Is NHS Test and Trace exacerbating COVID-19 inequalities?
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ABSTRACT:
SUBMITTER: Briggs ADM
PROVIDER: S-EPMC7834366 | biostudies-literature | 2021 Dec
REPOSITORIES: biostudies-literature
Publications
Is NHS Test and Trace exacerbating COVID-19 inequalities?
Briggs Adam D M ADM Fraser Caroline C
Lancet (London, England) 20201204 10267
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Project description:Crises lay bare the social fault lines of society. In the United States, race, gender, age, and education have affected vulnerability to COVID-19 infection. Yet, consequences likely extend far beyond morbidity and mortality. Temporarily closing the economy sent shock waves through communities, raising the possibility that social inequities, preexisting and current, have weakened economic resiliency and reinforced disadvantage, especially among groups most devastated by the Great Recession. We address pandemic precarity, or risk for material and financial insecurity, in Indiana, where manufacturing loss is high, metro areas ranked among the hardest hit by the Great Recession nationally, and health indicators stand in the bottom quintile. Using longitudinal data (n = 994) from the Person to Person Health Interview Study, fielded in 2019-2020 and again during Indiana's initial stay-at-home order, we provide a representative, probability-based assessment of adverse economic outcomes of the pandemic. Survey-weighted multivariate regressions, controlling for preexisting inequality, find Black adults over 3 times as likely as Whites to report food insecurity, being laid off, or being unemployed. Residents without a college degree are twice as likely to report food insecurity (compared to some college), while those not completing high school (compared to bachelor's degree) are 4 times as likely to do so. Younger adults and women were also more likely to report economic hardships. Together, the results support contentions of a Matthew Effect, where pandemic precarity disproportionately affects historically disadvantaged groups, widening inequality. Strategically deployed relief efforts and longer-term policy reforms are needed to challenge the perennial and unequal impact of disasters.
| S-EPMC7923675 | biostudies-literature
Project description:Initial COVID-19 containment in the United States focused on limiting mobility, including school and workplace closures. However, these interventions have had enormous societal and economic costs. Here, we demonstrate the feasibility of an alternative control strategy, test-trace-quarantine: routine testing of primarily symptomatic individuals, tracing and testing their known contacts, and placing their contacts in quarantine. We perform this analysis using Covasim, an open-source agent-based model, which has been calibrated to detailed demographic, mobility, and epidemiological data for the Seattle region from January through June 2020. With current levels of mask use and schools remaining closed, we find that high but achievable levels of testing and tracing are sufficient to maintain epidemic control even under a return to full workplace and community mobility and with low vaccine coverage. The easing of mobility restrictions in June 2020 and subsequent scale-up of testing and tracing programs through September provided real-world validation of our predictions. Although we show that test-trace-quarantine can control the epidemic in both theory and practice, its success is contingent on high testing and tracing rates, high quarantine compliance, relatively short testing and tracing delays, and moderate to high mask use. Thus, in order for test-trace-quarantine to control transmission with a return to high mobility, strong performance in all aspects of the program is required.
| S-EPMC8137690 | biostudies-literature
Project description:Testing the uploader tool with COVID-19 data
| PRJEB38185 | ENA
Project description:ObjectivesThe UK government's approach to the pandemic relies on a test, trace and isolate strategy, mainly implemented via the digital NHS Test & Trace Service. Feedback on user experience is central to the successful development of public-facing Services. As the situation dynamically changes and data accumulate, interpretation of feedback by humans becomes time-consuming and unreliable. The specific objectives were to 1) evaluate a human-in-the-loop machine learning technique based on structural topic modelling in terms of its Service ability in the analysis of vast volumes of free-text data, 2) generate actionable themes that can be used to increase user satisfaction of the Service.MethodsWe evaluated an unsupervised Topic Modelling approach, testing models with 5-40 topics and differing covariates. Two human coders conducted thematic analysis to interpret the topics. We identified a Structural Topic Model with 25 topics and metadata as covariates as the most appropriate for acquiring insights.ResultsResults from analysis of feedback by 37,914 users from May 2020 to March 2021 highlighted issues with the Service falling within three major themes: multiple contacts and incompatible contact method and incompatible contact method, confusion around isolation dates and tracing delays, complex and rigid system.ConclusionsStructural Topic Modelling coupled with thematic analysis was found to be an effective technique to rapidly acquire user insights. Topic modelling can be a quick and cost-effective method to provide high quality, actionable insights from free-text feedback to optimize public health Services.
| S-EPMC10719408 | biostudies-literature
Project description:Introduction This study aimed to quantify the impact of the COVID-19 pandemic on access and inequalities in primary care dental services among children and adults in Scotland.Methods Access was measured as any NHS Scotland primary care dental contacts derived from administrative data from January 2019 to May 2022, linked to the area-based Scottish Index of Multiple Deprivation for children and adults, and related to population denominator estimates from National Record Scotland. Inequalities for pre-pandemic (January 2019-January 2020) and recent (December 2021-February 2022, and March 2022-May 2022) periods for both children and adults were calculated and compared using the slope index of inequality and relative index of inequality.Results Following the first lockdown (March 2020) there was a dramatic fall to near zero dental contacts, followed by a slow recovery to 64.8% of pre-pandemic levels by May 2022. There was initial widening of relative inequalities in dental contacts in early 2022, which, more recently, had begun to return to pre-pandemic levels.Conclusion COVID-19 had a major impact on access to NHS primary dental care, and while inequalities in access are apparent as services recover from lockdown, these inequalities are not a new phenomenon.
| S-EPMC10208681 | biostudies-literature
Project description:The test-trace-isolate-quarantine (TTIQ) strategy, where confirmed-positive pathogen carriers are isolated from the community and their recent close contacts are identified and pre-emptively quarantined, is used to break chains of transmission during a disease outbreak. The protocol is frequently followed after an individual presents with disease symptoms, at which point they will be tested for the pathogen. This TTIQ strategy, along with hygiene and social distancing measures, make up the non-pharmaceutical interventions that are utilised to suppress the ongoing COVID-19 pandemic. Here we develop a tractable mathematical model of disease transmission and the TTIQ intervention to quantify how the probability of detecting and isolating a case following symptom onset, the fraction of contacts that are identified and quarantined, and the delays inherent to these processes impact epidemic growth. In the model, the timing of disease transmission and symptom onset, as well as the frequency of asymptomatic cases, is based on empirical distributions of SARS-CoV-2 infection dynamics, while the isolation of confirmed cases and quarantine of their contacts is implemented by truncating their respective infectious periods. We find that a successful TTIQ strategy requires intensive testing: the majority of transmission is prevented by isolating symptomatic individuals and doing so in a short amount of time. Despite the lesser impact, additional contact tracing and quarantine increases the parameter space in which an epidemic is controllable and is necessary to control epidemics with a high reproductive number. TTIQ could remain an important intervention for the foreseeable future of the COVID-19 pandemic due to slow vaccine rollout and highly-transmissible variants with the potential for vaccine escape. Our results can be used to assess how TTIQ can be improved and optimised, and the methodology represents an improvement over previous quantification methods that is applicable to future epidemic scenarios.
| S-EPMC8836351 | biostudies-literature
Project description:BackgroundDuring the COVID-19 pandemic, Test-Trace-Isolate (TTI) programs have been recommended as a risk mitigation strategy. However, many governments have hesitated to implement them due to their costs. This study aims to estimate the cost-effectiveness of implementing a national TTI program to reduce the number of severe and fatal cases of COVID-19 in Colombia.MethodsWe developed a Markov simulation model of COVID-19 infection combined with a Susceptible-Infected-Recovered structure. We estimated the incremental cost-effectiveness of a comprehensive TTI strategy compared to no intervention over a one-year horizon, from both the health system and the societal perspective. Hospitalization and mortality rates were retrieved from Colombian surveillance data. We included program costs of TTI intervention, health services utilization, PCR diagnosis test, productivity loss, and government social program costs. We used the number of deaths and quality-adjusted life years (QALYs) as health outcomes. Sensitivity analyses were performed.FindingsCompared with no intervention, the TTI strategy reduces COVID-19 mortality by 67%. In addition, the program saves an average of $1,045 and $850 per case when observed from the social and the health system perspective, respectively. These savings are equivalent to two times the current health expenditures in Colombia per year.InterpretationThe TTI program is a highly cost-effective public health intervention to reduce the burden of COVID-19 in Colombia. TTI programs depend on their successful and speedy implementation.FundingThis study was supported by the Colombian Ministry of Health through award number PUJ-04519-20 received by EPQ AVO and SDS declined to receive any funding support for this study. The contents are the responsibility of all the individual authors.
| S-EPMC8560002 | biostudies-literature
Project description:There have been calls for some time for a new approach to public health in the United Kingdom and beyond. This is consequent on the recognition and acceptance that health problems often have a complex and multi-faceted aetiology. At the same time, policies which utilise insights from research in behavioural economics and psychology ('behavioural science') have gained prominence on the political agenda. The relationship between the social determinants of health (SDoH) and behavioural science in health policy has not hitherto been explored. Given the on-going presence of strategies based on findings from behavioural science in policy-making on the political agenda, an examination of this is warranted. This paper begins by looking at the place of the SDoH within public health, before outlining, in brief, the recent drive towards utilising behavioural science to formulate law and public policy. We then examine the relationship between this and the SDoH. We argue that behavioural public health policy is, to a certain extent, blind to the social and other determinants of health. In section three, we examine ways in which such policies may perpetuate and/or exacerbate health inequities and social injustices. We argue that problems in this respect may be compounded by assumptions and practices which are built into some behavioural science methodologies. We also argue that incremental individual gains may not be enough. As such, population-level measures are sometimes necessary. In section four we defend this contention, arguing that an equitable and justifiable public health requires such measures.
| S-EPMC6208993 | biostudies-other
Project description:There are many contrasting results concerning the effectiveness of Test-Trace-Isolate (TTI) strategies in mitigating SARS-CoV-2 spread. To shed light on this debate, we developed a novel static-temporal multiplex network characterizing both the regular (static) and random (temporal) contact patterns of individuals and a SARS-CoV-2 transmission model calibrated with historical COVID-19 epidemiological data. We estimated that the TTI strategy alone could not control the disease spread: assuming R0 = 2.5, the infection attack rate would be reduced by 24.5%. Increased test capacity and improved contact trace efficiency only slightly improved the effectiveness of the TTI. We thus investigated the effectiveness of the TTI strategy when coupled with reactive social distancing policies. Limiting contacts on the temporal contact layer would be insufficient to control an epidemic and contacts on both layers would need to be limited simultaneously. For example, the infection attack rate would be reduced by 68.1% when the reactive distancing policy disconnects 30% and 50% of contacts on static and temporal layers, respectively. Our findings highlight that, to reduce the overall transmission, it is important to limit contacts regardless of their types in addition to identifying infected individuals through contact tracing, given the substantial proportion of asymptomatic and pre-symptomatic SARS-CoV-2 transmission.
| S-EPMC10501547 | biostudies-literature
Project description:This paper brings together evidence from various data sources and the most recent studies to describe what we know so far about the impacts of the COVID-19 crisis on inequalities across several key domains of life, including employment and ability to earn, family life and health. We show how these new fissures interact with existing inequalities along various key dimensions, including socio-economic status, education, age, gender, ethnicity and geography. We find that the deep underlying inequalities and policy challenges that we already had are crucial in understanding the complex impacts of the pandemic itself and our response to it, and that the crisis does in itself have the potential to exacerbate some of these pre-existing inequalities fairly directly. Moreover, it seems likely that the current crisis will leave legacies that will impact inequalities in the long term. These possibilities are not all disequalising, but many are.
| S-EPMC7362053 | biostudies-literature