ABSTRACT
IntroductionIn 2020, the UK Health Security Agency (UKHSA) established a large-scale testing programme to rapidly identify individuals in England who were infected with SARS-CoV-2 and had COVID-19. This comprised part of the UK governments COVID-19 response strategy, to protect those at risk of severe COVID-19 disease and death and to reduce the burden on the health system. To assess the success of this approach, UKHSA commissioned an independent evaluation of the activities delivered by the NHS testing programme in England. The primary purpose of this evaluation is to capture key learnings from the rollout of testing to different target populations via various testing services between October 2020 and March 2022 and to use these insights to formulate recommendations for future pandemic preparedness strategy. Methods and analysisThe proposed study involves a stepwise mixed-methods approach, aligned with established methods for the evaluation of complex interventions in health, with retrospective and prospective components. A bottom-up approach will be taken, focusing on each of nine population-specific service settings. We will use a Theory of Change to understand the causal pathways and intended and unintended outcomes of each service, also exploring the effect of context on each individual service settings intended outcomes. Subsequently, the insights gained will be synthesised to identify process and outcome indicators to evaluate how the combined aims of the testing programme were achieved. A forward-looking, prospective component of this work will aim to inform testing strategy in preparation for future pandemics, through a participatory modelling simulation and policy analysis exercise. DisclaimerThis is a provisional draft protocol that represents research in progress. This research was commissioned and funded by UKHSA, to be performed between August 2022 and March 2023. The scope and depth of testing services and channels covered by this research were pre-agreed with UKHSA and are limited to the availability and provision of data available at the time this protocol was written. Ethics and disseminationFindings arising from this evaluation will be used to inform lessons learnt and recommendations for UKHSA on appropriate pandemic preparedness testing programme designs; findings will also be disseminated in peer-reviewed journals and at academic conferences. Strengths and limitations of the studyO_LIStrengths of this mixed-methods evaluation protocol include the use of theory-based, complex evaluation approaches and an iterative and participatory approach with the stakeholder (UKHSA) to the evaluation process and prospective modelling. C_LIO_LIGiven the scale and complexity of the COVID-19 testing response in England, there is a scarcity of previous relevant research into this, either in England or appropriate international comparators, warranting the mixed-methods evaluation approach we are adopting. C_LIO_LIThis is the first national-scale evaluation of the testing response to COVID-19 in England to incorporate most service settings, a programme which formed an integral part of the UK pandemic response strategy. The approach proposed could be applied to the evaluation of pandemic responses in other contexts or to other types of interventions. C_LIO_LIWhereas most complex interventions are accompanied by a prospective evaluation design initiated at the time of the intervention or earlier, this study predominantly comprises a retrospective evaluation and is therefore limited by the quality of existing research and the data available to the research team at the time of conducting the evaluation within the specified period allocated by UKHSA. C_LI
ABSTRACT
ObjectiveTo determine the impact of the COVID-19 pandemic on mortality, life expectancy and lifespan inequality in the first half of 2020 (from week 1 to week 26 starting June 22) in England and Wales. DesignDemographic analysis of all-cause mortality from week 1 through week 26 of 2020 using publicly available death registration data from the Office for National Statistics. Setting and populationEngland and Wales population by age and sex in 2020. Main outcome measureAge and sex-specific excess mortality risk and deaths above a baseline adjusted for seasonality in the first half of 2020. We additionally provide estimates of life expectancy at birth and lifespan inequality defined as the standard deviation in age at death. ResultsWe estimate that there have been 53,937 (95% Prediction Interval: 53,092, 54,746) excess deaths in the first half of 2020, 54% of which occurred in men. Excess deaths increased sharply with age and men experienced elevated risks of death in all age groups. Life expectancy at birth dropped 1.7 and 1.9 years for females and males relative to the 2019 levels, respectively. Lifespan inequality also fell over the same period. ConclusionsQuantifying excess deaths and their impact on life expectancy at birth provides a more comprehensive picture of the full COVID-19 burden on mortality. Whether mortality will return to - or even fall below - the baseline level remains to be seen as the pandemic continues to unfold and diverse interventions are put in place. Summary boxesO_ST_ABSWhat is already known on this topicC_ST_ABSCOVID-19 related deaths may be misclassified as other causes of death thereby underestimating the full impact of the pandemic on mortality. Excess mortality, the difference between observed deaths and what would have been expected in the absence of the pandemic, is a useful metric to quantify the overall impact of the pandemic on mortality and population health. Life expectancy at birth and lifespan inequality assess the cumulative impact of the pandemic on population health. What this study addsWe examine death registration data from the Office for National Statistics from 2015 to week 26 (mid-year) in 2020 to quantify the impact of the COVID-19 pandemic on mortality in England and Wales thus far. We estimate excess mortality risk by age and sex, and quantify the impact of excess mortality risk on excess deaths, life expectancy and lifespan inequality. During weeks 10 through 26 of 2020, elevated mortality rates resulted in 53,937 additional deaths compared with baseline mortality. Life expectancy at birth for males and females in the first half of 2020 was 78 and 81.8 years, which represent a decline of 1.9 and 1.7 years of life lost relative to the year 2019. Lifespan inequality, a measure of the spread or variation in ages at death, declined due to the increase of mortality at older ages.
