Rapid response

Charities and academics have expressed concerns that children’s mental health is disproportionately affected by the intervention measures used during the pandemic. Child and adolescent mental health may be compromised by factors such as strained family relationships, academic stress and reduced social contact with friends. Child and adolescent mental health services (CAMHS) have been reduced during the pandemic. They are likely to be under strain to meet increased demand. The UK Government has announced funding to ensure that charities can continue supporting those in need.

There is very good evidence that children who have COVID-19 are much less likely to develop severe symptoms and much less likely to die from the disease than people in older age groups.There is good evidence that children under 13 years old are less susceptible to developing clinical disease (this means having recognisable signs and symptoms) than adults. It is not yet clear whether this is also the case for older children. There is some research indicating that children aged 13 years and under may be less susceptible to infection than adults, but the confidence in this evidence is low. There is insufficient research to say whether this is the case for older children. There is some evidence to suggest that children transmit the virus less than adults, but more research is needed to reduce uncertainty. Children are more likely to catch an infection from adult(s) in their household. There is evidence that schools are a low-risk environment for transmission. There are some limited data suggesting that children from a black, Asian or minority ethnic background may be at higher risk of severe disease, consistent with evidence for adults. Large and well-designed studies are needed in order to draw firm conclusions. Pregnant women are not more likely to contract the virus. Transmission of the virus from mothers to babies is low. Some babies born to COVID-19 positive mothers will develop an infection; these babies are not at increased risk of severe disease.

The effect of consumers stockpiling certain goods and the slow reaction of retailers to ration them exposed the limitations of cost-efficient and streamlined supply chains to be agile and adapt to unforeseen shocks. This suggests that changes may be needed to make the supply chain more resilient. Specific problems arose from the closure of parts of the catering sector and the lack of agility in redistributing supplies from this sector to retail outlets or the food donation/charity sector. This was due to challenges in packaging availability, logistics and labelling requirements; leading to an increase in food loss. Agricultural food producers and the wider supply chain may have incurred significant losses from the impacts of COVID-19. Food processing facilities have been responsible for a number of localised COVID-19 outbreaks. This may be influenced by a range of factors, including the proximity of workers for prolonged periods, the need to speak loudly to communicate over the noise of the machines or the shared welfare spaces external to the factory setting. The immediate effects of COVID-19 on the food supply system are the current policy concern, but the longer-term food system issues highlighted as a result of the pandemic will have to be addressed by considering how to build resilience to possible future shocks.

There are almost 150 coronavirus vaccine candidates under development. Only 19 of these are now being tested in humans. Many types of vaccines are rapidly progressing through clinical trials. Only two vaccine candidates have announced large scale Phase 3 trials, involving several thousands of people. Only one candidate has been approved for restricted human use. Measuring a reduction in COVID-19 levels is an obstacle for Phase 3 clinical trials, as they require a high infection rate among the tested population to prove vaccine efficacy. International agreements with countries where SARS-CoV-2 infection rates are still high are facilitating those trials. Future challenges in vaccine development include a better understanding of COVID-19 immunity and development of vaccination strategies.

This article was updated on 1 May and again on 6 July. Since its original publication on 17 April, the number of COVID-19 clinical trials has increased from 524 to 2,378. There is no cure for COVID-19. Researchers are testing existing drugs to see if they act against SARS-CoV-2 or alleviate the symptoms of the disease. New drugs are also in development, but this is at a very early stage. Results from trials on existing drugs have already been reported with some positive findings. Dexamethasone is a cheap steroid drug that reduces the risk of death of ventilated patients by 35% and by 20% for patients requiring oxygen therapy. Remdesivir is an antiviral drug; there is good evidence that it can reduce the length of time that hospitalised COVID-19 patients are ill. Negative findings are valuable because they allow researchers to focus on other drugs; there is good evidence that hydroxychloroquine does not offer any benefits to treat COVID-19 patients. Research to see if it might have a protective effect for at-risk groups, such as healthcare workers, is ongoing. There are numerous trials in progress to test a range of drugs that act on the immune system.

Contact tracing apps could be used to control the COVID-19 outbreak. Most of them work by automatically registering another smartphone when it is too close for an extended period of time. Then if a user tests positive for Coronavirus in the future, the contact tracing app notifies these contacts. Some countries like Singapore and Australia have already adopted or rolled out their own contact tracing apps. Concerns have been raised about misuse of personal data. Initial data suggests there has been slow uptake of this new technology by users, and it's unclear if contact tracing apps have had or will have an effect on the pandemic.

An infected person produces respiratory droplets when talking, coughing and sneezing. These are responsible for the transmission of virus between people. Droplets can travel up to 2m, with finer aerosols containing smaller viral particles travelling even further. Numerous complex and interacting factors influence how they move and settle onto surfaces, and how infectious they are. The further away a person is, the fewer droplets they will be exposed to and so their risk of being infected with the virus reduces. The advice on 2 m distancing is a risk assessment based on relative not absolute risk; 2 m does not represent zero risk. Measures to mitigate the increased risk of reducing physical distancing include ventilation, physical barriers (screens and face coverings), reduced building occupancy and enhanced cleaning. These will vary according to the context. The wider range of social distancing practices will need to be maintained to contain viral transmission even if the 2 m advice changes. Social distancing and other public health measures are likely to be needed long-term, until a vaccine or more effective treatments for COVID-19 are available. There are numerous knowledge gaps about SARS-CoV-2 transmission; research to address them will inform policy-making.

There is insufficient scientific evidence to know whether the presence of SARS-CoV-2 antibodies confers protection from subsequent infections, and if so at what level. Antibodies are only one part of the immune response to infection. Tests that detect SARS-CoV-2 antibodies are available. They can determine whether someone has had COVID-19. Tests can reveal those who are unaware that they had COVID-19 because they had mild or no symptoms. Test samples must be analysed in a laboratory – no home tests are authorised for use in the UK. The Government provides antibody tests for NHS and social care staff, hospital patients and care home residents. Commercial test kits are available for private use. These are of varying quality and results must be interpreted with caution. A positive test does not necessarily mean that someone will be protected from subsequent infections. There are concerns that access to private tests of variable quality will discourage the public from practising effective public health measures. Antibody tests are an important tool to understand the spread of the virus and how many people in a population have been infected. They are being used in infection surveillance surveys in the UK and elsewhere.

Scientific understanding of the immune response to COVID-19 is incomplete but numerous research studies are underway. There is little evidence to suggest that exposure to other coronaviruses can confer protection against SARS-CoV-2. There is very good evidence that it takes at least 14 days to develop an antibody response to SARS-CoV-2. A significant proportion of people exposed to SARS-CoV-2 make very little or no detectable antibodies at all. There is insufficient scientific evidence to know whether the presence of SARS-CoV-2 antibodies confers protection from subsequent infections, and if so at what level. The duration of immunity is not clear; long-term monitoring of this in large studies will be needed to provide clarity. Antibodies are only one part of the immune response to infection, which is complex, and understanding the overall immune response to COVID-19 is very important. Additional high-quality research evidence is needed in order to indicate the likelihood of future outbreaks of disease, how often and when they are likely to occur, and to inform the development of any future immunisation programmes.

There is very good evidence that children who have COVID-19 are much less likely to develop severe symptoms and much less likely to die from the disease than people in older age groups. There is good evidence that children under 13 years old are less susceptible to developing clinical disease (this means having recognisable signs and symptoms) than adults. It is not yet clear whether this is also the case for older children. There is some research indicating that children aged 13 years and under may be less susceptible to infection than adults, but the confidence in this evidence is low. There is insufficient research to say whether this is the case for older children. There is some evidence to suggest that children transmit the virus less than adults, but more research is needed to reduce uncertainty. Pregnant women are not more likely to contract the virus. Transmission of the virus from mothers to babies is low. Some babies born to COVID-19 positive mothers will develop an infection; these babies are not at increased risk of severe disease.

The UK Government announced its approach to exiting lockdown on 10 May in a statement by the Prime Minister and in a report published on 11 May. Current models suggest that 5.38% of the UK population has been infected with COVID-19. To lift restrictions the World Health Organisation has outlined key criteria that should guide decision making, such as ensuring that health systems can identify, isolate, test, trace contacts and quarantine COVID-19 cases. Several countries have eased measures with varying success including, Austria, France, Germany, Italy, Spain and China. Other countries such as Sweden and South Korea have taken alternative routes.