TY - JOUR
T1 - Areas of enduring COVID-19 prevalence
T2 - drivers of prevalence and mitigating strategies
AU - Lewis, Catherine
AU - Johnson, Sheena
AU - Hartwig, Angelique
AU - Ubido, Janet
AU - Coleman, Anna
AU - Gartland, Nicola
AU - Kamal, Atiya
AU - Gaokar, Amit
AU - Armitage, Christopher J.
AU - Fishwick, David
AU - van Tongeren, Martie
N1 - Funding Information:
We would like to thank all the individuals and organisations who were involved in the research, especially the Directors of Public Health who took part in the interviews. We would also like to thank the project steering group, including Professor Andrew Curran, Health and Safety Executive (HSE), Professor Martyn Regan, UK Health Security Agency (UKHSA), Eleanor Roaf, Trafford Council, and Professor Arpana Verma, University of Manchester. We would also like to thank Professor Richard Amlot (UKHSA) for editing the reports, Matt Gittins, Sarah Daniels and Laura Byrne for conducting the analysis of differences in infection rates, and Vicky Turner and Helen Kreissl, Thomas Ashton Institute (TAI) for providing administrative support with the research. Armitage is supported by the National Institute for Health and Care Research (NIHR) Manchester Biomedical Research Centre and NIHR Greater Manchester Patient Safety Research Collaboration. The views expressed in this publication are those of the authors and not necessarily those of NIHR.
Funding Information:
This work was supported by funding from the PROTECT COVID-19 National Core Study on transmission and environment, managed by the Health and Safety Executive on behalf of HM Government. The contents of this publication, including any opinions and/or conclusions expressed, are those of the authors alone and do not necessarily reflect HSE policy.
Funding Information:
We would like to thank all the individuals and organisations who were involved in the research, especially the Directors of Public Health who took part in the interviews. We would also like to thank the project steering group, including Professor Andrew Curran, Health and Safety Executive (HSE), Professor Martyn Regan, UK Health Security Agency (UKHSA), Eleanor Roaf, Trafford Council, and Professor Arpana Verma, University of Manchester. We would also like to thank Professor Richard Amlot (UKHSA) for editing the reports, Matt Gittins, Sarah Daniels and Laura Byrne for conducting the analysis of differences in infection rates, and Vicky Turner and Helen Kreissl, Thomas Ashton Institute (TAI) for providing administrative support with the research. Armitage is supported by the National Institute for Health and Care Research (NIHR) Manchester Biomedical Research Centre and NIHR Greater Manchester Patient Safety Research Collaboration. The views expressed in this publication are those of the authors and not necessarily those of NIHR.
Publisher Copyright:
© 2023, The Author(s).
PY - 2023/6/21
Y1 - 2023/6/21
N2 - Background: UK local authorities that experienced sustained high levels of COVID-19 between 1st March 2020 and 28th February 2021 were described by the UK Scientific Advisory Group for Emergencies as areas of enduring prevalence. This research was carried out in order to examine the views of local authority Directors of Public Health, who played a crucial role in the local response to COVID-19, on reasons for sustained high levels of prevalence in some areas, alongside an investigation of the mitigation strategies that they implemented during the course of the pandemic. Methods: Interviews were conducted with Directors of Public Health in 19 local authority areas across England, between July and November 2021. This included nine areas identified as areas of enduring prevalence and ten ‘comparison’ areas. Results: The outcomes of this study suggests that the geographical differences in prevalence rates are strongly influenced by health inequalities. Structural factors including deprivation, employment, and housing, due to their disproportionate impact on specific groups, converged with demographic factors, including ethnicity and age, and vaccination rates, and were identified as the main drivers of enduring prevalence. There are key differences in these drivers both within and, to a lesser extent, between local authorities. Other than these structural barriers, no major differences in facilitators or barriers to COVID-19 mitigation were identified between areas of varying prevalence. The main features of successful mitigation strategies were a locally tailored approach and partnership working involving local authority departments working with local health, community, voluntary and business organisations. Conclusions: This study is the first to add the voices of Directors of Public Health, who played a crucial role in the local COVID-19 response. Areas of enduring prevalence existed during the pandemic which were caused by a complex mix of structural factors related to inequalities. Participants advised that more research is needed on the effectiveness of mitigation strategies and other measures to reduce the impact of structural inequalities, to better understand the factors that drive prevalence. This would include an assessment of how these factors combine to predict transmission and how this varies between different areas.
AB - Background: UK local authorities that experienced sustained high levels of COVID-19 between 1st March 2020 and 28th February 2021 were described by the UK Scientific Advisory Group for Emergencies as areas of enduring prevalence. This research was carried out in order to examine the views of local authority Directors of Public Health, who played a crucial role in the local response to COVID-19, on reasons for sustained high levels of prevalence in some areas, alongside an investigation of the mitigation strategies that they implemented during the course of the pandemic. Methods: Interviews were conducted with Directors of Public Health in 19 local authority areas across England, between July and November 2021. This included nine areas identified as areas of enduring prevalence and ten ‘comparison’ areas. Results: The outcomes of this study suggests that the geographical differences in prevalence rates are strongly influenced by health inequalities. Structural factors including deprivation, employment, and housing, due to their disproportionate impact on specific groups, converged with demographic factors, including ethnicity and age, and vaccination rates, and were identified as the main drivers of enduring prevalence. There are key differences in these drivers both within and, to a lesser extent, between local authorities. Other than these structural barriers, no major differences in facilitators or barriers to COVID-19 mitigation were identified between areas of varying prevalence. The main features of successful mitigation strategies were a locally tailored approach and partnership working involving local authority departments working with local health, community, voluntary and business organisations. Conclusions: This study is the first to add the voices of Directors of Public Health, who played a crucial role in the local COVID-19 response. Areas of enduring prevalence existed during the pandemic which were caused by a complex mix of structural factors related to inequalities. Participants advised that more research is needed on the effectiveness of mitigation strategies and other measures to reduce the impact of structural inequalities, to better understand the factors that drive prevalence. This would include an assessment of how these factors combine to predict transmission and how this varies between different areas.
KW - Community engagement
KW - COVID-19
KW - Deprivation
KW - Employment
KW - Health inequalities
KW - Partnership working
UR - https://www.scopus.com/pages/publications/85163090029
U2 - 10.1186/s12889-023-15723-7
DO - 10.1186/s12889-023-15723-7
M3 - Article
C2 - 37344781
AN - SCOPUS:85163090029
SN - 1471-2458
VL - 23
JO - BMC Public Health
JF - BMC Public Health
IS - 1
M1 - 1203
ER -
