MRC/CSO Social and Public Health Sciences Unit

• Ethnic and socioeconomic differences in SARS-CoV-2 infection: prospective cohort study using UK Biobank (published in BMC Medicine). This study found that black and south Asian ethnic groups have a higher risk of testing positive with SARS-CoV-2, the virus which causes COVID-19. These groups were also at a higher risk of testing positive while attending hospital, suggesting they were also at greater risk of severe disease from the virus. This higher risk was not accounted for by differences in socioeconomic conditions, self-reported health or behavioural risk factors.
• Mitigating the wider health effects of Covid-19 pandemic response (published in the BMJ). Health inequalities are likely to widen without action to support those most vulnerable to the effects of social distancing measures. These effects have numerous mechanisms, including economic, social, health related behaviours, and disruption to services and education.
• Vitamin D concentrations and COVID-19 infection in UK Biobank (published in Diabetes & Metabolic Syndrome: Clinical Research & Reviews). The findings do not support a potential link between vitamin D concentrations and risk of COVID-19 infection, nor that vitamin D concentration may explain ethnic differences in COVID-19 infection.
• Black, Asian and Minority Ethnic groups in England are at increased risk of death from COVID-19: indirect standardisation of NHS mortality data (published in Wellcome Open Research). The analysis adds to evidence that BAME people are at increased risk of death from COVID-19 even after adjusting for geographical region, but was limited by the lack of data on deaths outside of NHS settings and ethnicity denominator data being based on the 2011 census. Despite these limitations, there is an urgent need to take action to reduce the risk of death for BAME groups and better understand why some ethnic groups experience greater risk. 
• BMI and future risk for COVID-19 infection and death across sex, age and ethnicity: Preliminary findings from UK Biobank (published in Diabetes and Metabolic Syndrome: Clinical Research & Reviews). BMI was associated strongly with positive test, and risk of death related to COVID-19. Obesity was more strongly linked to COVID-19-related deaths in younger people and non-white ethnicities. 
• Mental health and health behaviours before and during the initial phase of the COVID-19 lockdown: longitudinal analyses of the UK Household Longitudinal Study (published in Journal of Epidemiology and Community Health). During the UK coronavirus 'lockdown', smoking declined, but adverse alcohol use generally increased. The study also found that psychological distress markedly increased during the first month of lockdown, with women and younger people particularly adversely affected.
• Official report from Social & System Recovery - Environment and Spaces Group published by Public Health Scotland explores the change in use of green and open space following the COVID-19 lockdown. 
• Occupation and risk of severe COVID-19: prospective cohort study of 120,075 UK Biobank participants (published in Occupational and Environmental Medicine). Healthcare workers are seven times as likely to have severe COVID-19 infection as those with other types of ‘non-essential’ jobs. The study found those with jobs in the social care and transport sectors are twice as likely to have severe COVID-19, emphasising the need to ensure that key workers are adequately protected against the infection.
• Modifiable and non-modifiable risk factors for COVID-19, and comparison to risk factors for influenza and pneumonia: results from a UK Biobank prospective cohort study (published in BMJ Open). Findings suggest that modification of lifestyle may help to reduce the risk of COVID-19 and could be a useful adjunct to other interventions, such as social distancing and shielding of high risk.
• Correspondence to the EJPC in response to position paper by Ambrosetti M et al. 2020: Cardiovascular rehabilitation and COVID-19: The need to maintain access to evidence-based services from the safety of home (published in European Journal of Preventive Cardiology). 
• Impact of COVID-19 restrictions on pre-school children’s eating, activity and sleep behaviours: a qualitative study (pre-print). Children’s activity, screen time, eating, and sleep routines had some level of disruption during COVID-19 restrictions. Parents reported children ate more snacks during lockdown, but also spent more time preparing meals and eating as a family. Most parents reported a reduction in their children’s physical activity and an increase in screen time, which some linked to difficulties in getting their child to sleep.
• Exploring the effectiveness of a COVID-19 contact tracing app using an agent-based model (published in Scientific Reports). Findings suggest that COVID-19 smartphone apps can contribute to epidemic mitigation at any adoption level, but their efficacy strongly depends on the availability of testing and testing policy. The model also suggests that digital contact tracing is more effective when the virus circulates the most, i.e. when lockdown restrictions are relaxed.
• The inverse care law in critical care during the COVID-19 pandemic (commentary published in The Lancet Regional Health-Europe). 
• Effectiveness of First Dose of COVID-19 Vaccines Against Hospital Admissions in Scotland: National Prospective Cohort Study of 5.4 Million People (Preprints with The Lancet). Findings suggest that vaccination has been linked to a substantial reduction in the risk of COVID-19 admissions to Scotland’s hospitals.
• Predictors of COVID-19 vaccine hesitancy in the UK Household Longitudinal Study (published in Brain, Behavior, and Immunity). This study found willingness to be vaccinated was generally high across the UK population but vaccine hesitancy exists in population subgroups. Black and Pakistani/Bangladeshi ethnic groups had higher vaccine hesitancy, as did people with lower education levels.
• Ethnicity, household composition and COVID-19 mortality: a national linked data study (published in the Journal of the Royal Society of Medicine). Findings suggest that elderly adults living with younger people are at increased risk of COVID-19 mortality, and this is a contributing factor to the excess risk experienced by older South Asian women compared to White women. Relevant public health interventions should be directed at communities where such multi-generational households are highly prevalent.
• Disrupted prevention: condom and contraception access and use among young adults during the initial months of the COVID-19 pandemic. An online survey (published in BMJ Sexual and Reproductive Health). This study found that emerging barriers to STI and pregnancy prevention within the context of COVID-19 have the potential to undermine positive sexual and reproductive health practices, and widen inequalities, among young people.
• Unequal impact of the COVID-19 crisis on minority ethnic groups: a framework for understanding and addressing inequalities (Published in Epidemiology and Community Health). The COVID-19 pandemic has highlighted existing health inequalities among ethnic minority groups and exacerbated them. This study found that the unequal impacts of the pandemic can be mitigated, through more comprehensive and evidence informed action at each of the following pathways: differential exposure, differential vulnerability to infection/disease, differential disease consequences, differential social consequences, differential effectiveness of control measures and differential adverse consequences of control measures.
• Psychological distress among people with probable COVID-19 infection: analysis of the UK Household Longitudinal Study (published in BJPsych Open). Findings suggest that COVID-19 infection could lead to an increase in clinically significant psychological distress that persists months after infection and is additional to the mental health impact of societal changes during the pandemic.
• Tracking the mental health of home-carers during the first COVID-19 national lockdown: evidence from a nationally representative UK survey (published in Psychological Medicine). The study found that the mental health of home-carers deteriorated more during lockdown than non-carers. Policies that reinstate support for them and their care-recipients will benefit the health of both vulnerable groups.
• Remote history of VTE is associated with severe COVID-19 in middle and older age: UK Biobank cohort study (published in Journal of Thrombosis and Haemostatis). Venous thromboembolism (VTE) is a common, life-threatening complication of COVID-19 infection. The findings support inclusion of remote history of VTE in COVID-19 risk-prediction scores, and consideration of sex-specific risk scores.
• Risk of mortality among inpatients with COVID-19 and type 2 diabetes: National data from Kuwait (published in Endocrinology, Diabetes and Metabolism). Type 2 diabetes is a strong risk factor for COVID-19 death in the Middle East. Given the high prevalence of type 2 diabetes in the Middle East, as well as many Western countries, the public health implications are considerable.

• Exploring Inequalities in COVID-19 in Scotland. Vittal Katikireddi (lead), Kirsten Hainey, Paul Henery.

During the Covid-19 pandemic, research in England has identified certain groups in the population, who have been more adversely affected by Covid-19, both in the risk of infection and the risk of severe illness and death. Individuals in minority ethnic groups and those living in more deprived areas have been identified as at higher risk of Covid-19. The evidence of such patterns in Scotland is limited, but more research is required. Our research aims to explore the risk of Covid-19 in these groups in the Scottish population. The findings of our research will be used to inform healthcare planning and policy in Scotland.

Read more.

• Impact of school closures on socioeconomic inequalities in children's wellbeing and development, led by Peter Craig.

Over 100 countries, including the UK, have closed schools as part of their social distancing measures during the coronavirus pandemic. A possibly severe unintended consequence of school closures is a widening of educational inequalities, with implications for health inequalities down the line. Research in countries with a long summer break suggests that differential attainment losses account for a substantial fraction of total educational inequalities. Although UK schools have a relatively short summer holiday, the COVID-19 related closures will lead to (at least) a 3-4 month break from classroom teaching for most children, and the possibility of further disruption after that.

A range of surveys in the UK have reported widely varying levels of support for home schooling between pupils at private and publicly-funded schools, and between schools within the public sector.

The suspension of much education testing and survey fieldwork will make impacts difficult to measure directly, but it may be possible to get useful insights into possible consequences from existing data. Our study includes  (1) a rapid scoping review of the international evidence of differential attainment loss; (2) analysis of cognitive and social development measures for 5, 7, 11 and 13 year olds in the Millennium Cohort Study to identify whether disparities (e.g. by parental income or education) widen between the last month prior to the summer break and the first month after, and whether the pattern changes as children get older.

Read our consultation response to the UK Parliament Education Committee on the effects of school closures during the pandemic.

• Assessing policy to address the medium-run impact of COVID-19 on income and health inequality with models informed by the history of disease outbreaks. Rebecca Mancy (Co-I. PI is Konstantinos Angelopoulos)  

This project will model the evolution of inequalities in income, wealth and health following COVID-19, as informed by historical disease outbreaks, and use the models developed to assess mitigation policies. We will develop models of income, wealth and health inequality in the UK. Our models will be used to examine the effects of tax and benefits policies, as well as public health interventions, therefore informing a better policy response to the inequality impacts of COVID-19. This grant is funded by ESRC as part of UK Research and Innovation’s rapid response to COVID-19. Briefing: Post-pandemic mortality dynamics - historical city-level evidence was published in September 2020.

• Investigating incidence, severity and risk factors for COVID-19 in BAME and Migrant groups to inform public health action. Vittal Katikireddi (Co-I. PI Rob Aldridge, UCL)  

This project aims to better understand the impact of COVID-19 on minority ethnic and migrant groups and how to tackle it in community settings. The study will build on ‘Virus Watch’, which was previously funded by UKRI and NIHR to study 25,000 individuals across the country in a nationally representative household cohort to monitor spread of the novel coronavirus across England. This funding will enable the recruitment of approximately 12,000 more people from minority ethnic and migrant groups. Their symptoms will be followed over time and subsets of participants will receive antigen and antibody tests and they will study factors such as household transmission, occupation, co-morbidities, healthcare usage, and mental health and economic impacts. Separately, the project also utilise the Million Migrant Cohort study of healthcare and mortality outcomes in non-EU migrants and refugees to England since 2015. In collaboration with Public Health England, the team will link this with data on COVID-19 diagnosis and hospitalisation to determine how often these groups are diagnosed, hospitalised and die with COVID-19 and how this is affected by their socioeconomic situation and pre-existing health conditions. Read the news story on UKRI website: Multimillion investment in six new research projects to investigate COVID-19 and ethnicity.

• GCRF ARISE hub consortium and COVID-19. ARISE Hub team including Linsay Gray, Alastair Leyland, Eliud Kibuchi and Ross Forsyth.

Through the GCRF ARISE hub consortium, we are involved in the conduct of COVID-19 case studies in informal settlements in Bangladesh, India, Kenya and SierraLeone.

The purposes of these community-based participatory research (CBPR) studies are 1) to identify and explore accountability and governance deficits exposed by COVID-19, as well as any new opportunities to address these, in order to inform strategic responses by organisations to address these, within and across local, municipal, national and global spaces; 2) to understand how intersecting social inequalities may shape vulnerabilities and resilience to COVID-19 over time in order to inform efforts to work in an empowering way with the most marginalised; 3) to identify the health and well-being challenges that emerge over time during the pandemic to inform immediate actions in the short term and collective prioritisation for action in the medium term through CBPR cycles.

The COVID-19 case study aims to generate learning across different contexts (spatially) and through the different evolving stages of the pandemic responses (temporally), including documenting the (potential) emergence of new governance actors, modalities or interactions, accountability processes, and shifting health and well-being priorities.

• How has COVID-19 and associated mitigation measures impacted on the mental health of carers? Led by Elise Whitley.

It is estimated that approximately 9 million adults in the UK are carers with around half caring for someone in the same household. In the context of COVID-19, informal live-in carers have been especially important as formal and informal external care and services have been withdrawn. Prior to the pandemic, the mental health of carers was known to be worse than that of the general population and it is therefore important to understand the additional impact of COVID-19 and associated mitigation measures.

• Vittal Katikireddi is a member of SAGE subgroup on ethnicity and COVID-19.
• Ruth Dundas is part of The Scottish COVID-19 Response Consortium (SCRC) - a group of epidemiologists, mathematical modellers, data scientists, software developers and other scientists that have come together to develop new models to help inform the control of COVID-19.
• Vittal Katikireddi is co-chair of the Scottish Government’s Expert Reference Group on ethnicity and COVID-19.
• Eric Silverman is a member of Covid-19 Healthcare Coalition which is developing a decision-support dashboard intended to help policy-makers in the US to monitor the progress of the pandemic at the state and county level throughout the country. Eric is also a member of the Department of Health and Social Care College of Experts, reviewing grant proposals for their Covid-19 rapid-response call.
• Rich Mitchell and Jonathan Olsen are on Public Health Scotland's Social and System Recovery: Environments and Spaces Group. Rich is leading their Evidence and Data subgroup. The group is currently exploring the implications of the COVID-19 pandemic for open spaces, parks, streets and public spaces.
• Elise Whitley is a member of Public Health Scotland’s Mental Health Cell and currently contributing to priority setting for future work and advising on likely data sources for monitoring.
• Vittal Katikireddi is co-chair and Rachel Thomson, Theocharis Kromydas and Peter Craig are members of a group convened by Public Health Scotland to advise the Scottish Government and other stakeholders on the impacts of the COVID-19 response on health and health inequalities that arise through economic and related pathways, and on actions that may mitigate negative impacts and enhance positive impacts. The group has published a briefing looking at protecting the health of the working-age population as lockdown reduces.
• Alastair Leyland and Linsay Gray have joined the DHSC/UKRI Global Effort on COVID-19 Health Research College of Experts.
• Vittal Katikireddi has joined the DHSC/UKRI COVID-19 rapid research funding College of Experts.
• Jonathan Olsen is a member of SS&R Transport - Data and Evidence Sub Group hosted by Public Health Scotland.

• The Schools Health and Wellbeing Improvement Research Network (SHINE) have developed resources to help schools, their students and parents with their response to COVID-19. Visit the SHINE website to download these resources.
• Generation Scotland has launched a CovidLife survey to understand the psychological, social and economic impacts of COVID-19. SHINE is working with Generation Scotland to develop a TeenCovidLife survey for 12-17 years olds to see how COVID-19 is affecting their health and wellbeing, social and home life. Read about the findings. 
• The Transdisciplinary Research for the Improvement of Youth Mental Public Health (TRIUMPH) Network has created a COVID-19 hub with links to organisations who can offer information, mental health advice and support to children and young people, parents/carers, and others involved in supporting young people at this time. You can also read the latest evidence about the impact of COVID-19 on young people’s mental health. The TRIUMPH Network are also collaborating with Oxford Centre for Emotions and Affective Disorders on the Oxford ARC Study. This UK-wide study investigates resilience and how adolescents and their parents/carers are coping with social isolation during the COVID-19 pandemic, with weekly updates from the study published on the study website.
• Ruth Dundas and Alastair Leyland have written a blog contrasting government responses to the COVID-19 pandemic and inequality in the UK. While taking urgent and radical action according to the precautionary principle is entirely appropriate to address the pandemic, they argue that the inequalities challenge is at least as important and thereby should demand a similar urgency and seriousness of response. 
• Umberto Gostoli and Eric Silverman have written a public letter ‘Sound behavioural theories, not data, is what makes computational models useful’ published in Review of Artificial Societies and Social Simulation. 
• Carrie Purcell published an opinion piece on the IRESH website on how access to abortion might be supported during Covid-19.
• Whilst undertaking PhD research, Amrit Purba has written two articles published in Nursing Times discussing a number of approaches which could be adopted to reduce the baseline demand on the NHS and flatten the curve: ‘Enhance the NHS nursing workforce’s contribution to tackle COVID-19’ and 'How should the role of the nurse change in response to COVID-19?'
• Rod Taylor and Carrie Purcell have written a correspondence to the European Journal of Preventative Cardiology on the need to maintain access to cardiac rehabilitation during COVID-19.
• Vittal Katikireddi and IHW's Claire Niedzwiedz have published a piece in the Conversation on why black and Asian people are at greater risk of COVID-19.
• Eric Silverman is a member of Covid-19 Healthcare Coalition which is developing a decision-support dashboard intended to help policy-makers in the US to monitor the progress of the pandemic at the state and county level throughout the country.
• Clinical Research Fellow and PhD student Rachel Thomson has written a blog on her experience stepping back from academia into clinical public health during the COVID-10 pandemic.
• Public Health Scotland has published a briefing looking at protecting the health of the working-age population as lockdown reduces. Vittal Katikireddi, Peter Craig, Theocharis Kromydas and Rachel Thomson are members of the working group behind this briefing.
• Christina McMellon and Alice Maclachlan from TRIUMPH Network have contributed to The Alternative Children’s Rights Impact Assessment (CRIA) on COVID-19 related policy impacting on Scotland’s children and young people. This is an independent assessment of the children’s human rights implications of legislation and policies addressing the COVID-19 pandemic.
• Vittal Katikireddi took part in a BMJ and Independent SAGE public discussion on 7th July, chaired by Fiona Godlee, Editor in chief of The BMJ, asking: Can the British Isles achieve zero Covid-19? 
• Rich Mitchell and Jonathan Olsen have published two reports on the change in use of green and open space following the COVID-19 lockdown. Read Official report from Social & System Recovery - Environment and Spaces Group and COVID-19 Green and Open Space Use in Autumn 2020.
• Marcia Gibson has written a blog for Policy Scotland about whether a basic income could be an effective response to the COVID-19 crisis.
• Alastair Leyland has written a news piece, 'The UK society for social medicine and population health: reflections on COVID-19 in Europe' published in European Journal of Public Health.
• Jamie Lachman has written a correspondence, 'Parenting in a time of COVID-19', published in The Lancet.
• Carrie Purcell, Karen Maxwell, Rachel Wilson-Lowe and Lisa McDaid have responded to a Scottish Government consultation on Future arrangements for early medical abortion at home which sought views on whether temporary arrangements to ensure abortion access during the pandemic should be made permanent.
• COVID-19 engagement tool - this tool aims to start conversations around the wider impact of Covid-19 restrictions on health and society, with a focus on inequalities. The issues covered cut across the Unit’s programmes, and include employment, mental health, the environment and relationships.