over time, broadly in line with changes in restrictions. Engaging in highest risk social mixing was associated with being younger, less worried about COVID-19, perceiving a lower risk of COVID-19, perceiving COVID-19 to be a less severe illness, thinking the risks of COVID-19 were being exaggerated, not agreeing that one's personal behaviour had an impact on how COVID-19 spreads, and not agreeing that information from the UK Government about COVID-19 can be trusted. Our composite measure for risky social mixing varied in line with restrictions in place at the time of data collection, providing some validation of the measure. While messages targeting psychological factors may reduce higher risk social mixing, achieving a large change in risky social mixing in a short space of time may necessitate a reimposition of restrictions.

Intention to have the seasonal influenza vaccination during the COVID-19 pandemic among eligible adults in the UK: a cross-sectional survey

ObjectiveTo investigate the likelihood of having the seasonal influenza vaccination during the COVID-19 pandemic in individuals who were eligible to receive it.DesignWe conducted a cross-sectional online survey in July 2020. We included predictors informed by previous research, in the following categories: sociodemographic variables;uptake of influenza vaccine last winter and beliefs about vaccination.Participants570 participants (mean age: 53.07;56.3% female, 87.0% white) who were eligible for the free seasonal influenza vaccination in the UK.Results59.7% of our sample indicated they were likely to have the seasonal influenza vaccination, 22.1% reported being unlikely to have the vaccination and 18.2% were unsure. We used logistic regression to investigate variables associated with intention to receive a seasonal influenza vaccine in the 2020–2021 season. A positive attitude to vaccination in general predicted intention to have the influenza vaccine in 2020–2021 (OR 1.45, 95% CI 1.19 to 1.77, p<0.001) but the strongest predictor of intention was previous influenza vaccination behaviour (OR 278.58, 95% CI 78.04 to 994.46, p<0.001).ConclusionsPrevious research suggests that increasing uptake of the influenza vaccination may help contain a COVID-19 outbreak, so steps need to be taken to convert intention into behaviour and to reach those individuals who reported being unlikely or unsure about having the vaccine.