Disagreement among experts about public health decision making: is it polarisation and does it matter?

It is common for aspects of the COVID-19 response-and other public health initiatives before it-to be described as polarised. Public health decisions emerge from an interplay of facts, norms and preferred courses of action. What counts as 'evidence' is diverse and contestable, and disagreements over how it should be interpreted are often the product of differing choices between competing values. We propose a definition of polarisation for the context of public health expertise that acknowledges and accounts for epistemic and social values as part of evidence generation and its application to public health practice. The 'polarised' label should be used judiciously because the descriptor risks generating or exacerbating the problem by oversimplifying complex issues and positions and creating groups that seem dichotomous. 'Independence' as a one-size-fits-all answer to expert polarisation is insufficient; this solution is premised on a scientistic account of the role of evidence in decision making and does not make room for the value difference that is at the heart of both polarisation and evidence-based decision making.

Uncertainty and agency in COVID-19 hotel quarantine in Australia.

Mandatory 14-day hotel COVID-19 quarantine was introduced for international arrivals into Australia in late March 2020, with no precedent and little time to prepare. This public health initiative was a key factor in Australia's relatively low COVID-19 burden in the first 18 months of the pandemic. We conducted an empirical bioethics study exploring the experience of people who had quarantined in hotels in Australia. We used in depth interviews to develop an understanding of context and normative analysis to consider whether the way the program is conducted is ethically justifiable. 58 people participated; they had been in hotel quarantine in different parts of Australia in the period March 2020-January 2021. Participants faced considerable uncertainty while in quarantine and many experienced this as burdensome. Some uncertainty resulted from not being given information about key aspects of quarantine, some from rules that changed frequently or were otherwise inconsistent, some from being physically isolated. Lack of information and uncertainty contributed to diminished agency. Communication efforts made by individual hotels was well received. Earlier ethics literature about quarantine does not take into account the context our participants described, where the hotel and supervision arrangements were central to the experience. We argue that more suitable arrangements must be made if quarantine is to be an ongoing proposition.

Experiences of risk in Australian hotel quarantine: a qualitative study.

BACKGROUND: In response to the threat of COVID-19 infection, Australia mandated a 14 day quarantine period in a designated facility for all travellers returning from overseas from late March 2020. These facilities were usually hotels, or hotel-like serviced apartments, and also included a repurposed former mining village in the Northern Territory. This paper aimed to investigate the experiences of risk of people quarantined in designated supervised facilities in Australia, which has not been systematically explored before. METHODS: In this qualitative study semi-structured interviews were conducted with 58 participants quarantined between March 2020 and January 2021. Participants were returned Australian citizens and residents who were required to undergo mandatory supervised quarantine for COVID-19. Interviews were conducted using video teleconferencing (via Zoom), transcribed and coded, then analysed thematically. RESULTS: While participants generally supported the concept of quarantine to protect the Australian public, they were critical of elements of it where they felt exposed to risk (COVID-related or not). They also described instances where infection control within the system seemed inadequate. For some, particularly those quarantined with small children, they reported that the facilities were inadequate or inappropriate for health and wellbeing. Using thematic analysis, three major themes were identified that related to problems in the existing system: perception of being subjected to high risk through lax standards of COVID protection in the quarantine process; risks to the community identified in quarantine; and risk in non-hotel managed quarantine facilities. CONCLUSIONS: There are systemic issues with infection control in hotel quarantine, which can be further undermined by individual non-compliance. Risks to safety for those in quarantine can be reduced, both in terms of infection control within hotel quarantine and, in the case of the Northern Territory facility, timely in-person medical care as needed for non-COVID conditions. Systems of infection control need ongoing review to ensure that people entering quarantine are protected from known risks of infection at every stage. Medical services in quarantine facilities should be examined to ensure timely and appropriate non-COVID medical services are available.

Reflections on Experiencing Parental Bereavement as a Young Person: A Retrospective Qualitative Study.

Background: It is estimated that approximately 41,000 children and young people experience the death of a parent each year. Grief responses, such as anxiety and depression, can follow. This research investigated the adult reflections of experiencing parental death as a young person. Methods: Semi-structured interviews were conducted with adults (N = 14; female n = 8) who experienced parental death as a young person, which occurred over 5 years ago (time since death, M = 12.9 years; age at death, M = 16.4 years; age at interview, M = 30.9 years). The data were analysed inductively using thematic analysis. Results: Seven themes revealed that parental bereavement can lead to (1) "Distance and isolation" and is an (2) "Emotional journey" with (3) a "Physical impact". Many experienced (4) "Post-traumatic growth" but acknowledged that (5) "Life will never be the same", highlighting the importance of (6) "Support and understanding" and triggers for (7) "Re-grief". Conclusions: Parental bereavement has significant emotional and physical consequences, but can also lead to personal growth. Talking therapies were rarely accessed, often due to a lack of awareness or desire to engage, revealing a translational gap between existing support services and uptake. Enabling open conversations about grief and identifying suitable support is a public health priority. This need has been amplified since the start of the COVID-19 pandemic, which may be a trigger for grief empathy and re-grief in those who have already been bereaved.

The VICTORY (Investigation of Inflammacheck to Measure Exhaled Breath Condensate Hydrogen Peroxide in Respiratory Conditions) Study: Protocol for a Cross-sectional Observational Study.

BACKGROUND: More than 7% of the world's population is living with a chronic respiratory condition. In the United Kingdom, lung disease affects approximately 1 in 5 people, resulting in over 700,000 hospital admissions each year. People with respiratory conditions have several symptoms and can require multiple health care visits and investigations before a diagnosis is made. The tests available can be difficult to perform, especially if a person is symptomatic, leading to poor quality results. A new, easy-to-perform, point-of-care test that can be performed in any health care setting and that can differentiate between various respiratory conditions would have a significant, beneficial impact on the ability to diagnose respiratory diseases. OBJECTIVE: The objective of this study is to use a new handheld device (Inflammacheck) in different respiratory conditions to measure the exhaled breath condensate hydrogen peroxide (EBC H2O2) and compare these results with those of healthy controls and with each other. This study also aims to determine whether the device can measure other parameters, including breath humidity, breath temperature, breath flow dynamics, and end tidal carbon dioxide. METHODS: We will perform a single-visit, cross-sectional observational study of EBC H2O2 levels, as measured by Inflammacheck, in people with respiratory disease and volunteers with no known lung disease. Participants with a confirmed diagnosis of asthma, chronic obstructive pulmonary disease, lung cancer, bronchiectasis, pneumonia, breathing pattern disorder, and interstitial lung disease as well as volunteers with no history of lung disease will be asked to breathe into the Inflammacheck device to record their breath sample. RESULTS: The results from this study will be available in 2022, in anticipation of COVID-19-related delays. CONCLUSIONS: This study will investigate the EBC H2O2, as well as other exhaled breath parameters, for use as a future diagnostic tool.

Can Physical Activity Support Grief Outcomes in Individuals Who Have Been Bereaved? A Systematic Review.

BACKGROUND: In 2018, there were 616,014 registered deaths in the United Kingdom (UK). Grief is a natural consequence. Many mental health concerns, which can be identified as grief outcomes (e.g. anxiety and depression) in those who have experienced a bereavement, can be improved through physical activity. The objective of this review was to identify from the existing literature if physical activity can benefit grief outcomes in individuals who have been bereaved. METHODS: A systematic review of nine databases was performed. Included studies (qualitative and quantitative) explored physical activity to help individuals (of any age) who had experienced a human bereavement (excluding national loss). RESULTS: From 1299 studies screened, 25 met the inclusion criteria, detailing eight types of bereavement (parental (n = 5), spousal (n = 6), patient (n = 4), pre-natal (n = 3), later life (n = 1), caregiver (n = 1), multiple (n = 4) and non-defined (n = 1). Activities including yoga, running, walking and martial arts were noted as beneficial. Physical activity allowed a sense of freedom, to express emotions, provided a distraction and an escape from grief, whilst enhancing social support. CONCLUSION: There is some evidence that physical activity may provide benefit for the physical health and psychological wellbeing of those who have been bereaved, including when the loss has happened at a young age. This review is timely, given the wide-scale national loss of life due to COVID-19 and extends knowledge in this area. More research is needed to explore the benefits of physical activity for those who have been bereaved. In particular, there is a need for well-designed interventions which are tailored to specific activities, populations and grief outcomes.

How should we conduct pandemic vaccination?

Vaccination plays an important role in pandemic planning and response. The possibility of developing an effective vaccine for a novel pandemic virus is not assured. However, as we have seen with SARS-CoV-2 vaccine development, with sufficient resources and global focus, successful outcomes can be achieved in a relatively short period. However even when vaccine is available it will initially be scarce. When one becomes available, how should it be distributed? In this paper we explicate how ethical thinking that is carefully attuned to context is essential to decisions about how we should conduct vaccination in a pandemic where demand exceeds supply. We focus on two key issues. First, setting the aims for a pandemic vaccination programme. Second, thinking about the means of delivering a chosen aim. We outline how pandemic vaccine distribution strategies can be implemented with distinct aims, e.g. protecting groups at greater risk of harm, saving the most lives, or ensuring societal benefit. Each aim will result in a focus on a different priority population and each strategy will have a different benefit-harm profile. Once we have decided our aim, we still have choices to make about delivery. We may achieve at least some ends via direct or indirect strategies. Such policy decisions are not merely technical, but necessarily involve ethics. One important general issue is that such planning decisions about distribution will always be made under conditions of uncertainty about vaccine safety and effectiveness. However, planning how to distribute vaccine for SARS-CoV-2 is even harder because we understand relatively little about the virus, transmission, and its immunological impact in the short and long term.

The Impact of COVID-19 on Staff Working Practices in UK Horseracing.

Due to COVID-19, horseracing was required to cease all activity in March 2020; however, little is known about the pandemic's impact on staff working practices. This study investigated the impact of COVID-19 on staff working practices during the initial lockdown phases. An online survey about working conditions during lockdown was answered by 287 participants. Chi-squared tests for independence and binary logistic regression (BLR) analysis was undertaken. A total of 53.7% (n = 154) of staff were working during lockdown. Pandemic-specific workplace changes were reported as effective by 87.8% (n = 115) of staff. Flat grooms reported workplace changes as less effective (χ2 (52, n = 131) = 92.996, p < 0.001). A total of 67.2% (n = 193) of staff were positive about job security. Trainers and grooms were significantly less likely to report jobs as secure (χ2 (52, n = 287) = 75.653, p < 0.05). The findings suggest that most of the racing industry positively received changes made by their employers to tackle the pandemic, and for staff still working during lockdown, their health and safety was prioritised. Continued development of employee support structures to promote job security and workforce stability is advised, which will minimise the disruption of staff changes on the care and welfare of the horses.

COVID-19: Impact on United Kingdom Horse Owners.

COVID-19 was declared a global pandemic on 11 March 2020; the United Kingdom (UK) implemented quarantine measures shortly afterward, resulting in rapid changes in how owners managed and interacted with their horses. This study provides a rapid analysis of the initial impact of the COVID-19 outbreak on the management of UK leisure and competition horses. A 17 question online survey was distributed via equestrian social media sites to ascertain the impact of COVID-19 on horse and yard management and on human-horse interactions. Frequency analysis combined with Chi-squared and thematic analyses identified the impact of COVID-19 on UK horse owners. Major changes within horse management and horse-human interactions were reported for the majority of horse owners (>65%), regardless of the establishment type or region. Social distancing and visiting restrictions were implemented at most yards, but nearly half were not providing hand sanitization or disinfection protocols for the shared areas/equipment to prevent cross-contamination between users. The financial impact of the pandemic combined with restricted access to veterinary professionals resulted in owners expressing concerns that horse health and welfare may be compromised as a result. Horse owners also felt that the reduced opportunities for horse-human interactions were negatively affecting their mental health and wellbeing.

The Impact of COVID-19 on Staff Working Practices in UK Horseracing

Due to COVID-19, horseracing was required to cease all activity in March 2020;however, little is known about the pandemic’s impact on staff working practices. This study investigated the impact of COVID-19 on staff working practices during the initial lockdown phases. An online survey about working conditions during lockdown was answered by 287 participants. Chi-squared tests for independence and binary logistic regression (BLR) analysis was undertaken. A total of 53.7% (n = 154) of staff were working during lockdown. Pandemic-specific workplace changes were reported as effective by 87.8% (n = 115) of staff. Flat grooms reported workplace changes as less effective (χ2 (52, n = 131) = 92.996, p <0.001). A total of 67.2% (n = 193) of staff were positive about job security. Trainers and grooms were significantly less likely to report jobs as secure (χ2 (52, n = 287) = 75.653, p <0.05). The findings suggest that most of the racing industry positively received changes made by their employers to tackle the pandemic, and for staff still working during lockdown, their health and safety was prioritised. Continued development of employee support structures to promote job security and workforce stability is advised, which will minimise the disruption of staff changes on the care and welfare of the horses.

Health visiting with homeless families during the COVID-19 pandemic

This article outlines how the COVID-19 pandemic has brought into even greater focus the dire circumstances being experienced by homeless families in the UK, and how this is being witnessed on the front line by health visitors.