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1.
Policy Design and Practice ; : 1-16, 2022.
Article in English | Taylor & Francis | ID: covidwho-1852845
2.
PLoS One ; 17(3): e0264906, 2022.
Article in English | MEDLINE | ID: covidwho-1745315

ABSTRACT

OBJECTIVE: To identify the experiences and concerns of health workers (HWs), and how they changed, throughout the first year of the COVID-19 pandemic in the UK. METHODS: Longitudinal, qualitative study with HWs involved in patient management or delivery of care related to COVID-19 in general practice, emergency departments and hospitals. Participants were identified through snowballing. Semi-structured telephone or video interviews were conducted between February 2020 and February 2021, audio-recorded, summarised, and transcribed. Data were analysed longitudinally using framework and thematic analysis. RESULTS: We conducted 105 interviews with 14 participants and identified three phases corresponding with shifts in HWs' experiences and concerns. (1) Emergency and mobilisation phase (late winter-spring 2020), with significant rapid shifts in responsibilities, required skills, and training, and challenges in patient care. (2) Consolidation and preparation phase (summer-autumn 2020), involving gradual return to usual care and responsibilities, sense of professional development and improvement in care, and focus on learning and preparing for future. (3) Exhaustion and survival phase (autumn 2020-winter 2021), entailing return of changes in responsibilities, focus on balancing COVID-19 and non-COVID care (until becoming overwhelmed with COVID-19 cases), and concerns about longer-term impacts of unceasing pressure on health services. Participants' perceptions of COVID-19 risk and patient/public attitudes changed throughout the year, and tiredness and weariness turned into exhaustion. CONCLUSIONS: Results showed a long-term impact of the COVID-19 pandemic on UK HWs' experiences and concerns related to changes in their roles, provision of care, and personal wellbeing. Despite mobilisation in the emergency phase, and trying to learn from this, HWs' experiences seemed to be similar or worse in the second wave partly due to many COVID-19 cases. The findings highlight the importance of supporting HWs and strengthening system-level resilience (e.g., with resources, processes) to enable them to respond to current and future demands and emergencies.


Subject(s)
COVID-19/epidemiology , Delivery of Health Care/trends , Health Personnel/psychology , COVID-19/psychology , Clinical Competence , Disease Management , Hospitals , Humans , Longitudinal Studies , Qualitative Research , United Kingdom/epidemiology
3.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-316540

ABSTRACT

Background: As COVID-19 death rates have risen and health-care systems have experienced increased demand, national testing strategies have come under scrutiny. Utilising qualitative interview data from a larger COVID-19 study, this paper provides insights into influences on and the enactment of national COVID-19 testing strategies for health care workers (HCWs) in English NHS settings during wave one of the COVID-19 pandemic (March-August 2020). We aim to inform COVID-19 learning and future pandemic diagnostic preparedness. Methods: A remote qualitative, semi-structured longitudinal interview method was employed with a purposive snowball sample of senior scientific advisors to the UK Government on COVID-19, and HCWs employed in NHS primary and secondary health care settings in England. 24 interviews from 13 participants were selected from the larger project dataset. Framework analysis was informed by the non-adoption, abandonment, scale-up, spread, and sustainability of patient-facing health and care technologies implementation framework (NASSS) and by normalisation process theory (NPT). Results: Our account highlights tensions between the communication and implementation of national testing developments;scientific advisor and HCW perceptions about infectiousness;and uncertainties about the responsibility for testing and its implications at the local level. Conclusions: Consideration must be given to the implications of mass NHS staff testing, including the accuracy of information communicated to HCWs;how HCWs interpret, manage, and act on testing guidance;and the influence these have on health care organisations and services.

4.
The Lancet ; 398, 2021.
Article in English | ProQuest Central | ID: covidwho-1537140

ABSTRACT

Background The COVID-19 pandemic has posed severe challenges to policy makers in all countries: these include uncertainty about the science of the disease, its epidemiology, and public behaviour, coupled with the need to act fast. This real-time study was undertaken to capture UK Government scientific advisers' perceptions of how scientific advice worked and to learn lessons about what works best in a fast-moving response to a novel epidemic. Methods Regular semi-structured calls were recorded with ten prominent scientific advisers to elicit their roles in, and reactions to, the UK's COVID-19 response. Interviewees were recruited using the existing networks of the NIHR Health Protection Research Unit for Emerging and Zoonotic Infections. They were active in fields including biomedical research, modelling, and global health, and they included members of the Scientific Advisory Group for Emergencies (SAGE). In pandemic conditions interviewing was opportunistic: one participant spoke to us almost every 1–2 weeks, others at longer intervals. Interviews were transcribed and coded using a published analytical framework for the study of policy decision-making. Findings 93 interviews were conducted between Feb 17, 2020, and July 22, 2021. We report interviewees' perceptions that scientific advice had not led to sufficiently rapid policy decisions, and that a lack of transparency was sapping public trust. Interviewees also drew attention to policy makers' failure in the early months of the pandemic to frame a policy goal, and the problems this posed for giving scientific advice. It also became clear that scientific advisers and policy makers operated in different intellectual worlds, and that useful advice was most likely to be given when individuals could span this gap and understand the agendas of each group. Interpretation These findings provide empirical information about how science advice has worked, uncovering power dynamics and business processes that are not otherwise well understood. We argue that politicians abdicated responsibility by their early “follow the science” rhetoric, later renegotiated. The study would be strengthened if the perceptions of policy makers were also included. We requested interviews with eight policy makers, who declined due to unavailability. Funding UK Research and Innovation—National Institute for Health Research.

5.
Journal of Epidemiology and Community Health ; 75(Suppl 1):A3, 2021.
Article in English | ProQuest Central | ID: covidwho-1394144

ABSTRACT

BackgroundAsymptomatic transmission of SARS-CoV-2 poses a significant burden on managing the spread of COVID-19. Few studies have evaluated the impact of testing for asymptomatic COVID-19 among large populations or whole cities using empirical data. No study to our knowledge has considered if such interventions result in or exacerbate existing socioeconomic inequalities. The aim of our study is to explore social and spatial inequalities in uptake and case-detection of rapid lateral flow SARS-CoV-2 antigen tests (LFTs) offered to people without symptoms of COVID-19 in Liverpool between 6th November 2020 and 31st January 2021.MethodsLinked pseudonymised records for asymptomatic residents in Liverpool (UK) who received a LFT for COVID-19 between 6th November 2020 to 31st January 2021 were accessed using the Combined Intelligence for Population Health Action (CIPHA) data resource. Bayesian Hierarchical Poisson Besag, York, and Mollié models were used to estimate ecological associations for uptake and positivity of testing.Results214 525 residents (43%) received a LFT identifying 5557 individuals as positive cases of COVID-19 (1.3%). Uptake was highest in November when there was military assistance. High uptake was observed again in the week preceding Christmas and was sustained into a national lockdown. Overall uptake and repeat testing were lower among males (e.g. 40% uptake over the whole period), Black Asian and other Minority Ethnic groups (e.g. 27% uptake for ‘Mixed’ ethnicity) and in the most deprived areas (e.g. 32% uptake in most deprived areas). These population groups were also more likely to have received positive tests for COVID-19. Models demonstrated that uptake and repeat testing were lower in areas of higher deprivation, areas located further from test sites and areas containing populations less confident in the using Internet technologies. Positive tests were spatially clustered in deprived areas.ConclusionOur study provides the first substantial evidence on inequalities involved in large-scale asymptomatic rapid testing of populations for SARS-CoV-2. Large-scale voluntary asymptomatic community testing saw social, ethnic, and spatial inequalities in an ‘inverse care’ pattern, but with an added digital exclusion factor. While test uptake was popular, there was a disconnect between the populations accessing testing and those experiencing harms relating to COVID-19. COVID-19 testing and support to isolate need to be more accessible to the vulnerable communities most impacted by the pandemic, including non-digital means of access.

6.
BMC Public Health ; 21(1): 1216, 2021 06 24.
Article in English | MEDLINE | ID: covidwho-1282252

ABSTRACT

BACKGROUND: As COVID-19 death rates have risen and health-care systems have experienced increased demand, national testing strategies have come under scrutiny. Utilising qualitative interview data from a larger COVID-19 study, this paper provides insights into influences on and the enactment of national COVID-19 testing strategies for health care workers (HCWs) in English NHS settings during wave one of the COVID-19 pandemic (March-August 2020). Through the findings we aim to inform learning about COVID-19 testing policies and practices; and to inform future pandemic diagnostic preparedness. METHODS: A remote qualitative, semi-structured longitudinal interview method was employed with a purposive snowball sample of senior scientific advisors to the UK Government on COVID-19, and HCWs employed in NHS primary and secondary health care settings in England. Twenty-four interviews from 13 participants were selected from the larger project dataset using a key term search, as not all of the transcripts contained references to testing. Framework analysis was informed by the non-adoption, abandonment, scale-up, spread, and sustainability of patient-facing health and care technologies implementation framework (NASSS) and by normalisation process theory (NPT). RESULTS: Our account highlights tensions between the communication and implementation of national testing developments; scientific advisor and HCW perceptions about infectiousness; and uncertainties about the responsibility for testing and its implications at the local level. CONCLUSIONS: Consideration must be given to the implications of mass NHS staff testing, including the accuracy of information communicated to HCWs; how HCWs interpret, manage, and act on testing guidance; and the influence these have on health care organisations and services.


Subject(s)
COVID-19 , State Medicine , COVID-19 Testing , England , Health Personnel , Humans , Pandemics , Policy , SARS-CoV-2
7.
Lancet Reg Health Eur ; 6: 100107, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-1225323

ABSTRACT

BACKGROUND: Large-scale asymptomatic testing of communities in Liverpool (UK) for SARS-CoV-2 was used as a public health tool for containing COVID-19. The aim of the study is to explore social and spatial inequalities in uptake and case-detection of rapid lateral flow SARS-CoV-2 antigen tests (LFTs) offered to people without symptoms of COVID-19. METHODS: Linked pseudonymised records for asymptomatic residents in Liverpool who received a LFT for COVID-19 between 6th November 2020 to 31st January 2021 were accessed using the Combined Intelligence for Population Health Action resource. Bayesian Hierarchical Poisson Besag, York, and Mollié models were used to estimate ecological associations for uptake and positivity of testing. FINDINGS: 214 525 residents (43%) received a LFT identifying 5192 individuals as positive cases of COVID-19 (1.3% of tests were positive). Uptake was highest in November when there was military assistance. High uptake was observed again in the week preceding Christmas and was sustained into a national lockdown. Overall uptake were lower among males (e.g. 40% uptake over the whole period), Black Asian and other Minority Ethnic groups (e.g. 27% uptake for 'Mixed' ethnicity) and in the most deprived areas (e.g. 32% uptake in most deprived areas). These population groups were also more likely to have received positive tests for COVID-19. Models demonstrated that uptake and repeat testing were lower in areas of higher deprivation, areas located further from test sites and areas containing populations less confident in the using Internet technologies. Positive tests were spatially clustered in deprived areas. INTERPRETATION: Large-scale voluntary asymptomatic community testing saw social, ethnic, digital and spatial inequalities in uptake. COVID-19 testing and support to isolate need to be more accessible to the vulnerable communities most impacted by the pandemic, including non-digital means of access. FUNDING: Department of Health and Social Care (UK) and Economic and Social Research Council.

8.
ProQuest Central; 2020.
Preprint in English | ProQuest Central | ID: ppcovidwho-2112

ABSTRACT

We argue that predictions of a ‘tsunami’ of mental health problems as a consequence of the pandemic of coronavirus disease 2019 (COVID-19) and the lockdown are overstated;feelings of anxiety and sadness are entirely normal reactions to difficult circumstances, not symptoms of poor mental health. Some people will need specialised mental health support, especially those already leading tough lives;we need immediate reversal of years of underfunding of community mental health services. However, the disproportionate effects of COVID-19 on the most disadvantaged, especially BAME people placed at risk by their social and economic conditions, were entirely predictable. Mental health is best ensured by urgently rebuilding the social and economic supports stripped away over the last decade. Governments must pumfunds into local authorities to rebuild community services, peer support, mutual aid and local community and voluntary sector organisations. Health care organisations must tackle racism and discrimination to ensure genuine equal access to universal health care. Government must replace highly conditional benefit systems by something like a universal basic income. All economic and social policies must be subjected to a legally binding mental health audit. This may sound unfeasibly expensive, but the social and economic costs, not to mention the costs in personal and community suffering, though often invisible, are far greater.

9.
Wellcome Open Res ; 5: 166, 2020.
Article in English | MEDLINE | ID: covidwho-657527

ABSTRACT

We argue that predictions of a 'tsunami' of mental health problems as a consequence of the pandemic of coronavirus disease 2019 (COVID-19) and the lockdown are overstated; feelings of anxiety and sadness are entirely normal reactions to difficult circumstances, not symptoms of poor mental health.  Some people will need specialised mental health support, especially those already leading tough lives; we need immediate reversal of years of underfunding of community mental health services.  However, the disproportionate effects of COVID-19 on the most disadvantaged, especially BAME people placed at risk by their social and economic conditions, were entirely predictable. Mental health is best ensured by urgently rebuilding the social and economic supports stripped away over the last decade. Governments must pump funds into local authorities to rebuild community services, peer support, mutual aid and local community and voluntary sector organisations.  Health care organisations must tackle racism and discrimination to ensure genuine equal access to universal health care.  Government must replace highly conditional benefit systems by something like a universal basic income. All economic and social policies must be subjected to a legally binding mental health audit. This may sound unfeasibly expensive, but the social and economic costs, not to mention the costs in personal and community suffering, though often invisible, are far greater.

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