Rapid response

Since early 2020, the UK has been carrying out wastewater monitoring for COVID-19. Wastewater samples are collected regularly across the country and analysed for SARS-CoV-2, the virus that causes COVID-19. Wastewater monitoring is part of monitoring systems to detect new COVID-19 outbreaks and support test and trace approaches. How can SARS-CoV-2 be detected in wastewater? How can wastewater monitoring be used as part of the response to the COVID-19 outbreak? And how are wastewater monitoring programmes being used across the UK and worldwide?

With several potential vaccines approaching the end of clinical trials, a new focus is how they will be approved for general use. How does this process work? Who will receive the first COVID-19 vaccines when they become available in the UK? What are public attitudes towards a COVID-19 vaccine in the UK?

The COVID-19 Winter Plan, published 23 November, relies on three factors to provide the UK with a “route back to normality”: vaccines, treatments and testing. In addition to PCR testing, lateral flow devices are now being rolled out across England and Wales for the rapid testing of certain occupational groups, community testing and as an alternative to self-isolation following exposure to the virus. How well validated have these tests been? Are they accurate enough for their proposed purposes? And how have they performed to date in mass testing trials?

The use of technology to perpetrate domestic abuse, referred to as tech abuse, has become increasingly common. Domestic abuse charity Refuge reported that in 2019, 72% of women accessing its services said that they had been subjected to technology-facilitated abuse. Common devices such as smartphones and tablets can be misused to stalk, harass, impersonate and threaten victims. Some groups have raised concerns that the growing use of internet-connected home devices (such as smart speakers) may provide perpetrators with a wider and more sophisticated range of tools to harm victims. How is technology being used to perpetrate domestic abuse, how can this be prevented and what role can technology play in supporting victims?

Vaccines are the most powerful tool against infectious diseases, and there are over 200 COVID-19 vaccines in development. Which COVID-19 vaccines are closer to the finish line? Which ones have been approved already for use in humans? When will a vaccine be available in the UK?

People’s behaviour has a major role in the success of test, trace and isolate programmes. Uncertainty about whether to report symptoms, low perceived risk of COVID-19 disease and concerns about the consequences of self-isolation are among the barriers to adherence. Has the Scientific Advisory Group for Emergencies looked at adherence to TTI? What evidence is there on people’s understanding and willingness to be tested, provide contact details and self-isolate? Is there anything that can be done to improve this?

Test, trace and isolate programmes across the UK are under pressure as COVID-19 cases rise in all age groups and demand for tests grows. Further pressure comes from people seeking tests because they have symptoms caused by other respiratory viruses but need a test in order to rule out COVID-19. The Scientific Advisory Group on Emergencies has described the impact of current test and tracing on the transmission of the virus as “marginal”. How does test and trace work and what are the current challenges limiting its effectiveness in reducing COVID-19 cases?

Some occupational groups have experienced higher rates of both COVID-19 infections and related deaths. Many people who work within these groups are involved in caring for people or patients that are more likely to be infected, or have otherwise been unable to work from home during the peaks of transmission. Which occupations have been most affected, what factors are contributing to this risk and are some sectors of the population being impacted more than others?

During the first 6 months of the pandemic, people from ethnic minority groups were more likely to have COVID-19 disease and also more likely to experience severe outcomes from infection, including death. Lockdown measures have also disproportionately affected some communities more than others. What is driving this increased prevalence and death rates in ethnic minority groups? To what extent is it due to biology or pre-existing health? Or does it represent a continuation and exacerbation of social inequalities?

On 9 September, the Prime Minister announced a moonshot plan for mass COVID-19 testing. Recently there have been capacity issues in the NHS Test and Trace programme and current technologies cannot be scaled easily to millions of tests per day. So, how is COVID-19 testing undertaken, how reliable are current tests, and what technologies or strategies are emerging that would make this moonshot feasible?

There is emerging evidence that the COVID-19 outbreak is negatively affecting the mental health and well-being of NHS staff. A greater understanding of these impacts can inform the development of effective interventions to support staff during the current outbreak and beyond.

Testing people to see if they are currently infected or previously infected with SARS-CoV-2, the virus that causes COVID-19, is a key component of medical management, public health monitoring and research. Diagnosing people as having active infections is a fundamental part of any test and contact tracing system. Improving the speed and accuracy of tests that detect current infections is a research priority and the focus of recent UK Government investment and policy decisions. Antibody tests are also an important tool to understand how many people in the population have been infected and how their immune system responded.