1
|
Duval D, Evans B, Sanders A, Hill J, Simbo A, Kavoi T, Lyell I, Simmons Z, Qureshi M, Pearce-Smith N, Arevalo CR, Beck CR, Bindra R, Oliver I. Non-pharmaceutical interventions to reduce COVID-19 transmission in the UK: a rapid mapping review and interactive evidence gap map. J Public Health (Oxf) 2024; 46:e279-e293. [PMID: 38426578 PMCID: PMC11141784 DOI: 10.1093/pubmed/fdae025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/15/2024] [Accepted: 01/23/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Non-pharmaceutical interventions (NPIs) were crucial in the response to the COVID-19 pandemic, although uncertainties about their effectiveness remain. This work aimed to better understand the evidence generated during the pandemic on the effectiveness of NPIs implemented in the UK. METHODS We conducted a rapid mapping review (search date: 1 March 2023) to identify primary studies reporting on the effectiveness of NPIs to reduce COVID-19 transmission. Included studies were displayed in an interactive evidence gap map. RESULTS After removal of duplicates, 11 752 records were screened. Of these, 151 were included, including 100 modelling studies but only 2 randomized controlled trials and 10 longitudinal observational studies.Most studies reported on NPIs to identify and isolate those who are or may become infectious, and on NPIs to reduce the number of contacts. There was an evidence gap for hand and respiratory hygiene, ventilation and cleaning. CONCLUSIONS Our findings show that despite the large number of studies published, there is still a lack of robust evaluations of the NPIs implemented in the UK. There is a need to build evaluation into the design and implementation of public health interventions and policies from the start of any future pandemic or other public health emergency.
Collapse
Affiliation(s)
- D Duval
- Research, Evidence and Knowledge Division, UK Health Security Agency (UKHSA), London E14 5EA, UK
| | - B Evans
- Research, Evidence and Knowledge Division, UK Health Security Agency (UKHSA), London E14 5EA, UK
| | - A Sanders
- Research, Evidence and Knowledge Division, UK Health Security Agency (UKHSA), London E14 5EA, UK
| | - J Hill
- Clinical and Public Health Response Division, UKHSA, London E14 5EA, UK
| | - A Simbo
- Evaluation and Epidemiological Science Division, UKHSA, Colindale NW9 5EQ, UK
| | - T Kavoi
- Cheshire and Merseyside Health Protection Team, UKHSA, Liverpool L3 1DS, UK
| | - I Lyell
- Greater Manchester Health Protection Team, UKHSA, Manchester M1 3BN, UK
| | - Z Simmons
- Research, Evidence and Knowledge Division, UK Health Security Agency (UKHSA), London E14 5EA, UK
| | - M Qureshi
- Clinical and Public Health Response Division, UKHSA, London E14 5EA, UK
| | - N Pearce-Smith
- Research, Evidence and Knowledge Division, UK Health Security Agency (UKHSA), London E14 5EA, UK
| | - C R Arevalo
- Research, Evidence and Knowledge Division, UK Health Security Agency (UKHSA), London E14 5EA, UK
| | - C R Beck
- Evaluation and Epidemiological Science Division, UKHSA, Salisbury SP4 0JG, UK
| | - R Bindra
- Clinical and Public Health Response Division, UKHSA, London E14 5EA, UK
| | - I Oliver
- Director General Science and Research and Chief Scientific Officer, UKHSA, London E14 5EA, UK
| |
Collapse
|
2
|
Anand A, Vialard F, Esmail A, Ahmad Khan F, O’Byrne P, Routy JP, Dheda K, Pant Pai N. Self-tests for COVID-19: What is the evidence? A living systematic review and meta-analysis (2020-2023). PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002336. [PMID: 38324519 PMCID: PMC10849237 DOI: 10.1371/journal.pgph.0002336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 01/18/2024] [Indexed: 02/09/2024]
Abstract
COVID-19 self-testing strategy (COVIDST) can rapidly identify symptomatic and asymptomatic SARS-CoV-2-infected individuals and their contacts, potentially reducing transmission. In this living systematic review, we evaluated the evidence for real-world COVIDST performance. Two independent reviewers searched six databases (PubMed, Embase, Web of Science, World Health Organization database, Cochrane COVID-19 registry, Europe PMC) for the period April 1st, 2020, to January 18th, 2023. Data on studies evaluating COVIDST against laboratory-based conventional testing and reported on diagnostic accuracy, feasibility, acceptability, impact, and qualitative outcomes were abstracted. Bivariate random effects meta-analyses of COVIDST accuracy were performed (n = 14). Subgroup analyses (by sampling site, symptomatic/asymptomatic infection, supervised/unsupervised strategy, with/without digital supports) were conducted. Data from 70 included studies, conducted across 25 countries with a median sample size of 817 (range: 28-784,707) were pooled. Specificity and DOR was high overall, irrespective of subgroups (98.37-99.71%). Highest sensitivities were reported for: a) symptomatic individuals (73.91%, 95%CI: 68.41-78.75%; n = 9), b) mid-turbinate nasal samples (77.79%, 95%CI: 56.03-90.59%; n = 14), c) supervised strategy (86.67%, 95%CI: 59.64-96.62%; n = 13), and d) use of digital interventions (70.15%, 95%CI: 50.18-84.63%; n = 14). Lower sensitivity was attributed to absence of symptoms, errors in test conduct and absence of supervision or a digital support. We found no difference in COVIDST sensitivity between delta and omicron pre-dominant period. Digital supports increased confidence in COVIDST reporting and interpretation (n = 16). Overall acceptability was 91.0-98.7% (n = 2) with lower acceptability reported for daily self-testing (39.5-51.1%). Overall feasibility was 69.0-100.0% (n = 5) with lower feasibility (35.9-64.6%) for serial self-testing. COVIDST decreased closures in school, workplace, and social events (n = 4). COVIDST is an effective rapid screening strategy for home-, workplace- or school-based screening, for symptomatic persons, and for preventing transmission during outbreaks. These data will guide COVIDST policy. Our review demonstrates that COVIDST has paved the way for self-testing in pandemics worldwide.
Collapse
Affiliation(s)
- Apoorva Anand
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Infectious Diseases and Immunity in Global Health, Research Institute of McGill University Health Centre, Montreal, Quebec, Canada
| | - Fiorella Vialard
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Infectious Diseases and Immunity in Global Health, Research Institute of McGill University Health Centre, Montreal, Quebec, Canada
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Aliasgar Esmail
- Centre for Lung Infection and Immunity, Division of Pulmonology, UCT Lung Institute and Department of Medicine, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Faiz Ahmad Khan
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Patrick O’Byrne
- Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Jean-Pierre Routy
- Infectious Diseases and Immunity in Global Health, Research Institute of McGill University Health Centre, Montreal, Quebec, Canada
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Keertan Dheda
- Centre for Lung Infection and Immunity, Division of Pulmonology, UCT Lung Institute and Department of Medicine, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Nitika Pant Pai
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Infectious Diseases and Immunity in Global Health, Research Institute of McGill University Health Centre, Montreal, Quebec, Canada
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| |
Collapse
|
3
|
Bradley Z, Coleman PA, Courtney MA, Fishlock S, McGrath J, Uniacke-Lowe T, Bhalla N, McLaughlin JA, Hogan J, Hanrahan JP, Yan KT, McKee P. Effect of Selenium Nanoparticle Size on IL-6 Detection Sensitivity in a Lateral Flow Device. ACS OMEGA 2023; 8:8407-8414. [PMID: 36910974 PMCID: PMC9996617 DOI: 10.1021/acsomega.2c07297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 02/17/2023] [Indexed: 06/18/2023]
Abstract
Sepsis is the body's response to an infection. Existing diagnostic testing equipment is not available in primary care settings and requires long waiting times. Lateral flow devices (LFDs) could be employed in point-of-care (POC) settings for sepsis detection; however, they currently lack the required sensitivity. Herein, LFDs are constructed using 150-310 nm sized selenium nanoparticles (SeNPs) and are compared to commercial 40 nm gold nanoparticles (AuNPs) for the detection of the sepsis biomarker interleukin-6 (IL-6). Both 310 and 150 nm SeNPs reported a lower limit of detection (LOD) than 40 nm AuNPs (0.1 ng/mL compared to 1 ng/mL), although at the cost of test line visual intensity. This is to our knowledge the first use of larger SeNPs (>100 nm) in LFDs and the first comparison of the effect of the size of SeNPs on assay sensitivity in this context. The results herein demonstrate that large SeNPs are viable alternatives to existing commercial labels, with the potential for higher sensitivity than standard 40 nm AuNPs.
Collapse
Affiliation(s)
- Zoe Bradley
- Biopanda
Reagents Ltd., Unit 14, Carrowreagh Business
Park, Carrowreagh Road, Belfast BT16 1QQ, United
Kingdom
- Nanotechnology
and Integrated Bioengineering Centre, School of Engineering, University of Ulster, Belfast BT15 1ED, United Kingdom
| | - Patrick A. Coleman
- Environmental
Research Institute, Glantreo Ltd., Cork T23 XE10, Ireland
- Department
of Chemistry, College of SEFS, University
College Cork, Kane Building, Cork T12 YN60, Ireland
| | | | - Sam Fishlock
- Nanotechnology
and Integrated Bioengineering Centre, School of Engineering, University of Ulster, Belfast BT15 1ED, United Kingdom
| | - Joseph McGrath
- Environmental
Research Institute, Glantreo Ltd., Cork T23 XE10, Ireland
| | - Therese Uniacke-Lowe
- Department
of Chemistry, School of Food and Nutritional Sciences, University College Cork, Level 2 Food Science Building, Cork T12 TP07, Ireland
| | - Nikhil Bhalla
- Nanotechnology
and Integrated Bioengineering Centre, School of Engineering, University of Ulster, Belfast BT15 1ED, United Kingdom
- Healthcare
Technology Hub, School of Engineering, University
of Ulster, Belfast BT15 1ED, United
Kingdom
| | - James A. McLaughlin
- Nanotechnology
and Integrated Bioengineering Centre, School of Engineering, University of Ulster, Belfast BT15 1ED, United Kingdom
| | - John Hogan
- Environmental
Research Institute, Glantreo Ltd., Cork T23 XE10, Ireland
| | - John P. Hanrahan
- Environmental
Research Institute, Glantreo Ltd., Cork T23 XE10, Ireland
| | - Ke-Ting Yan
- Biopanda
Reagents Ltd., Unit 14, Carrowreagh Business
Park, Carrowreagh Road, Belfast BT16 1QQ, United
Kingdom
| | - Philip McKee
- Biopanda
Reagents Ltd., Unit 14, Carrowreagh Business
Park, Carrowreagh Road, Belfast BT16 1QQ, United
Kingdom
| |
Collapse
|
4
|
Daily use of lateral flow devices by contacts of confirmed COVID-19 cases to enable exemption from isolation compared with standard self-isolation to reduce onward transmission of SARS-CoV-2 in England: a randomised, controlled, non-inferiority trial. THE LANCET. RESPIRATORY MEDICINE 2022; 10:1074-1085. [PMID: 36228640 PMCID: PMC9625116 DOI: 10.1016/s2213-2600(22)00267-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/19/2022] [Accepted: 07/12/2022] [Indexed: 11/05/2022]
Abstract
Background In the UK, during the study period (April to July, 2021), all contacts of people with COVID-19 were required to self-isolate for 10 days, which had adverse impacts on individuals and society. Avoiding the need to self-isolate for those who remain uninfected would be beneficial. We investigated whether daily use of lateral flow devices (LFDs) to test for SARS-CoV-2, with removal of self-isolation for 24 h if negative, could be a safe alternative to self-isolation as a means to minimise onward transmission of the virus. Methods We conducted a randomised, controlled, non-inferiority trial in adult contacts identified by COVID-19 contact tracing in England. Consenting participants were randomly assigned to self-isolation (single PCR test, 10-day isolation) or daily contact testing (DCT; seven LFD tests, two PCR tests, no isolation if negative on LFD); participants from a single household were assigned to the same group. Participants were prospectively followed up, with the effect of each intervention on onward transmission established from routinely collected NHS Test and Trace contact tracing data for participants who tested PCR-positive for SARS-CoV-2 during the study period and tertiary cases arising from their contacts (ie, secondary contacts). The primary outcome of the study was the attack rate, the percentage of secondary contacts (close contacts of SARS-CoV-2-positive study participants) who became COVID-19 cases (tertiary cases) in each group. Attack rates were derived from Bernoulli regression models using Huber-White (robust) sandwich estimator clustered standard errors. Attack rates were adjusted for household exposure, vaccination status, and ability to work from home. The non-inferiority margin was 1·9%. The primary analysis was a modified intention-to-treat analysis excluding those who actively withdrew from the study as data from these participants were no longer held. This study is registered with the Research Registry (number 6809). Data collection is complete; analysis is ongoing. Findings Between April 29 and July 28, 2021, 54 923 eligible individuals were enrolled in the study, with final group allocations (following withdrawals) of 26 123 (52·6%) participants in the DCT group and 23 500 (47·4%) in the self-isolation group. Overall, 4694 participants tested positive for SARS-CoV-2 by PCR (secondary cases), 2364 (10·1%) in the self-isolation group and 2330 (8·9%) in the DCT group. Adjusted attack rates (among secondary contacts) were 7·5% in the self-isolation group and 6·3% in the DCT group (difference of –1·2% [95% CI –2·3 to –0·2]; significantly lower than the non-inferiority margin of 1·9%). Interpretation DCT with 24 h exemption from self-isolation for essential activities appears to be non-inferior to self-isolation. This study, which provided evidence for the UK Government's daily lateral flow testing policy for vaccinated contacts of COVID-19 cases, indicated that daily testing with LFDs could allow individuals to reduce the risk of onward transmission while minimising the adverse effects of self-isolation. Although contacts in England are no longer required to isolate, the findings will be relevant for future policy decisions around COVID-19 or other communicable infections. Funding UK Government Department of Health and Social Care.
Collapse
|
5
|
Love NK, Ready DR, Turner C, Yardley L, Rubin GJ, Hopkins S, Oliver I. The acceptability of testing contacts of confirmed COVID-19 cases using serial, self-administered lateral flow devices as an alternative to self-isolation. J Med Microbiol 2022; 71. [PMID: 35947525 DOI: 10.1099/jmm.0.001567] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Introduction. Evidence suggests that although people modify their behaviours, full adherence to self-isolation guidance in England may be suboptimal, which may have a detrimental impact on COVID-19 transmission rates.Hypothesis. Testing asymptomatic contacts of confirmed COVID-19 cases for the presence of SARS-CoV-2 could reduce onward transmission by improving case ascertainment and lessen the impact of self-isolation on un-infected individuals.Aim. This study investigated the feasibility and acceptability of implementing a 'test to enable approach' as part of England's tracing strategy.Methodology. Contacts of confirmed COVID-19 cases were offered serial testing as an alternative to self-isolation using daily self-performed lateral flow device (LFD) tests for the first 7 days post-exposure. Asymptomatic participants with a negative LFD result were given 24 h of freedom from self-isolation between each test. A self-collected confirmatory PCR test was performed on testing positive or at the end of the LFD testing period.Results. Of 1760 contacts, 882 consented to daily testing, of whom 812 individuals were within 48 h of exposure and were sent LFD testing packs. Of those who declined to participate, 39.1% stated they had already accessed PCR testing. Of the 812 who were sent LFD packs, 570 (70.2%) reported one or more LFD results; 102 (17.9%) tested positive. Concordance between reported LFD result and a supplied LFD image was 97.1%. In total, 82.8% of PCR-positive samples and 99.6% of PCR-negative samples were correctly detected by LFD. The proportion of secondary cases from contacts of those who participated in the study and tested positive (6.3%; 95% CI: 3.4-11.1%) was comparable to a comparator group who self-isolated (7.6%; 95% CI: 7.3-7.8%).Conclusion. This study shows a high acceptability, compliance and positivity rates when using self-administered LFDs among contacts of confirmed COVID-19 cases. Offering routine testing as a structured part of the contact tracing process is likely to be an effective method of case ascertainment.
Collapse
Affiliation(s)
| | - Derren R Ready
- UK Health Security Agency, England, UK.,Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
| | | | - Lucy Yardley
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,School of Psychological Science, University of Bristol, Bristol, UK.,Department of Psychology, University of Southampton, Southampton, UK
| | - G James Rubin
- Health Protection Research Unit in Emergency Preparedness and Response, King's College London, London, UK
| | | | - Isabel Oliver
- UK Health Security Agency, England, UK.,Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
| |
Collapse
|
6
|
Marsden L, Hughes DM, Corcoran R, Cheyne CP, Ashton M, Buchan I, Coffey E, García-Fiñana M. Daily testing of contacts of SARS-CoV-2 infected cases as an alternative to quarantine for key workers in Liverpool: A prospective cohort study. EClinicalMedicine 2022; 50:101519. [PMID: 35795716 PMCID: PMC9249302 DOI: 10.1016/j.eclinm.2022.101519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 05/23/2022] [Accepted: 05/27/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Covid-19 test-to-release from quarantine policies affect many lives. The SMART Release pilot was the foundation of these policies and an element of the world's largest population cohort study of community-wide, SARS-CoV-2 rapid antigen testing. The objective of the study was to evaluate daily lateral flow testing (LFT) as an alternative to 10-14 days quarantine for key worker contacts of known Covid-19 (or SARS-CoV-2 infection) cases. METHODS Prospective cohort study incorporating quantitative and qualitative research methods to consider how serial LFT compares with PCR testing to detect SARS-CoV-2 infections and to understand experiences/compliance with testing and the viability of this quarantine harm-reduction strategy. Participants were residents of the Liverpool area who were key workers at participating fire, police, NHS and local government organisations in Liverpool, and who were identified as close contacts of cases between December 2020 and August 2021. Thematic qualitative analysis was used to evaluate stakeholder meetings. FINDINGS Compliance with the daily testing regime was good across the three main organisations in this study with 96·9%, 93·7% and 92·8% compliance for Merseyside Police, Merseyside Fire & Rescue Service and Alder Hey Children's Hospital respectively. Out of 1657 participants, 34 positive Covid-19 cases were identified and 3 undetected by the daily LFT regime. A total of 8291 workdays would have been lost to self-isolation but were prevented due to negative daily tests. Organisations reported that daily contact testing proved useful, flexible and well-tolerated initiative to sustain key worker services. INTERPRETATION Compliance with daily testing among key workers was high, helping sustain service continuity during periods of very high risk of staffing shortage. Services reported that the pilot was a "lifeline" and its successful delivery in Liverpool has been replicated elsewhere. FUNDING This report is independent research commissioned by DHSC and part funded by DHSC and NIHR. Further funding was received from Liverpool City Council, the EPSRC and MRC.
Collapse
Affiliation(s)
- Lucy Marsden
- Public Health Department, Liverpool City Council, Liverpool, Cunard Building, Water Street, Liverpool, L3 1DS
| | - David M. Hughes
- Department of Health Data Science, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Rhiannon Corcoran
- Department of Primary Care and Mental Health, Institute of Population Health, University of Liverpool
| | - Christopher P. Cheyne
- Department of Health Data Science, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Matt Ashton
- Public Health Department, Liverpool City Council, Liverpool, Cunard Building, Water Street, Liverpool, L3 1DS
| | - Iain Buchan
- Department of Public Health, Policy and Systems, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Emer Coffey
- Public Health Department, Liverpool City Council, Liverpool, Cunard Building, Water Street, Liverpool, L3 1DS
| | - Marta García-Fiñana
- Department of Health Data Science, Institute of Population Health, University of Liverpool, Liverpool, UK
- Corresponding author at: Professor of Health Data Science, Institute of Population Health, University of Liverpool, Block F, Waterhouse Bld, 1-5 Brownlow Street, Liverpool, L69 3GL, UK.
| |
Collapse
|
7
|
Denford S, Martin AF, Towler L, Mowbray F, Essery R, Bloomer R, Ready D, Love N, Amlôt R, Oliver I, Rubin GJ, Yardley L. A qualitative process analysis of daily contact testing as an alternative to self-isolation following close contact with a confirmed carrier of SARS-CoV-2. BMC Public Health 2022; 22:1373. [PMID: 35850742 PMCID: PMC9294818 DOI: 10.1186/s12889-022-13800-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 07/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In July 2021, a randomised controlled trial was conducted to compare the effect on SARS-CoV-2 transmission of seven days of Daily Contact Testing (DCT) using Lateral Flow Test (LFT) and two Polymerase Chain Reaction (PCR) tests as an alternative to 10 days of standard self-isolation with one PCR, following close contact with a SARS-CoV-2 carrier. In this qualitative study, we used a nested process evaluation to aid interpretation of the trial and provide insight into factors influencing use of tests, understanding of test results, and how tests were used to inform behavioural decisions. METHODS Interviews were conducted with 60 participants (42 randomised to DCT and 18 randomised to self-isolation) who had been in close contact with a confirmed SARS-CoV-2 carrier and had consented to take part in the trial. RESULTS Data were organised into three overarching themes: (1) assessing the risks and benefits of DCT (2) use of testing during the study period and (3) future use of testing. Attitudes toward DCT as an alternative to self-isolation and behaviour during the testing period appeared to be informed by an assessment of the associated risks and benefits. Participants reported how important it was for them to avoid isolation, how necessary self-isolation was considered to be, and the ability of LFTs to detect infection. Behaviour during the testing period was modified to reduce risks and harms as much as possible. Testing was considered a potential compromise, reducing both risk of transmission and the negative impact of self-isolation, and was regarded as a way to return to normal. CONCLUSION Participants in this study viewed DCT as a sensible, feasible, and welcome means of avoiding unnecessary self-isolation. Although negative LFTs provided reassurance, most people still restricted their activity as recommended. DCT was also highly valued by those in vulnerable households as a means of providing reassurance of the absence of infection and as an important means of detecting infection and prompting self-isolation when necessary.
Collapse
Affiliation(s)
- Sarah Denford
- Health Protection Research Unit in Behavioural Science and Evaluation at the University of Bristol in Collaboration With UK Health Security Agency, Bristol, UK. .,Population Health Sciences, Bristol Medical School, University of Bristol, Priory Road Complex, BS8 1TU, Bristol, UK. .,School of Psychological Science, University of Bristol, Bristol, UK.
| | - Alex F Martin
- Health Protection Research Unit in Emergency Preparedness and Response at King's College London in Collaboration With UK Health Security Agency, London, UK
| | - Lauren Towler
- School of Psychological Science, University of Bristol, Bristol, UK.,School of Psychology, University of Southampton, Southampton, UK
| | - Fiona Mowbray
- Health Protection Research Unit in Emergency Preparedness and Response at King's College London in Collaboration With UK Health Security Agency, London, UK
| | - Rosie Essery
- Health Protection Research Unit in Behavioural Science and Evaluation at the University of Bristol in Collaboration With UK Health Security Agency, Bristol, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Priory Road Complex, BS8 1TU, Bristol, UK.,School of Psychological Science, University of Bristol, Bristol, UK.,School of Psychology, University of Southampton, Southampton, UK
| | - Rachael Bloomer
- Population Health Sciences, Bristol Medical School, University of Bristol, Priory Road Complex, BS8 1TU, Bristol, UK
| | - Derren Ready
- Health Protection Research Unit in Behavioural Science and Evaluation at the University of Bristol in Collaboration With UK Health Security Agency, Bristol, UK.,UK Health Security Agency, London, England, UK
| | - Nicola Love
- Health Protection Research Unit in Behavioural Science and Evaluation at the University of Bristol in Collaboration With UK Health Security Agency, Bristol, UK.,UK Health Security Agency, London, England, UK
| | - Richard Amlôt
- Health Protection Research Unit in Behavioural Science and Evaluation at the University of Bristol in Collaboration With UK Health Security Agency, Bristol, UK.,Health Protection Research Unit in Emergency Preparedness and Response at King's College London in Collaboration With UK Health Security Agency, London, UK.,UK Health Security Agency, London, England, UK
| | - Isabel Oliver
- Health Protection Research Unit in Behavioural Science and Evaluation at the University of Bristol in Collaboration With UK Health Security Agency, Bristol, UK.,UK Health Security Agency, London, England, UK
| | - G James Rubin
- Health Protection Research Unit in Emergency Preparedness and Response at King's College London in Collaboration With UK Health Security Agency, London, UK
| | - Lucy Yardley
- Health Protection Research Unit in Behavioural Science and Evaluation at the University of Bristol in Collaboration With UK Health Security Agency, Bristol, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Priory Road Complex, BS8 1TU, Bristol, UK.,School of Psychological Science, University of Bristol, Bristol, UK.,School of Psychology, University of Southampton, Southampton, UK
| |
Collapse
|
8
|
An evaluation of a pilot of daily testing of SARS-CoV-2 contacts in acute hospital and ambulance trusts in England. Public Health 2022; 209:46-51. [PMID: 35809350 PMCID: PMC9174334 DOI: 10.1016/j.puhe.2022.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 05/17/2022] [Accepted: 05/19/2022] [Indexed: 11/30/2022]
Abstract
Objectives Healthcare worker (HCW) SARS-CoV-2 contacts in England have been required to quarantine, creating staff shortages. We piloted daily contact testing (DCT) to assess its feasibility as an alternative. Study design Observational service evaluation. Methods We conducted an observational service evaluation of 7-day DCT using antigen lateral flow devices (LFDs) at four acute hospital trusts and one ambulance trust in England. Mixed methods were used, using aggregate and individual-level test monitoring data, semi-structured interviews, and a survey of eligible contacts. Results In total, 138 HCWs were identified as contacts of a confirmed SARS-CoV-2 case. Of these, 111 (80%) consented to daily LFD testing, of whom 82 (74%) completed the required programme without interruption and 12 (11%) completed with interruption. Fifty-eight participants (52%) and two non-participants (7.4%) completed the survey. In total, 28 interviews were conducted with participants, site and infection control leads, and union representatives. One participant tested positive on LFD and polymerase chain reaction (PCR) test. Three participants tested positive on PCR but not LFD. DCT was well-accepted by trusts and staff. Participants reported no relaxation of their infection prevention and control behaviours. No incidents of transmission were detected. An estimated 729 potential days of work absence were averted. Conclusions DCT can be acceptably operated in a healthcare setting, averting quarantine-related work absences in HCW SARS-CoV-2 contacts.
Collapse
|
9
|
Robinson PG, Murray A, Watson M, Close G, Kinane DF. Risk assessment and implementation of risk reduction measures is not associated with increased transmission of SARS-CoV-2 compared with standard isolation at professional golf events. BMJ Open Sport Exerc Med 2022; 8:e001324. [PMID: 35601139 PMCID: PMC9108433 DOI: 10.1136/bmjsem-2022-001324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2022] [Indexed: 12/20/2022] Open
Abstract
Objectives The purpose of this prospective study was to report incidence and transmission of SARS-CoV-2, among professional golfers and essential support staff undergoing risk assessment and enhanced risk reduction measures when considered a close contact as opposed to standard isolation while competing on the DP World Tour during the 2021 season. Methods This prospective cohort study included all players and essential support staff participating in 26 DP World Tour events from 18 April 2021 to 21 November 2021. High-risk contacts were isolated for 10 days. Moderate-risk contacts received education regarding enhanced medical surveillance, had daily rapid antigen testing for 5 days, with reverse transcriptase-polymerase chain reaction (RT-PCR) tesing on day 5, mandated mask use and access to outside space for work purposes only. Low-risk contacts typically received rapid antigen testing every 48 hours and RT-PCR testing on day 5. Results The total study cohort compromised 13 394 person-weeks of exposure. There were a total of 30 positive cases over the study period. Eleven contacts were stratified as ‘high risk’. Two of these subsequently tested positive for SARS-CoV-2. There were 79 moderate-risk contact and 73 low-risk contacts. One moderate-risk contact subsequently tested positive for SARS-CoV-2 but did not transmit the virus. All other contacts, remained negative and asymptomatic to the end of the tournament week. Conclusions A risk assessment and risk reduction-based approach to contact tracing was safe in this professional golf event setting when Alpha and Delta were the predominant variants. It enabled professional golfers and essential support staff to work.
Collapse
Affiliation(s)
- Patrick Gordon Robinson
- Royal Infirmary of Edinburgh, Edinburgh Orthopaedics, Edinburgh, UK.,European Tour Performance Institute, Virginia Water, UK
| | - Andrew Murray
- European Tour Performance Institute, Virginia Water, UK.,Physical Activity for Health Research Centre, University of Edinburgh, Edinburgh, UK
| | - Matt Watson
- European Tour Performance Institute, Virginia Water, UK
| | - Graeme Close
- European Tour Performance Institute, Virginia Water, UK.,Liverpool John Moores University, Liverpool, UK
| | - Denis F Kinane
- School of Dental Medicine, University of Bern, Bern, Switzerland.,Medical and Scientific Department, Cignpost Diagnostics, Farnborough, UK
| |
Collapse
|
10
|
Robinson PG, Murray A, Close G, Glover D, Du Plessis WJ. Returning persons with SARS-CoV-2 to the field of play in professional golf: a risk assessment and risk reduction approach. BMJ Open Sport Exerc Med 2022; 8:e001347. [PMID: 35539286 PMCID: PMC9066089 DOI: 10.1136/bmjsem-2022-001347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2022] [Indexed: 12/23/2022] Open
Abstract
Objectives This pilot study aimed to see whether a risk assessment and risk reduction approach was a practical and feasible approach, as compared with standard isolation for fully vaccinated, asymptomatic persons positive for SARS-CoV-2. Methods This prospective cohort study included all players and caddies participating in two large professional golf events from 7 to 20 February 2022 in South Africa. Fully vaccinated persons testing positive who were asymptomatic were subject to risk assessment and risk reduction measures to protect the integrity of the event. Asymptomatic individuals who could socially distance in outdoor areas were allowed to participate. Close contacts were subject to daily rapid antigen tests and asked to prioritise outdoor space. Results The protocols put in place for the events were practical, feasible, and well accepted by event participants and staff during the study period. There was a total of 378 player-week episodes and 378 caddie-week episodes during the study period. Three persons tested positive while registered at events during the study period (0.4% of person episodes). The positive tests were returned from two players and one caddie, all of which were asymptomatic at the time of testing. There was one high-risk contact who consistently returned negative antigen tests. There was no evidence of transmission. Conclusions The approach was practical and feasible. A risk assessment and risk reduction approach allowed fully vaccinated asymptomatic persons with SARS-CoV-2 to participate in golf, an outdoor sport where social distancing is possible, compared with standard isolation.
Collapse
Affiliation(s)
- Patrick Gordon Robinson
- Royal Infirmary of Edinburgh, Edinburgh Orthopaedics, Edinburgh, UK
- European Tour Performance Institute, Virginia Water, UK
| | - Andrew Murray
- European Tour Performance Institute, Virginia Water, UK
- Physical Activity for Health Research Centre, University of Edinburgh, Edinburgh, UK
| | - Graeme Close
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Danny Glover
- European Tour Performance Institute, Virginia Water, UK
| | - Wimpie J Du Plessis
- Medical and Scientific Department, The Sunshine Tour, Somerset West, South Africa
| |
Collapse
|
11
|
Denford S, Towler L, Ali B, Treneman-Evans G, Bloomer R, Peto TE, Young BC, Yardley L. Feasibility and acceptability of daily testing at school as an alternative to self-isolation following close contact with a confirmed case of COVID-19: a qualitative analysis. BMC Public Health 2022; 22:742. [PMID: 35418065 PMCID: PMC9007577 DOI: 10.1186/s12889-022-13204-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 04/08/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Daily testing using a rapid Lateral Flow Device (LFD) has been suggested as an alternative to self-isolation. A randomised trial comparing daily contact testing (DCT) in schools with self-isolation found that SARS-CoV-2 transmission within school was comparable and low in both groups. However, if this approach is to be adopted widely, it is critical that we understand the perspective of those who will be delivering and receiving DCT. The aim of this qualitative process study embedded in the randomised controlled trial (RCT) was to improve understanding of a range of behavioural factors that could influence implementation. METHODS Interviews were conducted with 63 participants, including staff, students, and parents of students who had been identified as being in close contact with someone with COVID-19. The topic guide explored perceptions of daily testing, understanding of positive and negative test results, and adherence to guidance. Data were analysed using an inductive thematic approach. RESULTS Results were organised under three main headings: (1) factors influencing daily testing (2) interpretation of test results (3) behaviour during testing period. Participants recognized that daily testing may allow students to remain in school, which was viewed as necessary for both education and social needs. Whilst some felt safer as a result of daily testing, others raised concerns about safety. Participants did not always understand how to interpret and respond to test results, and although participants reported high levels of adherence to the guidance, improved communications were desired. CONCLUSION Daily testing may be a feasible and acceptable alternative to self-isolation among close contacts of people who test positive. However, improved communications are needed to ensure that all students and parents have a good understanding of the rationale for testing, what test results mean, how test results should be acted on, and how likely students are to test positive following close contact. Support is needed for students and parents of students who have to self-isolate and for those who have concerns about the safety of daily testing.
Collapse
Affiliation(s)
- Sarah Denford
- Population Health Sciences, Bristol Medical School, University of Bristol, Priory Road Complex, Bristol, England, BS8 1TU.
- NIHR Health Protection Research Unit (HPRU) in Behavioural Science and Evaluation at the University of Bristol, a partnership between the UK Health Security Agency (UKHSA) and the University of Bristol, Bristol, England.
- School of Psychological Science, University of Bristol, Bristol, BS8 1TU, UK.
| | - Lauren Towler
- School of Psychological Science, University of Bristol, Bristol, BS8 1TU, UK
- School of Psychology, University of Southampton, Southampton, UK
| | - Behiye Ali
- Population Health Sciences, Bristol Medical School, University of Bristol, Priory Road Complex, Bristol, England, BS8 1TU
- NIHR Health Protection Research Unit (HPRU) in Behavioural Science and Evaluation at the University of Bristol, a partnership between the UK Health Security Agency (UKHSA) and the University of Bristol, Bristol, England
- School of Psychological Science, University of Bristol, Bristol, BS8 1TU, UK
| | - Georgia Treneman-Evans
- Population Health Sciences, Bristol Medical School, University of Bristol, Priory Road Complex, Bristol, England, BS8 1TU
- NIHR Health Protection Research Unit (HPRU) in Behavioural Science and Evaluation at the University of Bristol, a partnership between the UK Health Security Agency (UKHSA) and the University of Bristol, Bristol, England
- School of Psychological Science, University of Bristol, Bristol, BS8 1TU, UK
| | - Rachael Bloomer
- Population Health Sciences, Bristol Medical School, University of Bristol, Priory Road Complex, Bristol, England, BS8 1TU
| | - Tim Ea Peto
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
- NIHR Health Protection Research Unit in in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford, UK
| | | | - Lucy Yardley
- NIHR Health Protection Research Unit (HPRU) in Behavioural Science and Evaluation at the University of Bristol, a partnership between the UK Health Security Agency (UKHSA) and the University of Bristol, Bristol, England
- School of Psychological Science, University of Bristol, Bristol, BS8 1TU, UK
- School of Psychology, University of Southampton, Southampton, UK
| |
Collapse
|
12
|
Young BC, Eyre DW, Kendrick S, White C, Smith S, Beveridge G, Nonnenmacher T, Ichofu F, Hillier J, Oakley S, Diamond I, Rourke E, Dawe F, Day I, Davies L, Staite P, Lacey A, McCrae J, Jones F, Kelly J, Bankiewicz U, Tunkel S, Ovens R, Chapman D, Bhalla V, Marks P, Hicks N, Fowler T, Hopkins S, Yardley L, Peto TEA. Daily testing for contacts of individuals with SARS-CoV-2 infection and attendance and SARS-CoV-2 transmission in English secondary schools and colleges: an open-label, cluster-randomised trial. Lancet 2021; 398:1217-1229. [PMID: 34534517 PMCID: PMC8439620 DOI: 10.1016/s0140-6736(21)01908-5] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 08/17/2021] [Accepted: 08/19/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND School-based COVID-19 contacts in England have been asked to self-isolate at home, missing key educational opportunities. We trialled daily testing of contacts as an alternative to assess whether this resulted in similar control of transmission, while allowing more school attendance. METHODS We did an open-label, cluster-randomised, controlled trial in secondary schools and further education colleges in England. Schools were randomly assigned (1:1) to self-isolation of school-based COVID-19 contacts for 10 days (control) or to voluntary daily lateral flow device (LFD) testing for 7 days with LFD-negative contacts remaining at school (intervention). Randomisation was stratified according to school type and size, presence of a sixth form, presence of residential students, and proportion of students eligible for free school meals. Group assignment was not masked during procedures or analysis. Coprimary outcomes in all students and staff were COVID-19-related school absence and symptomatic PCR-confirmed COVID-19, adjusted for community case rates, to estimate within-school transmission (non-inferiority margin <50% relative increase). Analyses were done on an intention-to-treat basis using quasi-Poisson regression, also estimating complier average causal effects (CACE). This trial is registered with the ISRCTN registry, ISRCTN18100261. FINDINGS Between March 18 and May 4, 2021, 204 schools were taken through the consent process, during which three decided not to participate further. 201 schools were randomly assigned (control group n=99, intervention group n=102) in the 10-week study (April 19-May 10, 2021), which continued until the pre-appointed stop date (June 27, 2021). 76 control group schools and 86 intervention group schools actively participated; additional national data allowed most non-participating schools to be included in analysis of coprimary outcomes. 2432 (42·4%) of 5763 intervention group contacts participated in daily contact testing. There were 657 symptomatic PCR-confirmed infections during 7 782 537 days-at-risk (59·1 per 100 000 per week) in the control group and 740 during 8 379 749 days-at-risk (61·8 per 100 000 per week) in the intervention group (intention-to-treat adjusted incidence rate ratio [aIRR] 0·96 [95% CI 0·75-1·22]; p=0·72; CACE aIRR 0·86 [0·55-1·34]). Among students and staff, there were 59 422 (1·62%) COVID-19-related absences during 3 659 017 person-school-days in the control group and 51 541 (1·34%) during 3 845 208 person-school-days in the intervention group (intention-to-treat aIRR 0·80 [95% CI 0·54-1·19]; p=0·27; CACE aIRR 0·61 [0·30-1·23]). INTERPRETATION Daily contact testing of school-based contacts was non-inferior to self-isolation for control of COVID-19 transmission, with similar rates of symptomatic infections among students and staff with both approaches. Infection rates in school-based contacts were low, with very few school contacts testing positive. Daily contact testing should be considered for implementation as a safe alternative to home isolation following school-based exposures. FUNDING UK Government Department of Health and Social Care.
Collapse
Affiliation(s)
| | - David W Eyre
- National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, University of Oxford, Oxford, UK; NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford, UK; Big Data Institute, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | - Chris White
- Department of Health and Social Care, London, UK
| | | | | | | | - Fegor Ichofu
- Department of Health and Social Care, London, UK
| | | | - Sarah Oakley
- Microbiology Department, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | | | - Fiona Dawe
- Office for National Statistics, Newport, UK
| | - Ieuan Day
- Office for National Statistics, Newport, UK
| | | | | | | | | | | | | | | | - Sarah Tunkel
- Department of Health and Social Care, London, UK
| | | | | | | | - Peter Marks
- Department of Health and Social Care, London, UK
| | - Nick Hicks
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK; Department of Health and Social Care, London, UK; Public Health England, London, UK
| | - Tom Fowler
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | | | - Lucy Yardley
- Health Protection Research Unit in Behavioural Science, University of Bristol, Bristol, UK; School of Psychology, University of Southampton, Southampton, UK
| | - Tim E A Peto
- Nuffield Department of Medicine, University of Oxford, Oxford, UK; National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, University of Oxford, Oxford, UK; NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford, UK
| |
Collapse
|
13
|
Smith LE, Potts HWW, Amlȏt R, Fear NT, Michie S, Rubin GJ. Do members of the public think they should use lateral flow tests (LFT) or polymerase chain reaction (PCR) tests when they have COVID-19-like symptoms? The COVID-19 Rapid Survey of Adherence to Interventions and Responses study. Public Health 2021; 198:260-262. [PMID: 34487869 PMCID: PMC8316130 DOI: 10.1016/j.puhe.2021.07.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 07/20/2021] [Indexed: 11/30/2022]
Abstract
Objectives This study aimed to investigate public use of lateral flow tests (LFT) and polymerase chain reaction (PCR) tests when experiencing key COVID-19 symptoms. Study design In this study, data from two waves of a cross-sectional nationally representative online survey (data collected 1 and 2 June, and 14 and 15 June 2021; n = 3665 adults aged ≥18 years living in England or Scotland) were used. Methods We report data investigating which type of test, if any, the public think Government guidance asks people to use if they have COVID-19 symptoms. In people with key COVID-19 symptoms (high temperature / fever; new, continuous cough; loss of sense of smell; loss of taste), we also describe the uptake of testing, if any. Results Ten percent of respondents thought Government guidance stated that they should take an LFT if symptomatic, whereas 18% of people thought that they should take a PCR test; 60% of people thought they should take both types of test (12% did not select either option). In people who were symptomatic, 32% reported taking a test to confirm whether they had COVID-19. Of these, 53% reported taking a PCR test and 44% reported taking an LFT. Conclusions Despite Government guidance stating that anyone with key COVID-19 symptoms should complete a PCR test, a significant percentage of the population use LFT tests when symptomatic. Communications should emphasise the superiority of, and need for, PCR tests in people with symptoms.
Collapse
Affiliation(s)
- L E Smith
- Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, Weston Education Centre, Cutcombe Road, London, SE5 9RJ, UK; NIHR Health Protection Research Unit in Emergency Preparedness and Response, King's College London, Weston Education Centre, Cutcombe Road, London, SE5 9RJ, UK.
| | - H W W Potts
- Institute of Health Informatics, University College London, Institute of Health Informatics, 222 Euston Road, London, NW1 2DA, UK
| | - R Amlȏt
- NIHR Health Protection Research Unit in Emergency Preparedness and Response, King's College London, Weston Education Centre, Cutcombe Road, London, SE5 9RJ, UK; Behavioural Science and Insights Unit, Public Health England, Behavioural Science and Insights Unit, Porton Down, Salisbury, Wiltshire, SP4 0JG, UK
| | - N T Fear
- Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, Weston Education Centre, Cutcombe Road, London, SE5 9RJ, UK; Academic Department of Military Mental Health, King's Centre for Military Health Research, London, UK
| | - S Michie
- Centre for Behaviour Change, University College London, Centre for Behaviour Change, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - G J Rubin
- Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, Weston Education Centre, Cutcombe Road, London, SE5 9RJ, UK; NIHR Health Protection Research Unit in Emergency Preparedness and Response, King's College London, Weston Education Centre, Cutcombe Road, London, SE5 9RJ, UK
| |
Collapse
|
14
|
Denford S, Martin AF, Love N, Ready D, Oliver I, Amlôt R, Yardley L, Rubin GJ. Engagement With Daily Testing Instead of Self-Isolating in Contacts of Confirmed Cases of SARS-CoV-2: A Qualitative Analysis. Front Public Health 2021; 9:714041. [PMID: 34414160 PMCID: PMC8369371 DOI: 10.3389/fpubh.2021.714041] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 07/08/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: In December 2020 and January 2021 Public Health England (PHE) with NHS Test and Trace conducted a study to explore the feasibility and acceptability of daily testing as an alternative to self-isolation following close contact with a confirmed COVID-19 case. This qualitative paper aims to identify factors influencing uptake among those offered daily testing, and the subsequent impact on behaviour. Methods: We conducted in-depth interviews with 52 participants who had taken part in the feasibility study. Participants were asked about their experiences of daily testing or self-isolating, their reasons for choosing to test or isolate, and their behaviour during the study period. Data were analysed using inductive thematic analysis. Results: Results are presented under two main headings: (1) factors influencing acceptance of testing and (2) impact of test results. Participants appeared highly motivated to engage in behaviours that would protect others from the virus. Factors influencing the decision to accept testing included (1) needing to avoid self-isolation, (2) concerns about test sensitivity, and (3) perceived benefits of detecting infection. Participants who were taking tests reported: (1) positive consequences following confirmation of COVID status, (2) engaging in essential activities, (3) uncertainty, and (4) self-isolating whilst testing. Conclusions: This study has identified a range of factors that appear to influence the decision to engage in daily testing or to self-isolate following close contact with a positive case, many of which could be addressed by clear communications. Covid-19 infection rates and government restrictions influenced experiences, and so further research is needed to explore perceptions of daily testing and behaviour following close contact with a positive case among a wider range of individuals, in the context of lower rates of COVID-19, few government restrictions on general population behaviour and more widespread testing.
Collapse
Affiliation(s)
- Sarah Denford
- Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, United Kingdom
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- School of Psychological Science, University of Bristol, Bristol, United Kingdom
| | - Alex F. Martin
- Health Protection Research Unit in Emergency Preparedness and Response, King's College London, London, United Kingdom
| | - Nicola Love
- National Infection Service, Public Health England, Bristol, United Kingdom
| | - Derren Ready
- Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, United Kingdom
- National Infection Service, Public Health England, Bristol, United Kingdom
| | - Isabel Oliver
- Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, United Kingdom
- National Infection Service, Public Health England, Bristol, United Kingdom
| | - Richard Amlôt
- Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, United Kingdom
- Health Protection Research Unit in Emergency Preparedness and Response, King's College London, London, United Kingdom
- Behavioural Science Team, Emergency Response Department Science and Technology, Public Health England, Salisbury, United Kingdom
| | - Lucy Yardley
- Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, United Kingdom
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- School of Psychological Science, University of Bristol, Bristol, United Kingdom
- School of Psychology, University of Southampton, Southampton, United Kingdom
| | - G. James Rubin
- Health Protection Research Unit in Emergency Preparedness and Response, King's College London, London, United Kingdom
| |
Collapse
|
15
|
Drury J, Mao G, John A, Kamal A, Rubin GJ, Stott C, Vandrevala T, Marteau TM. Behavioural responses to Covid-19 health certification: a rapid review. BMC Public Health 2021; 21:1205. [PMID: 34162364 PMCID: PMC8221819 DOI: 10.1186/s12889-021-11166-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 05/27/2021] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Covid-status certification - certificates for those who test negative for the SARS-CoV-2 virus, test positive for antibodies, or who have been vaccinated against SARS-CoV-2 - has been proposed to enable safer access to a range of activities. Realising these benefits will depend in part upon the behavioural and social impacts of certification. The aim of this rapid review was to describe public attitudes towards certification, and its possible impact on uptake of testing and vaccination, protective behaviours, and crime. METHOD A search was undertaken in peer-reviewed databases, pre-print databases, and the grey literature, from 2000 to December 2020. Studies were included if they measured attitudes towards or behavioural consequences of health certificates based on one of three indices of Covid-19 status: test-negative result for current infectiousness, test-positive for antibodies conferring natural immunity, or vaccination(s) conferring immunity. RESULTS Thirty-three papers met the inclusion criteria, only three of which were rated as low risk of bias. Public attitudes were generally favourable towards the use of immunity certificates for international travel, but unfavourable towards their use for access to work and other activities. A significant minority was strongly opposed to the use of certificates of immunity for any purpose. The limited evidence suggested that intention to get vaccinated varied with the activity enabled by certification or vaccination (e.g., international travel). Where vaccination is seen as compulsory this could lead to unwillingness to accept a subsequent vaccination. There was some evidence that restricting access to settings and activities to those with antibody test certificates may lead to deliberate exposure to infection in a minority. Behaviours that reduce transmission may decrease upon health certificates based on any of the three indices of Covid-19 status, including physical distancing and handwashing. CONCLUSIONS The limited evidence suggests that health certification in relation to COVID-19 - outside of the context of international travel - has the potential for harm as well as benefit. Realising the benefits while minimising the harms will require real-time evaluations allowing modifications to maximise the potential contribution of certification to enable safer access to a range of activities.
Collapse
Affiliation(s)
- John Drury
- School of Psychology, University of Sussex, Brighton, UK
| | - Guanlan Mao
- School of Psychology, University of Sussex, Brighton, UK
| | - Ann John
- Swansea University, Population Data Science, Swansea, UK
| | - Atiya Kamal
- Department of Psychology, Birmingham City University, Birmingham, UK
| | - G. James Rubin
- Department of Psychological Medicine, King’s College London, London, UK
| | | | - Tushna Vandrevala
- Department of Psychology, Kingston University, Kingston upon Thames, UK
| | - Theresa M. Marteau
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, UK
| |
Collapse
|