ABSTRACT
OBJECTIVES: Human behavioural factors are an important consideration in the response to COVID-19 outbreaks. Prior to the emergence of highly infectious variants of SARS-CoV-2 and implementation of vaccination programmes, we conducted a study to explore the role of behavioural factors influencing transmission at an essential services workplace during an outbreak of COVID-19. STUDY DESIGN: Observational cohort study. METHODS: In response to a COVID-19 outbreak in November 2020 at an office-based call centre workplace providing an essential service in Thames Valley, we designed and conducted an anonymous staff questionnaire to explore potential behavioural factors of staff behaviour that influence transmission. RESULTS: A total of 45 staff (27%) tested positive for SARS-CoV-2 over a six-week period between 26 October and 14 December 2020. The online questionnaire was cascaded to 168 staff members; the response rate was 41%. Self-reported use of hand sanitiser, face masks and cleaning of equipment in line with workplace guidance was 86%, 66% and 63% respectively. On the same behaviours, respondents reported that 33%, 31% and 14% of their colleagues followed the recommendations. Almost two thirds of respondents (63%) reported that they were unable to maintain social distancing at the workplace, primarily due to operational constraints. CONCLUSIONS: Prevention and control of COVID-19 outbreaks at workplaces providing an essential service is challenging. Operational requirements, often compounded by reduced staff availability, impede implementation of more robust control measures. Ongoing assessment of human behavioural factors in the control of COVID-19 outbreaks at workplaces in the post-vaccine era is essential.
ABSTRACT
BACKGROUND: Major infectious disease outbreaks are a constant threat to human health. Clinical research responses to outbreaks generate evidence to improve outcomes and outbreak control. Experiences from previous epidemics have identified multiple challenges to undertaking timely clinical research responses. This scoping review is a systematic appraisal of political, economic, administrative, regulatory, logistical, ethical and social (PEARLES) challenges to clinical research responses to emergency epidemics and solutions identified to address these. METHODS: A scoping review. We searched six databases (MEDLINE, Embase, Global Health, PsycINFO, Scopus and Epistemonikos) for articles published from 2008 to July 2018. We included publications reporting PEARLES challenges to clinical research responses to emerging epidemics and pandemics and solutions identified to address these. Two reviewers screened articles for inclusion, extracted and analysed the data. RESULTS: Of 2678 articles screened, 76 were included. Most presented data relating to the 2014-2016 Ebola virus outbreak or the H1N1 outbreak in 2009. The articles related to clinical research responses in Africa (n = 37), Europe (n = 8), North America (n = 5), Latin America and the Caribbean (n = 3) and Asia (n = 1) and/or globally (n = 22). A wide range of solutions to PEARLES challenges was presented, including a need to strengthen global collaborations and coordination at all levels and develop pre-approved protocols and equitable frameworks, protocols and standards for emergencies. Clinical trial networks and expedited funding and approvals were some solutions implemented. National ownership and community engagement from the outset were a key enabler for delivery. Despite the wide range of recommended solutions, none had been formally evaluated. CONCLUSIONS: To strengthen global preparedness and response to the COVID-19 pandemic and future epidemics, identified solutions for rapid clinical research deployment, delivery, and dissemination must be implemented. Improvements are urgently needed to strengthen collaborations, funding mechanisms, global and national research capacity and capability, targeting regions vulnerable to epidemics and pandemics. Solutions need to be flexible to allow timely adaptations to context, and research led by governments of affected regions. Research communities globally need to evaluate their activities and incorporate lessons learnt to refine and rehearse collaborative outbreak response plans in between epidemics.