Expert elicitation on the relative importance of possible SARS-CoV-2 transmission routes and the effectiveness of mitigations.

OBJECTIVES: To help people make decisions about the most effective mitigation measures against SARS-CoV-2 transmission in different scenarios, the likelihoods of transmission by different routes need to be quantified to some degree (however uncertain). These likelihoods need to be communicated in an appropriate way to illustrate the relative importance of different routes in different scenarios, the likely effectiveness of different mitigation measures along those routes, and the level of uncertainty in those estimates. In this study, a pragmatic expert elicitation was undertaken to supply the underlying quantitative values to produce such a communication tool. PARTICIPANTS: Twenty-seven individual experts from five countries and many scientific disciplines provided estimates. OUTCOME MEASURES: Estimates of transmission parameters, assessments of the quality of the evidence, references to relevant literature, rationales for their estimates and sources of uncertainty. RESULTS AND CONCLUSION: The participants' responses showed that there is still considerable disagreement among experts about the relative importance of different transmission pathways and the effectiveness of different mitigation measures due to a lack of empirical evidence. Despite these disagreements, when pooled, the majority views on each parameter formed an internally consistent set of estimates (for example, that transmission was more likely indoors than outdoors, and at closer range), which formed the basis of a visualisation to help individuals and organisations understand the factors that influence transmission and the potential benefits of different mitigation measures.

Correlates of intended COVID-19 vaccine acceptance across time and countries: results from a series of cross-sectional surveys.

OBJECTIVE: Describe demographical, social and psychological correlates of willingness to receive a COVID-19 vaccine. SETTING: Series of online surveys undertaken between March and October 2020. PARTICIPANTS: A total of 25 separate national samples (matched to country population by age and sex) in 12 different countries were recruited through online panel providers (n=25 334). PRIMARY OUTCOME MEASURES: Reported willingness to receive a COVID-19 vaccination. RESULTS: Reported willingness to receive a vaccine varied widely across samples, ranging from 63% to 88%. Multivariate logistic regression analyses reveal sex (female OR=0.59, 95% CI 0.55 to 0.64), trust in medical and scientific experts (OR=1.28, 95% CI 1.22 to 1.34) and worry about the COVID-19 virus (OR=1.47, 95% CI 1.41 to 1.53) as the strongest correlates of stated vaccine acceptance considering pooled data and the most consistent correlates across countries. In a subset of UK samples, we show that these effects are robust after controlling for attitudes towards vaccination in general. CONCLUSIONS: Our results indicate that the burden of trust largely rests on the shoulders of the scientific and medical community, with implications for how future COVID-19 vaccination information should be communicated to maximise uptake.

How do the UK public interpret COVID-19 test results? Comparing the impact of official information about results and reliability used in the UK, USA and New Zealand: a randomised controlled trial.

OBJECTIVES: To assess the effects of different official information on public interpretation of a personal COVID-19 PCR test result. DESIGN: A 5×2 factorial, randomised, between-subjects experiment, comparing four wordings of information about the test result and a control arm of no additional information; for both positive and negative test results. SETTING: Online experiment using recruitment platform Respondi. PARTICIPANTS: UK participants (n=1744, after a pilot of n=1657) quota-sampled to be proportional to the UK national population on age and sex. INTERVENTIONS: Participants were given a hypothetical COVID-19 PCR test result for 'John' who was presented as having a 50% chance of having COVID-19 based on symptoms alone. Participants were randomised to receive either a positive or negative result for 'John', then randomised again to receive either no more information, or text information on the interpretation of COVID-19 test results copied in September 2020 from the public websites of the UK's National Health Service, the USA's Centers for Disease Control, New Zealand's Ministry of Health or a modified version of the UK's wording. Information identifying the source of the wording was removed. MAIN OUTCOME MEASURES: Participants were asked 'What is your best guess as to the percent chance that John actually had COVID-19 at the time of his test, given his result?'; questions about their feelings of trustworthiness in the result, their perceptions of the quality of the underlying evidence and what action they felt 'John' should take in the light of his result. RESULTS: Of those presented with a positive COVID-19 test result for 'John', the mean estimate of the probability that he had the virus was 73% (71.5%-74.5%); for those presented with a negative result, 38% (36.7%-40.0%). There was no main effect of information (wording) on these means. However, those participants given the official information from the UK website, which did not mention the possibility of false negatives or false positives, were more likely to give a categorical (100% or 0%) answer (UK: 68/343, 19.8% (15.9%-24.4%); control group: 42/356, 11.8% (8.8%-15.6%)); the reverse was true for those viewing the New Zealand (NZ) wording, which highlighted the uncertainties most explicitly (20/345: 5.8% (3.7%-8.8%)). Aggregated across test result (positive/negative), there was a main effect of wording (p<0.001) on beliefs about how 'John' should behave, with those seeing the NZ wording marginally more likely to agree that 'John' should continue to self-isolate than those viewing the control or the UK wording. The proportion of participants who felt that a symptomatic individual who tests negative definitely should not self-isolate was highest among those viewing the UK wording (31/178, 17.4% (12.5%-23.7%)), and lowest among those viewing the NZ wording (6/159, 3.8% (1.6%-8.2%)). Although the NZ wording was rated harder to understand, participants reacted to the uncertainties given in the text in the expected direction: there was a small main effect of wording on trust in the result (p=0.048), with people perceiving the test result as marginally less trustworthy after having read the NZ wording compared with the UK wording. Positive results were generally viewed as more trustworthy and as having higher quality of evidence than negative results (both p<0.001). CONCLUSIONS: The public's default assessment of the face value of both the positive and negative test results (control group) indicate an awareness that test results are not perfectly accurate. Compared with other messaging tested, participants shown the UK's 2020 wording about the interpretation of the test results appeared to interpret the results as more definitive than is warranted. Wording that acknowledges uncertainty can help people to have a more nuanced and realistic understanding of what a COVID-19 test result means, which supports decision making and behavioural response. PREREGISTRATION AND DATA REPOSITORY: Preregistration of pilot at osf.io/8n62f, preregistration of main experiment at osf.io/7rcj4, data and code available online (osf.io/pvhba).