COVID and health inequalities

By The Independent Scientific Advisory Group for Emergencies (SAGE) November 2020

This report examines health inequalities in Covid-19, contextualising them within the wider issue of health inequalities. It outlines key recommendations that local government and devolved authorities, the NHS and national government should follow to reduce these inequalities.

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Rapid Evidence Summaries – What evidence is there to inform the development and safe delivery of a COVID-19 mass vaccination campaign in developed countries that maximises uptake and minimises the risk of infection?

By Public Health Wales Observatory (2020)

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The future of public health: the NIHP and other public health functions

By Department of Health and Social Care  (2020)

This document provides an overview of the government’s plans to better protect and improve the public’s health.
It follows the Secretary of State for Health and Social Care’s announcement of the new National Institute for Health Protection on 18 August 2020.

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Vulnerability in childhood: a public health informed approach

By Public Health England (2020)

Reports for local government and their partners to inform their co-ordinated approaches to reduce vulnerability and adversity in childhood.

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Associations between a smoke-free homes intervention and childhood admissions to hospital in Scotland: an interrupted time-series analysis of whole-population data

The Lancet Public Health Volume 5, ISSUE 9, e493-e500, September 01, 2020

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Background
Many children are exposed to second-hand smoke in the home and are at increased risk of asthma and other respiratory conditions. In Scotland, a public health mass-media campaign was launched on March 24, 2014, called Take it Right Outside (TiRO), with a focus on reducing the exposure of children to domestic second-hand smoke. In this study, our aim was to establish whether the TiRO campaign was followed by a decrease in hospital admissions for childhood asthma and other respiratory conditions related to second-hand smoke exposure across Scotland.
Methods
For an interrupted time-series analysis, data were obtained on all hospital admissions in Scotland between 2000 and 2018 for children aged younger than 16 years. We studied changes in the monthly incidence of admissions for conditions potentially related to second-hand smoke exposure (asthma, lower respiratory tract infection, bronchiolitis, croup, and acute otitis media) per 1000 children following the 2014 TiRO campaign, while considering national legislation banning smoking in public spaces from 2006. We considered asthma to be the primary condition related to second-hand smoke exposure, with monthly asthma admissions as the primary outcome. Gastroenteritis was included as a control condition. The analysis of asthma admissions considered subgroups stratified by age and area quintile of the Scottish Index of Multiple Deprivations (SIMD).
Findings
740 055 hospital admissions were recorded for children. 138 931 (18·8%) admissions were for respiratory conditions potentially related to second-hand smoke exposure, of which 32 342 (23·3%) were for asthma. After TiRO in 2014, we identified a decrease relative to the underlying trend in the slope of admissions for asthma (−0·48% [–0·85 to −0·12], p=0·0096) in younger children (age <5 years), but not in older children (age 5–15 years). Asthma admissions did not change after TiRO among children 0–15 years of age when data were analysed according to area deprivation quintile. Following the 2006 legislation, independent of TiRO, asthma admissions decreased in both younger children (−0·36% [–0·67 to −0·05], p=0·021) and older children (−0·68% [–1·00 to −0·36], p<0·0001), and in children from the most deprived (SIMD 1; −0·49% [–0·87 to −0·11], p=0·011) and intermediate deprived (SIMD 3; −0·70% [–1·17 to −0·23], p=0·0043) area quintiles, but not in those from the least deprived (SIMD 5) area quintile.
Interpretation
Our findings suggest that smoke-free home interventions could be an important tool to reduce asthma admissions in young children, and that smoke-free public space legislation might improve child health for many years, especially in the most deprived communities.

Risk of COVID-19 among front-line health-care workers and the general community: a prospective cohort study

The Lancet Public Health Volume 5, ISSUE 9, e475-e483, September 01, 2020

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Background
Data for front-line health-care workers and risk of COVID-19 are limited. We sought to assess risk of COVID-19 among front-line health-care workers compared with the general community and the effect of personal protective equipment (PPE) on risk.
Methods
We did a prospective, observational cohort study in the UK and the USA of the general community, including front-line health-care workers, using self-reported data from the COVID Symptom Study smartphone application (app) from March 24 (UK) and March 29 (USA) to April 23, 2020. Participants were voluntary users of the app and at first use provided information on demographic factors (including age, sex, race or ethnic background, height and weight, and occupation) and medical history, and subsequently reported any COVID-19 symptoms. We used Cox proportional hazards modelling to estimate multivariate-adjusted hazard ratios (HRs) of our primary outcome, which was a positive COVID-19 test. The COVID Symptom Study app is registered with ClinicalTrials.gov, NCT04331509.
Findings
Among 2 035 395 community individuals and 99 795 front-line health-care workers, we recorded 5545 incident reports of a positive COVID-19 test over 34 435 272 person-days. Compared with the general community, front-line health-care workers were at increased risk for reporting a positive COVID-19 test (adjusted HR 11·61, 95% CI 10·93–12·33). To account for differences in testing frequency between front-line health-care workers and the general community and possible selection bias, an inverse probability-weighted model was used to adjust for the likelihood of receiving a COVID-19 test (adjusted HR 3·40, 95% CI 3·37–3·43). Secondary and post-hoc analyses suggested adequacy of PPE, clinical setting, and ethnic background were also important factors.
Interpretation
In the UK and the USA, risk of reporting a positive test for COVID-19 was increased among front-line health-care workers. Health-care systems should ensure adequate availability of PPE and develop additional strategies to protect health-care workers from COVID-19, particularly those from Black, Asian, and minority ethnic backgrounds. Additional follow-up of these observational findings is needed

Wider impacts of COVID-19 on health monitoring tool

by Public Health England (2020)

National monitoring tool that brings together metrics to assess the wider impacts of coronavirus (COVID-19) on health.

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Adapting sexual and reproductive health services in response to COVID-19: examples of practice

by Public Health England (2020)

During the COVID-19 response sexual and reproductive health services have adapted swiftly to ensure continued provision of essential services. This has included, for example, the scale up of online triaging and delivery, and prioritising face-to-face consultations for less well served groups, clinically complex cases and to address safeguarding concerns.
Public Health England is collating practice examples to capture how sexual and reproductive health services have adapted during the COVID-19 response with a particular focus on changes put in place to meet the needs of less well served populations. The practice examples below have been collected and published with no assumption or evidence of effectiveness at this stage. They are intended to briefly capture what has been done locally for the purpose of rapid knowledge translation. The practice examples were collected by PHE from local sexual and reproductive health providers and commissioners. PHE is collecting examples on an ongoing basis.

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Impact of delays on effectiveness of contact tracing strategies for COVID-19: a modelling study

The Lancet Public Health Volume 5, ISSUE 8, e452-e459, August 01, 2020

In countries with declining numbers of confirmed cases of COVID-19, lockdown measures are gradually being lifted. However, even if most physical distancing measures are continued, other public health measures will be needed to control the epidemic. Contact tracing via conventional methods or mobile app technology is central to control strategies during de-escalation of physical distancing. We aimed to identify key factors for a contact tracing strategy to be successful.

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Rapid review of COVID-19 impacts

By North West Health  & Population Network (June 2020)

The impacts of COVID-19 have not been felt equally. The pandemic has both exposed and exacerbated longstanding inequalities in society. As we move from the response phase into recovery, the direct and wider impacts of the pandemic on individuals, households and communities will influence their capacity to recover. By providing a summary of the direct and indirect impacts of COVID-19 on health and wellbeing, this review aims to assist with the development of priorities and mitigating actions to support recovery” ( Dr Andrew Turner, Health Policy Lead & Public Health Specialty Registrar Liverpool City Region Combined Authority)

Click here to review this review