Existing statistical methods used to model COVID-19 risk for smaller geographical locations
Policy and control measures, such as local lockdowns, have been informed through the detection of local differences in infection rates, and have been used to help control the spread of COVID-19. However, risk factors such as social deprivation or ethnicity vary over small distances and so risk of COVID-19 needs to be modelled in smaller areas to avoid bias.
Researchers from universities across the UK, including HDR UK’s Richard Fry, Joe Hollinghurst, Daniel Thompson, Chris Orton, Ronan Lyons, David Ford, Aziz Sheikh and Peter Diggle, collaborated to test existing geospatial statistical methods using data from the COVID Symptom Study app and the SAIL databank. Using these methods, which were originally created for global health applications, they demonstrated near-real-time prediction of COVID-19 prevalence in small geographical areas. Additionally, they found it to work well in an anonymised databank environment, which means the privacy of those who contribute their data is maintained.
Pandemic has led to new differences in mental health amongst young adults in BAME populations
Evidence has shown that people from BAME populations have a higher risk of COVID-19 infection and related mortality. A recent study in the US found that COVID-19 has disproportionately added to the mental health burden of BAME populations through increases in perceived racial bias and COVID-19 victimisation – referring to situations in which blame is placed on ethnic minorities for the spread of COVID-19 because the prevalence is higher in BAME populations. It also found evidence that the pandemic, and potentially other infectious disease crises, can reverse the usual protective effects of employment on mental health, as people from BAME populations are more likely to be employed in settings that increase their exposure to infection.
Following the results of this study, the authors suggest a need to create mental health services tailored to the specific needs of racial/ethnic minorities during the COVID-19 pandemic and any other future health crises.
No association between hospital discharge and increase in COVID-19 risk in care homes
Evidence has shown that those living in adult care homes are at greater risk of COVID-19 infection and mortality. To better understand the effects of COVID-19 on care homes, a recent study explored whether there was a link between the number of discharges from hospital to Welsh adult care homes and the subsequent outbreaks of COVID-19.
Using data from a total of 1068 care homes, whilst larger care homes were at a greater risk of a COVID-19 outbreak, the study did not find an association between discharge from hospital and a significant increase in risk. The authors suggest that further research should explore the factors behind residential care outbreaks, including the risks to and from staff and the overlap with other forms of community transmission. They also highlight the need for strict policies on testing and isolation given the high level of risk of an outbreak in residential care if there is an individual who has tested positive for COVID-19.
Reopening secondary schools is likely to have greater impact on community transmission than reopening primary schools
Using data from the UK Department for Education, a recent study explored whether reopening of schools would have an impact on transmission levels. It found that reopening schools for those aged 4-6 years old and 10-11 years old resulted in the lowest risk of transmission between schools and reopening all secondary schools has the potential to result in large clusters of outbreaks putting up to 50% of related households at risk if transmission continued.
As the study suggests that reopening secondary schools will likely have a bigger impact on transmission in the community compared to primary schools, it is vital that transmission with schools is limited to reduce the risk of larger outbreaks amongst school aged children and their households. Given this is an observational study, further research could explore the factors behind this increased risk.
Children and young people have less severe acute COVID-19 than adults
A recent study looked to characterise the clinical features of children and young people admitted to hospital with laboratory confirmed COVID-19 in the UK. This study specifically focused on those aged under 19 years old and researchers, including HDR UK’s Annemarie Doherty and Ewen Harrison, also explored factors related to a multisystem inflammatory syndrome in children and adolescents (MIS-C) that has been associated with COVID-19.
From the 651 children and young people who were part of this study, there were a large proportion of male (56%) and white ethnicity (57%) who were admitted to hospital. Whilst 18% of the children and young people in the study were admitted to critical care, it was associated with those under 1 years old, between 10-14 years old and/or of black ethnicity. The study also found that those with MIS-C were more likely to present with fatigue, headache, myalgia, sore throat, lymphadenopathy (lymph nodes are abnormal in size or consistency) and lower platelet count.
In addition to confirming that children and young people have less severe acute COVID-19 when compared to adults, this study has identified additional characteristics that could be used to better refine the World Health Organisation stated criteria for MIS-C.
Interactive tool highlights the challenges of false positive COVID-19 results
A team, including HDR UK’s Cathie Sudlow, Peter Diggle, David Seymour, Ben Gordon and Rhos Walker, have developed an interactive tool to highlight the challenges that can arise with false positive results in cases where there is large-scale testing of populations. The tool indicates that whilst diagnostic tests may perform well in controlled laboratory conditions, no test is 100% accurate in real-world clinical settings. Even in highly specific tests, the lower the frequency of infection in a population, the higher the proportion of false positive results. This is particularly important to consider given the calls for widespread testing.
Results using the interactive tool show that in areas of low infection frequency, a high percentage of positive results will be false positives. Whilst the study sees the need for population-wide testing in determining local, regional and national policy, it is necessary to consider the importance of extremely high test specificity (the likelihood of providing an accurate result) and confirmatory testing so as to avoid unnecessary restrictions.
Suggestive evidence of association between Vitamin D and the risk or severity of COVID-19
There is existing evidence showing the role of Vitamin D in improving the function of immune cells and poor Vitamin D status has been associated with an increased susceptibility to viral and bacterial respiratory infections. Using data from UK Biobank, a recent study found some evidence that suggests an association between Vitamin D and increased risk or severity of COVID-19. The authors believe that this would therefore be important to consider if a second wave occurs during the autumn or winter months, where natural Vitamin D may be lower. However, further research is needed to better understand and explore the role of Vitamin D in COVID-19 risk and outcomes.
Higher proportion of patients have had “do not attempt CPR” status documented during the pandemic
Cardiopulmonary resuscitation (CPR) is used for patients who go into cardiac arrest. Whilst it is potentially lifesaving, it can cause other issues such as neurological deficits. Additionally, during the COVID-19 pandemic, staff who perform CPR should be wearing full personal protective equipment to reduce the risk of transmission of COVID-19. With this in mind, it does complicate the benefit vs harm balance of performing CPR.
Results from a recent study that analysed data from ‘Do Not Attempt CPR’ forms found that during the pandemic, where decisions about CPR were in a patient’s electronic healthcare record, patients were younger (79 years pre-COVID-19 compared to 74 years during COVID-19), less likely to have various co-morbidities and less likely to have a referral to the palliative care team. The study also found evidence that suggests a change from having these discussions and making decisions only in critically ill patients to a much wider group of inpatients.
Understanding patient preferences around life-sustaining treatment is a key part of shared decision making and the authors see it as beneficial that the discussion about resuscitation is happening with a wider population. However, it is unclear whether these attitudinal changes will be sustained after COVID-19 admissions decrease.
Tweet of the Week
It’s time to highlight the ‘Tweet of the Week’. This week we find out more about how 3 million citizen scientists using the COVID Symptom Study app led to health data helping to identify new COVID-19 symptoms.
More information and tools
1. Submit your research question or project – we are calling on anyone with a research question for COVID-19 that requires health data to share your ideas via our online form.
Questions will be shared in our HDR UK COVID-19 Knowledge + Skills Matchmaker. We prioritise all of the questions using a transparent and objective process to identify the questions that most urgently need to access to data. Progress of the prioritised questions is reported weekly to the government’s Scientific Advisory Group for Emergencies (SAGE).
2. HDR UK GitHub repository – The HDR UK community is developing computer-based tools and methodologies to analyse and handle health data, including those that can help overcome the COVID-19 challenge. These are all shared in a central repository, which is open to the public, so that we can all learn from each other and build on each other’s work. They are shared in HDR UK’s area of GitHub
3. COVID-19 Slack channels – researchers and innovators looking to collaborate to use health data to address the pandemic can apply to join our dedicated Slack channels. Complete the form to register your interest in joining here.
4. Take a look at our Skills + Knowledge Matchmaker to see a full list of COVID-19 ongoing projects, or visit COVID-19 page to see the latest version of HDR UK’s strategy to support efforts to tackle the pandemic.