Impact of the COVID-19 pandemic on community antibiotic prescribing and stewardship: a qualitative interview study with general practitioners in England

The COVID-19 pandemic has had a profound impact on the delivery of primary care services. We aimed to identify general practitioners (GPs) perceptions and experiences of how the COVID-19 pandemic influenced antibiotic prescribing and antimicrobial stewardship (AMS) in general practice in England. Twenty-four semi-structured interviews were conducted with 18 GPs at two time-points: autumn 2020 (14 interviews) and spring 2021 (10 interviews). Interviews were audio-recorded, transcribed and analysed thematically, taking a longitudinal approach. Participants reported a lower threshold for antibiotic prescribing (and fewer consultations) for respiratory infections and COVID-19 symptoms early in the pandemic, then returning to more usual (pre-pandemic) prescribing. They perceived less impact on antibiotic prescribing for urinary and skin infections. Participants perceived the changing ways of working and consulting (e.g., proportions of remote and in-person consultations), and the changing patient presentations and GP workload as influencing the fluctuations in antibiotic prescribing. This was compounded by decreased engagement with, and priority of, AMS due to COVID-19-related urgent priorities. Re-engagement with AMS is needed, e.g., through reviving antibiotic prescribing feedback and targets/incentives. While the pandemic disrupted the usual ways of working, it also produced opportunities, e.g., for re-organising ways of managing infections and AMS in the future.

Following the science? Views from scientists on government advisory boards during the COVID-19 pandemic: a qualitative interview study in five European countries

ObjectivesTo explore the views and experiences of scientists working on government advisory boards during the COVID-19 pandemic, with the aim to learn lessons for future pandemic management and preparedness. DesignExplorative qualitative interview study. ParticipantsTwenty one scientists with an official government advisory role during the COVID-19 pandemic in Belgium, the Netherlands, UK, Sweden or Germany. MethodsOnline video or telephone semi-structured interviews took place between December 2020 and April 2021. They were audio recorded and transcribed, and analyzed using a combination of inductive and deductive thematic analysis techniques. ResultsScientists found working on the advisory boards during the COVID-19 pandemic to be a rewarding experience. However, they identified numerous challenges including learning to work in an interdisciplinary way, ensuring that evidence is understood and taken on board by governments, and dealing with media and public reactions. Scientists found themselves taking on new roles, the boundaries of which were not clearly defined. Consequently, they received substantial media attention and were often perceived and treated as a public figure. ConclusionsScientists working on advisory boards in European countries faced similar challenges, highlighting key lessons to be learnt. Future pandemic preparedness efforts should focus on building interdisciplinary collaboration within advisory boards; ensuring transparency in how boards operate; defining and protecting boundaries of the scientific advisor role; and supporting scientists to inform the public in the fight against disinformation, whilst dealing with potential hostile reactions. O_TEXTBOXWhat is already known on this topicO_LITo tackle the COVID-19 pandemic, governments have established various types of scientific advisory boards to provide evidence and recommendations to policy makers. C_LIO_LIWith science becoming a focal point of this pandemic, scientific advisors also found themselves in the public eye. C_LIO_LIAs more attention is being paid to analysing what we can do to be better prepared for the next pandemic, the views of key actors, i.e. government scientific advisors, is still largely missing. C_LI What this study addsO_LIThe government scientific advisors working during the COVID-19 pandemic faced a number of challenges such as working in an interdisciplinary way with their peers on scientific boards, establishing a working relationship with government allowing evidence to be taken on board, and dealing with media and public reactions. C_LIO_LIIt is crucial that we take on board key lessons shared by scientific advisors, which calls for building interdisciplinary collaboration within advisory boards; ensuring transparency in both how boards operate and clear boundaries of scientists-government relationship; and supporting scientists in their role of informing the public. C_LI C_TEXTBOX

Conditionality of COVID-19 vaccine acceptance in European countries

The COVID-19 vaccine rollout in recent months offers a powerful preventive measure that may help control SARS-CoV-2 transmission. Nevertheless, long-standing public hesitation around vaccines has heightened public health concerns that vaccine coverage may not achieve desired public health impacts.This cross-sectional survey was conducted online in December 2020 among 7000 respondents (aged 18 to 65) in Belgium, France, Germany, Italy, Spain, Sweden, and Ukraine. The survey included open text boxes for fuller explanation of responses. Projected COVID-19 vaccine coverage varied and may not be sufficiently high among certain populations to achieve herd immunity. Overall, 56.9% would accept a COVID-19 vaccine, 19.0% would not, and 24.1% did not know or preferred not to say. By country, between 44% (France) and 66% (Italy) of respondents would accept a COVID-19 vaccine. Respondents expressed conditionality in open responses, voicing concerns about vaccine safety and mistrust of authorities. Public health campaigns must tackle these safety concerns. HighlightsO_LIMixed-method survey studied expected COVID vaccine uptake in 7 European countries. C_LIO_LIProjected COVID vaccine acceptance by country ranged from 44% to 66%. C_LIO_LIExplicit COVID vaccine acceptance or rejection was conditional. C_LIO_LIStudy finds concerns about vaccine safety and authorities competence and honesty. C_LIO_LIVaccine communications should address safety anxieties and target specific groups. C_LI

Perceptions on undertaking regular asymptomatic self-testing for COVID-19 using lateral flow tests: A qualitative study of university students and staff

BackgroundThere has been an increased interest from governments in implementing mass testing for COVID-19 of asymptomatic individuals using Lateral Flow Tests (LFTs). Successful implementation of such programmes depends on several factors, including feasibility, acceptability and how people act on test results. There is a paucity of studies examining these issues. ObjectiveWe aimed to examine experiences of university students and staff with experience of regular asymptomatic self-testing using LFTs, and their subsequent behaviours. MethodsWe invited people who were participating in a weekly testing feasibility study. We conducted semi-structured remote interviews between December 2020 and January 2021. Additional qualitative data from a survey were also analysed. Data were analysed thematically. ResultsWe interviewed 18 and surveyed 214 participants. Participants were motivated to regularly self-test as they wanted to know whether or not they were infected with SARS-CoV-2. Most reported that a negative test result did not change their behaviour but it did provide them with reassurance to engage with permitted activities. In contrast, some participants reported making decisions about visiting other people when they would not have done so otherwise, because they felt reassured by a negative test result. Participants valued the test training but some participants still doubted their ability to carry out the test. Participants were concerned about safety of attending test sites with lots of people and reported home testing was most convenient. ConclusionsIf governments want to increase uptake of LFT use, clear messages highlighting the benefits of regular testing for family, friends and society in identifying asymptomatic cases are needed. This should be coupled with transparent communication about accuracy of LFTs and how to act on either a positive or negative result. Concerns about safety, convenience of testing, and ability to do tests need to be addressed to ensure successful scaling up asymptomatic testing.

The experience of European hospital-based healthcare workers on following infection prevention and control procedures for COVID-19

BackgroundWorking under pandemic conditions exposes health care workers (HCWs) to infection risk and psychological strain. Protecting the physical and psychological health of HCWs is a key priority. This study assessed the perceptions of European hospital HCWs of local infection prevention and control (IPC) procedures during the COVID-19 pandemic and the impact on their emotional wellbeing. MethodsWe performed two rounds of an international cross-sectional survey, between 31 March and 17 April 2020 via existing research networks (round 1), and between 14 May and 31 August 2020 via online convenience sampling (round 2). Main outcome measures were (1) behavioural determinants of HCW adherence with IPC procedures, (2) WHO-5 Well-Being Index, a validated scale of 0-100 reflecting emotional wellbeing. The WHO-5 was interpreted as a score below or above 50 points, a cut-off score used in previous literature to screen for depression. Results2,289 HCWs (round 1: n=190, round 2: n=2,099) from 40 countries in Europe participated. Mean age of respondents was 42 ({+/-}11) years, 66% were female, 47% and 39% were medical doctors and nurses, respectively. 74% (n=1699) of HCWs were directly treating patients with COVID-19, of which 32% (n=527) reported they were fearful of caring for these patients. HCWs reported high levels of concern about COVID-19 infection risk to themselves (71%) and their family (82%) as a result of their job. 40% of HCWs considered that getting infected with COVID-19 was not within their control. This was more common among junior than senior HCWs (46% versus 38%, P value <.01). Sufficient COVID-19-specific IPC training, confidence in PPE use and institutional trust were positively associated with the feeling that becoming infected with COVID-19 was within their control. Female HCWs were more likely than males to report a WHO-5 score below 50 points (aOR 1.5 (95% confidence interval (CI) 1.2-1.8). ConclusionsIn Europe, the COVID-19 pandemic has had a differential impact on those providing direct COVID-19 patient care, junior staff and women. Health facilities must be aware of these differential impacts, build trust and provide tailored support for this vital workforce during the current COVID-19 pandemic.