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Evans RA, Dube S, Lu Y, Yates M, Arnetorp S, Barnes E, Bell S, Carty L, Evans K, Graham S, Justo N, Moss P, Venkatesan S, Yokota R, Ferreira C, McNulty R, Taylor S, Quint JK. Impact of COVID-19 on immunocompromised populations during the Omicron era: insights from the observational population-based INFORM study. Lancet Reg Health Eur 2023; 35:100747. [PMID: 38115964 PMCID: PMC10730312 DOI: 10.1016/j.lanepe.2023.100747] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 09/15/2023] [Accepted: 09/21/2023] [Indexed: 12/21/2023]
Abstract
Background Immunocompromised individuals are not optimally protected by COVID-19 vaccines and potentially require additional preventive interventions to mitigate the risk of severe COVID-19. We aimed to characterise and describe the risk of severe COVID-19 across immunocompromised groups as the pandemic began to transition to an endemic phase. Methods COVID-19-related hospitalisations, intensive care unit (ICU) admissions, and deaths (01/01/2022-31/12/2022) were compared among different groups of immunocompromised individuals vs the general population, using a retrospective cohort design and electronic health data from a random 25% sample of the English population aged ≥12 years (Registration number: ISRCTN53375662). Findings Overall, immunocompromised individuals accounted for 3.9% of the study population, but 22% (4585/20,910) of COVID-19 hospitalisations, 28% (125/440) of COVID-19 ICU admissions, and 24% (1145/4810) of COVID-19 deaths in 2022. Restricting to those vaccinated with ≥3 doses of COVID-19 vaccine (∼84% of immunocompromised and 51% of the general population), all immunocompromised groups remained at increased risk of severe COVID-19 outcomes, with adjusted incidence rate ratios (aIRR) for hospitalisation ranging from 1.3 to 13.1. At highest risk for COVID-19 hospitalisation were individuals with: solid organ transplant (aIRR 13.1, 95% confidence interval [95% CI] 11.2-15.3), moderate to severe primary immunodeficiency (aIRR 9.7, 95% CI 6.3-14.9), stem cell transplant (aIRR 11.0, 95% CI 6.8-17.6), and recent treatment for haematological malignancy (aIRR 10.6, 95% CI 9.5-11.9). Results were similar for COVID-19 ICU admissions and deaths. Interpretation Immunocompromised individuals continue to be impacted disproportionately by COVID-19 and have an urgent need for additional preventive measures beyond current vaccination programmes. These data can help determine the immunocompromised groups for which targeted prevention strategies may have the highest impact. Funding This study was funded by AstraZeneca UK.
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Affiliation(s)
- Rachael A. Evans
- Department of Respiratory Sciences, University of Leicester, Leicester, United Kingdom
| | - Sabada Dube
- AstraZeneca UK Limited, BioPharmaceuticals Medical, Vaccines & Immunotherapies, Eastbrook House, First Floor, Shaftesbury Road, Cambridge, CB2 8DU, United Kingdom
| | - Yi Lu
- Evidera, The Ark, 201 Talgarth Road, London W6 8BJ, United Kingdom
| | - Mark Yates
- Data Analytics - Real World Evidence, Evidera, London, United Kingdom
| | - Sofie Arnetorp
- Vaccines and Immune Therapies, Global Market Access and Pricing, AstraZeneca R&D, 431 83 Mölndal, Sweden
| | - Eleanor Barnes
- Nuffield Department of Medicine, University of Oxford, OUH Hospital NHS Trust, Oxford, United Kingdom
| | - Samira Bell
- Population Health and Genomics, School of Medicine, University of Dundee, Ninewells Hospital, Dundee, DD1 9SY, Scotland, United Kingdom
| | - Lucy Carty
- Medical and Payer Evidence Statistics, BioPharmaceuticals Medical, AstraZeneca, Cambridge, United Kingdom
| | | | - Sophie Graham
- Evidera, The Ark, 201 Talgarth Road, London W6 8BJ, United Kingdom
| | - Nahila Justo
- Integrated Solutions – Real World Evidence, Evidera, Stockholm, Sweden
| | - Paul Moss
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
- University Hospitals Birmingham, NHS Foundation Trust, Birmingham, United Kingdom
| | - Sudhir Venkatesan
- Medical and Payer Evidence, BioPharmaceuticals Medical, AstraZeneca, Cambridge, United Kingdom
| | | | - Catia Ferreira
- AstraZeneca LP, 1800 Concord Pike, Wilmington, DE, 19850-5437, USA
| | - Richard McNulty
- Medical Affairs, AstraZeneca UK Limited, BioPharmaceuticals Medical, Vaccines & Immunotherapies, Eastbrook House, First Floor, Shaftesbury Road, Cambridge, CB2 8DU, United Kingdom
| | - Sylvia Taylor
- Medical Evidence, AstraZeneca UK Limited, BioPharmaceuticals Medical, Vaccines & Immunotherapies, Eastbrook House, First Floor, Shaftesbury Road, Cambridge, CB2 8DU, United Kingdom
| | - Jennifer K. Quint
- National Heart & Lung Institute, Imperial College London, United Kingdom
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Sewell B, Farr A, Akbari A, Carson-Stevens A, Dale J, Edwards A, Evans BA, John A, Torabi F, Jolles S, Kingston M, Lyons J, Lyons RA, Porter A, Watkins A, Williams V, Snooks H. The cost of implementing the COVID-19 shielding policy in Wales. BMC Public Health 2023; 23:2342. [PMID: 38008730 PMCID: PMC10680245 DOI: 10.1186/s12889-023-17169-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 11/06/2023] [Indexed: 11/28/2023] Open
Abstract
BACKGROUND The EVITE Immunity study investigated the effects of shielding Clinically Extremely Vulnerable (CEV) people during the COVID-19 pandemic on health outcomes and healthcare costs in Wales, United Kingdom, to help prepare for future pandemics. Shielding was intended to protect those at highest risk of serious harm from COVID-19. We report the cost of implementing shielding in Wales. METHODS The number of people shielding was extracted from the Secure Anonymised Information Linkage Databank. Resources supporting shielding between March and June 2020 were mapped using published reports, web pages, freedom of information requests to Welsh Government and personal communications (e.g. with the office of the Chief Medical Officer for Wales). RESULTS At the beginning of shielding, 117,415 people were on the shielding list. The total additional cost to support those advised to stay home during the initial 14 weeks of the pandemic was £13,307,654 (£113 per person shielded). This included the new resources required to compile the shielding list, inform CEV people of the shielding intervention and provide medicine and food deliveries. The list was adjusted weekly over the 3-month period (130,000 people identified by June 2020). Therefore the cost per person shielded lies between £102 and £113 per person. CONCLUSION This is the first evaluation of the cost of the measures put in place to support those identified to shield in Wales. However, no data on opportunity cost was available. The true costs of shielding including its budget impact and opportunity costs need to be investigated to decide whether shielding is a worthwhile policy for future health emergencies.
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Affiliation(s)
- Bernadette Sewell
- Swansea Centre for Health Economics, Faculty of Medicine, Health and Life Science, Swansea University, Singleton Park, Swansea, SA2 8PP, UK.
| | - Angela Farr
- Swansea Centre for Health Economics, Faculty of Medicine, Health and Life Science, Swansea University, Singleton Park, Swansea, SA2 8PP, UK
| | - Ashley Akbari
- Population Data Science, Faculty of Medicine, Health and Life Science, Swansea University, Singleton Park, Swansea, SA2 8PP, UK
| | - Andrew Carson-Stevens
- PRIME Centre Wales, Division of Population Medicine, Cardiff University, Heath Park, Cardiff, CF14 4YS, UK
| | - Jeremy Dale
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Adrian Edwards
- PRIME Centre Wales, Division of Population Medicine, Cardiff University, Heath Park, Cardiff, CF14 4YS, UK
| | - Bridie Angela Evans
- Swansea University Medical School and PRIME Centre Wales, Faculty of Medicine, Health and Life Science, Swansea University, Singleton Park, Swansea, SA2 8PP, UK
| | - Ann John
- Population Data Science, Faculty of Medicine, Health and Life Science, Swansea University, Singleton Park, Swansea, SA2 8PP, UK
| | - Fatemeh Torabi
- Population Data Science, Faculty of Medicine, Health and Life Science, Swansea University, Singleton Park, Swansea, SA2 8PP, UK
| | - Stephen Jolles
- Immunodeficiency Centre for Wales, University Hospital of Wales, Cardiff, CF14 4XW, UK
| | - Mark Kingston
- Swansea University Medical School and PRIME Centre Wales, Faculty of Medicine, Health and Life Science, Swansea University, Singleton Park, Swansea, SA2 8PP, UK
| | - Jane Lyons
- Population Data Science, Faculty of Medicine, Health and Life Science, Swansea University, Singleton Park, Swansea, SA2 8PP, UK
| | - Ronan A Lyons
- Population Data Science, Faculty of Medicine, Health and Life Science, Swansea University, Singleton Park, Swansea, SA2 8PP, UK
| | - Alison Porter
- Swansea University Medical School, Faculty of Medicine, Health and Life Science, Swansea University, Singleton Park, Swansea, SA2 8PP, UK
| | - Alan Watkins
- Swansea University Medical School, Faculty of Medicine, Health and Life Science, Swansea University, Singleton Park, Swansea, SA2 8PP, UK
| | - Victoria Williams
- Swansea University Medical School, Faculty of Medicine, Health and Life Science, Swansea University, Singleton Park, Swansea, SA2 8PP, UK
| | - Helen Snooks
- Swansea University Medical School, Faculty of Medicine, Health and Life Science, Swansea University, Singleton Park, Swansea, SA2 8PP, UK
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Porter A, Akbari A, Carson-Stevens A, Dale J, Dixon L, Edwards A, Evans B, Griffiths L, John A, Jolles S, Kingston MR, Lyons R, Morgan J, Sewell B, Whiffen A, Williams VA, Snooks H. Rationale for the shielding policy for clinically vulnerable people in the UK during the COVID-19 pandemic: a qualitative study. BMJ Open 2023; 13:e073464. [PMID: 37541747 PMCID: PMC10407356 DOI: 10.1136/bmjopen-2023-073464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 07/19/2023] [Indexed: 08/06/2023] Open
Abstract
INTRODUCTION Shielding aimed to protect those predicted to be at highest risk from COVID-19 and was uniquely implemented in the UK during the first year of the pandemic from March 2020. As the first stage in the EVITE Immunity evaluation (Effects of shielding for vulnerable people during COVID-19 pandemic on health outcomes, costs and immunity, including those with cancer:quasi-experimental evaluation), we generated a logic model to describe the programme theory underlying the shielding intervention. DESIGN AND PARTICIPANTS We reviewed published documentation on shielding to develop an initial draft of the logic model. We then discussed this draft during interviews with 13 key stakeholders involved in putting shielding into effect in Wales and England. Interviews were recorded, transcribed and analysed thematically to inform a final draft of the logic model. RESULTS The shielding intervention was a complex one, introduced at pace by multiple agencies working together. We identified three core components: agreement on clinical criteria; development of the list of people appropriate for shielding; and communication of shielding advice. In addition, there was a support programme, available as required to shielding people, including food parcels, financial support and social support. The predicted mechanism of change was that people would isolate themselves and so avoid infection, with the primary intended outcome being reduction in mortality in the shielding group. Unintended impacts included negative impact on mental and physical health and well-being. Details of the intervention varied slightly across the home nations of the UK and were subject to minor revisions during the time the intervention was in place. CONCLUSIONS Shielding was a largely untested strategy, aiming to mitigate risk by placing a responsibility on individuals to protect themselves. The model of its rationale, components and outcomes (intended and unintended) will inform evaluation of the impact of shielding and help us to understand its effect and limitations.
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Affiliation(s)
- Alison Porter
- Swansea University Medical School, Swansea University, Swansea, UK
| | - Ashley Akbari
- Swansea University Medical School, Swansea University, Swansea, UK
| | | | - Jeremy Dale
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Lucy Dixon
- Public Contributor, SUPER group, Swansea, UK
| | | | - Bridie Evans
- Swansea University Medical School, Swansea University, Swansea, UK
| | | | - Ann John
- Swansea University Medical School, Swansea University, Swansea, UK
| | | | | | - Ronan Lyons
- Swansea University Medical School, Swansea University, Swansea, UK
| | | | - Bernadette Sewell
- College of Human and Health Sciences, Swansea University, Swansea, UK
| | - Anthony Whiffen
- Administrative Data Research Unit, Welsh Government, Cardiff, UK
| | | | - Helen Snooks
- Swansea University Medical School, Swansea University, Swansea, UK
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