On December 31, 2020 the four UK Chief Medical Officers (CMOs) published a statement announcing changes to the dosing schedule for the second dose of the Pfizer/BioNTech and University of Oxford/AstraZeneca vaccines. It stated that the interval between the first and second dose should be extended from 3–4 weeks to up to 12 weeks. This rapid response examines the evidence behind this decision.
- Over 1,100 experts have shared with us their concerns about COVID-19 and COVID-impacted areas in the immediate and longer term future.
- This report outlines concerns about public health.
- Experts have concerns about future preparedness for public health crises. These include future waves of COVID-19, as well as other potential public health crises. They are interested in seeing how the National Risk Register and Civil Contingencies Act might be updated to reflect lessons learned from COVID-19.
- There are also concerns about physical and mental health of the UK public. It’s unknown how fear and loneliness are affecting people during isolation. It’s also unclear how habits such as smoking, alcohol consumption, and eating have been affected by the outbreak
- Experts are also concerned about health inequalities. They note that some groups, such as people with low incomes, might be more likely to catch the virus and experience worse outcomes.
- Finally there are concerns about housing, and how certain types of housing might increase exposure to the virus, and be overall detrimental to occupants’ health.
- You can find all our horizon scanning work on COVID-19 here.
Our survey of over 1,100 experts asked them what their most important concerns were in the short (next 3 months), medium (next 3 to 9 months) and long-term (beyond the next 9 months) relating to the COVID-19 outbreak. Their responses were analysed and synthesised. This synthesis comes from survey responses submitted between 3 and 30 April. Experts raised 560 concerns relating to public health. Below are the areas of concerns that experts have relating to this area.
Preparedness for public health crises
Over 250 concerns focus on preparedness for future waves of the COVID-19 outbreak and for other potential public health crises. In the medium-term, 60 concerns focus on how to prevent subsequent waves of the COVID-19 outbreak. Experts are concerned that not enough is being done to monitor and prevent future waves. Without a vaccine, experts note that the UK will have to handle waves of infections and they suggest that easing restrictions is likely to trigger waves. Some experts are concerned that there is not a clear plan for how to deal with these waves, especially if there are more infections than the current peak of the outbreak. Experts note that subsequent waves could cause more damage to the economy, health service and communities than the initial one. They want more information about what early warning signs the Government will use to detect subsequent waves. They also want to know what measures will be taken to prevent or limit re-emergence.
In the long-term, nearly 30 concerns focus on what lessons will be learned from the handling of the COVID-19 outbreak. Some experts suggest that there should be an inquiry or report detailing exactly what lessons have been learned and what changes will be made for the future.
In the medium and long-term, experts raise nearly 170 concerns about how the UK will ensure it is prepared for future public health crises. Some experts note that pandemics are listed in the UK’s National Risk Register. However, they suggest that there appears to be a lack of clear mechanisms in place for dealing with the COVID-19 outbreak. Experts are concerned that key changes will not be made to prepare the UK for future public health crises. They suggest various changes that they would expect to see in the future. For example, some want to know how the National Risk Register and Civil Contingencies Act will be amended after the COVID-19 outbreak. Some suggest there has been too much focus over the last few decades on potential terrorist threats and not on public health threats. Some experts suggest that there needs to be greater cooperation globally to ensure international health security and share information about potential public health threats earlier. Other experts suggest the UK needs better warning systems and protocols for when new public health threats emerge globally. Other concerns focus around a lack of clear strategy, data collection, and investment in research and development. Experts suggest that there needs to be money readily available for data collection and research in the event of a public health threat. They also suggest that the UK needs to consider how to make its economy and society more resilient to future shocks, possibly through investment in technology.
Example of a typical long-term concern in this area: How will the ‘preparedness strategies’ be strengthened to ensure improved readiness for future waves of COVID-19 (or similar pandemics) and minimise the economic and public health impact?
Mental health and well-being
Over 190 concerns focus on the effects of the COVID-19 outbreak on mental health and well-being in the short, medium and long-term. Experts are concerned about the potential damage to mental health and well-being caused by fear of the virus and by the restrictions being placed on people to combat it (including social distancing and school closures). They note that isolation and loneliness are generally damaging to people’s mental health and well-being. However, with the whole UK population facing some kind of isolation, the effects on mental health and well-being in the population are unknown. Experts suggest that it is likely to exacerbate the depression and anxiety of those who already have these conditions. They also suggest it is likely to cause an increase in these conditions in the population in the short, medium and long-term.
Some experts note that there could be a rise in the short and medium-term of other issues, such as addiction, self-harm and eating disorders. They note that people with pre-existing conditions (such as addictions, mental health conditions or eating disorders) will not have access to their usual support networks, which could cause relapses. Experts express particular concerns for children and young people, who could be facing isolation from their peers during critical stages of their development. They suggest that children and young people may be at greater risk of developing a mental health condition during or after the COVID-19 outbreak.
Experts raise concerns that there is not enough being done to support mental health in the short-term. For example, some experts note that there is a lack of adequate bereavement support or workplace support for key workers. In the long-term, they suggest that this could lead to an increase in post-traumatic stress disorder (PTSD) and other mental health conditions. They note that mental health services were oversubscribed before the COVID-19 outbreak. In the long-term, these services are likely to have to deal with a backlog of cases as well as an influx of new cases. Experts suggest that there is not currently enough investment in mental health services to cope with this future demand.
Example of a typical long-term concern in this area: We need to recognise that the impact of trauma and lack of normal developmental opportunities on the mental health and wellbeing of children and young people may have lasting effects.
Physical health and fitness
Over 50 concerns focus on the effects of the COVID-19 outbreak on the physical health and fitness of the population. Experts are concerned that, in the short and medium-term, there could be an increase in the levels of smoking and alcohol consumption across the population. They are also concerned that people are more likely to overeat and less likely to eat healthily during this period. They note that some households will struggle to access healthy food. This may be because of difficulties buying fresh produce while self-isolating. It may also be because some people cannot afford to buy high-quality food, especially if they have lost their regular income. Some experts are particularly concerned about families who usually rely on free school meals and/or food banks. Other experts raise concerns about people leading more sedentary lives and exercising less. They are concerned that a combination of unhealthy eating and a lack of exercise could cause a greater percentage of the population to become overweight or obese. Some experts are concerned that there is not enough guidance being given to people about how to remain active and healthy during the COVID-19 outbreak. Experts suggest that there is likely to be a long-term negative effect on the health service from increases in obesity, smoking and alcohol consumption. However, some experts suggest that people may be using more active modes of travel (like cycling and walking) than before. They suggest that the Government should do more to encourage this behaviour in the long-term.
Example of a typical long-term concern in this area: The potential effects on physical and mental health (e.g. sedentary behaviour and chronic disease, obesity, anxiety, depression) due to social distancing measures.
Experts raise 30 concerns about the impact of the COVID-19 on health inequalities (unfair and avoidable differences in health across the population) in the short, medium and long-term. They suggest that health inequalities are likely to widen, with certain groups likely to be affected more by the outbreak than others. Experts note that there are some groups that are likely to catch the virus at higher rates than the general population and also to experience worse outcomes. They expressed particular concern about people with low incomes, people living in more deprived geographic areas, people from minority ethnic backgrounds and people belonging to vulnerable groups (including migrants, refugees, travellers and homeless people). Experts want to know what measures are in place to protect these groups and to ensure that this does not increase health inequalities in the long-term.
Example of a typical short-term concern in this area: I am expecting a crisis in care homes who seem to have been left to their own devices, that BAME key workers, the elderly and disabled people will be disproportionately affected by COVID-19.
Housing and health
Over 20 concerns focus on the impact of housing on health. Experts are concerned that some people’s living situations could leave them at greater risk of contracting/spreading the virus and at greater risk of other mental or physical health conditions. Experts note that overcrowding in homes or blocks of flats may lead to greater transmission of the virus in certain areas. Some experts also note that it is difficult for infected people to isolate easily if they live in a house in multiple occupation (HMO) or in a multi-generational household. Other concerns focus on the quality of UK housing. Experts suggest that some housing may contribute to the spread of the virus and other diseases through poorly maintained ventilation or wastewater systems. Other experts also express concern about people spending more time inside their homes where they are exposed to indoor pollutants and potentially poorer air quality than at a workplace. They suggest this could have unknown long-term health impacts.
Example of a typical short-term concern in this area: The poor quality of much of the housing stock in the UK will mean that extended periods of time spent in home will begin to have wider negative impacts (both physical through Indoor Air Quality, and mental, through crowding, discomfort and stress caused by fuel poverty) on population health.
You can find rapid response content from POST on COVID-19 here.
The body of research investigating the effects of Coronavirus infection on pregnancy is growing. What is the available evidence? How does COVID-19 affect pregnant women and their babies? Is the virus transmitted between mothers and babies? Are some women and babies at greater risk than others?
COVID-19 vaccine roll-out started in the UK on 8 December 2020. Results from Phase 3 clinical trials have been published for all the vaccines approved for use in the UK. But how does the performance of vaccines under real world conditions differ from clinical trial results? When will we able to observe the impacts of the COVID-19 vaccination programme?