#COVIDisAirborne: AI-Enabled Multiscale Computational Microscopy of Delta SARS-CoV-2 in a Respiratory Aerosol (preprint)

We seek to completely revise current models of airborne transmission of respiratory viruses by providing never-before-seen atomic- level views of the SARS-CoV-2 virus within a respiratory aerosol. Our work dramatically extends the capabilities of multiscale computational microscopy to address the significant gaps that exist in current experimental methods, which are limited in their ability to interrogate aerosols at the atomic/molecular level and thus obscure our understanding of airborne transmission. We demonstrate how our integrated data-driven platform provides a new way of exploring the composition, structure, and dynamics of aerosols and aerosolized viruses, while driving simulation method development along several important axes. We present a series of initial scientific discoveries for the SARS-CoV-2 Delta variant, noting that the full scientific impact of this work has yet to be realized.

Does capability, opportunity, and motivation predict intentions to repeat self-isolation if required? An analysis of a national telephone survey with contacts of confirmed COVID-19 cases in Wales. (preprint)

ObjectiveSelf-isolation is a key strategy to prevent the transmission of COVID-19 and other infectious diseases. This study examined whether capability, opportunity, and motivation significantly predicted intentions to self-isolate again amongst COVID-19 contacts. DesignA cross-sectional survey was completed with 1,011 participants of the Contact Adherence Behavioural Insights Survey (CABINS), a larger within-subjects study. CABINS was a 15-minute telephone survey conducted with contacts of cases of COVID-19, identified through the national NHS Wales Test Trace Protect database between 12th September and 22nd October, 2020. Main Outcome MeasuresDeterminants of intention to self-isolate were derived from the British Psychological Society’s guidance on self-isolation and the COM-B model. Measures included intention to self-isolate again if required, and items related to psychological capability, physical and social opportunity, and reflective and automatic motivation.ResultsResults of a binary logistic regression indicated three significant predictors of self-isolate intent: (1) knowledge and understanding about self-isolation; (2) making plans to prepare for self-isolation; and (3) beliefs about the effectiveness of self-isolation. ConclusionThis study suggests that an increase in aspects of psychological capability and reflective motivation are associated with increases in self-isolation intent. Future pandemics or outbreaks of disease should target these factors prior to individuals self-isolating.

Impact of COVID-19 on Care-Home Mortality and Life Expectancy in Scotland (preprint)

Introduction COVID-19 deaths are commoner among care-home residents, but the mortality burden has not been quantified. Methods Care-home residency was identified via a national primary care registration database linked to national mortality data. Life expectancy was estimated using Makeham-Gompertz models, to (i) describe yearly life expectancy from Nov 2015 to Oct 2020 (ii) compare life expectancy (during 2016-2018) between care-home residents and the wider Scottish population and (iii) apply care-home life expectancy estimates to COVID-19 death counts to estimate years of life lost (YLL). Results Among care-home residents, life expectancy in 2015/16 to 2019/20 ranged from 2.7 to 2.3 years for women and 2.3 to 1.8 years for men. Life expectancy was lowest in 2019/20. Age-sex specific life expectancy in 2016-2018 in care-home residents was lower than in the Scottish population (10 and 2.5 years in those aged 70 and 90 respectively). Rather than using national life tables, applying care-home specific life expectancies to COVID-19 deaths yields, mean YLLs for care-home residents were 2.6 and 2.2 for women and men respectively, with total care-home resident YLLs of 3,560 years in women and 2,046 years in men. In people aged over-70, approximately half of deaths and a quarter of YLL attributed to COVID-19 were accounted for by the 5% of over-70s who were care-home residents. Conclusion Prioritising care-home residents for vaccination is justified not only in terms of total deaths, but also in terms of years of life lost. Research in context Evidence before this study We searched PubMed to 1 st December 2020, with the terms (“nursing home” OR “care-home” OR “long-term care” OR “residential care”) AND (“mortality” OR “life expectancy” OR “length of stay”). We also searched for studies specific to the impact of the COVID-19 pandemic on those living in care-homes. We restricted our search to publications in English. Usual care-home life expectancy, in a UK context, has not previously been defined. One systematic review of length of stay was identified, which found significant heterogeneity in factors and associations. The impact of COVID-19 on excess mortality among care-home residents was noted, but the impact on life expectancy was not reported. Studies evaluating life expectancy among older people in the COVID-19 pandemic have not taken account of residency in their estimates. Added value of this study Using Scottish national representative linked data we describe the usual life expectancy of older adults (aged ≥70 years) living in care-homes, compared to older people living elsewhere. Deaths among care-home residents account for a considerable proportion of all mortality in older adults, around 19% for men and 30% for women. Life expectancy in care-home residents during the pandemic fell by almost 6 months, from 2.7 to 2.3 years in men and 2.1 to 1.8 years in women. In total, over 5,600 Years of Life were Lost (YLL) by care-home residents in Scotland who died with COVID-19. Around half of COVID-19 deaths and a quarter of YLL in those aged 70 years and over occurred among care-home residents. During the COVID-19 pandemic a smaller proportion of deaths among care-home residents occurred in hospitals. Implications of all the available evidence Prioritising the 5% of older adults who are care-home residents for vaccination against COVID-19 is justified both in terms of total deaths and total years of life lost. Individual and societal planning for care needs in older age relies on understanding usual care-home life expectancy and patterns of mortality. Understanding life expectancy may help clinicians, residents and their families make decisions about their health care, facilitating more informed discussions around their priorities and wishes. Population-wide estimates of YLL and burden of disease should take account of residency status, given the significant differences between life expectancy of those living in care-homes from their peers in other settings.