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Not by choice – the unequal impact of the COVID-19 pandemic

A recent comprehensive report by UCL researchers in collaboration with the Race Equality Foundation and charity Doctors of the World revealed that the COVID-19 pandemic disproportionately affected ethnic minority and migrant communities.

The report drew its data from UCL’s Virus Watch study, which regularly surveyed a cohort of 60,000 people in England and Wales during the pandemic.

The report found that ethnic minorities and migrants faced an increased risk of infection, hospitalisation, and death, as well as limited access to sick pay, inadequate support schemes and unequal vaccination coverage.

The report called for evidence-based policies and inclusive approaches to address systemic barrier to healthcare access and tackle the underlying social determinants of health. It emphasised the need for targeted interventions and public health campaigns to raise awareness and mitigate the disproportionate impact of COVID-19 on ethnic minority and migrant communities. Additionally, implementing inclusive and accessible sick pay policies, strengthening support schemes as well as ensuring equitable vaccine distribution, were highlighted as essential measures to protect these vulnerable populations.

This work has been reported on: Medical Express, my Science, Mirage News.

For a link to the full report please see: https://raceequalityfoundation.org.uk/health-and-care/not-by-choice-the-unequal-impact-of-the-covid-19-pandemic/

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What are the effects of anti-spike antibody levels on SARS-CoV-2 infection risk?

A rendering of a SARS-CoV-2 molecule
Image Credit: Naeblys/Shutterstock

A sub-cohort of Virus Watch participated in monthly at-home capillary blood sampling to test for antibodies to SARS-CoV-2. Anti-spike and nucleocapsid antibody titers were measured using Elecsys anti-spike and -nucleocapsid electro-chemiluminescent immunoassays. 

A breakthrough infection was defined as a positive SARS-CoV-2 test in double-vaccinated individuals occurring at least 14 days after the second vaccination. First, antibody waning was estimated by comparing anti-spike antibody levels in ChAdOx1 and BNT162b2 recipients by sex, age, clinical vulnerability, and time since vaccination.

Nearly 25,000 samples from more than 9400 individuals were included in the analysis of anti-spike antibody decay; most people (5960) received a second dose of ChAdOx1, and 3490 received BNT162b2, and 2% of the cohort received different first and second doses. 

The study found that anti-spike antibody levels peaked after three- or four weeks post-administration of the second dose, with the geometric mean being nine-fold higher for BNT162b2 than ChAdOx1. A substantial waning of anti-spike levels was evident after administering either vaccine. Notably, higher anti-spike levels were associated with a lower risk of vaccine breakthrough infection.

The team included 9244 subjects in the analysis of the effect of anti-spike antibody levels on SARS-CoV-2 infection risk. There was no association between second dose vaccine type and anti-spike levels. Overall, the antibody waning analysis findings suggested that ChAdOx1 recipients were at an elevated risk of breakthrough infection. This was further confirmed by the test-negative case-control analysis, which revealed that recipients of two ChAdOx1 doses had 1.64 increased odds of breakthrough infection relative to double-vaccinated BNT162b2 recipients.  

This work has been reported on here: 

https://www.news-medical.net/news/20220823/What-are-the-effects-of-anti-spike-antibody-levels-on-SARS-CoV-2-infection-risk.aspx

For a link to the full article please see: https://www.nature.com/articles/s41467-022-32265-5

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Study finds a significant reduction in the risk of COVID-19 infection among those who always wear glasses.

A woman wearing glasses taking off a mask
Image Credit: DimaBerlin/Shutterstock

This study hypothesized and evaluated the use of spectacles in a community context for minimizing the likelihood of COVID-19. 

Among the 58,670 volunteers of the Virus Watch cohort, the researchers invited 31,749 participants to answer a monthly survey about contact lenses and spectacle use, and 19,166 responded to this questionnaire. The questionnaire covered topics including purpose, frequency of use, and probability of using a face mask with spectacles.

While 22.99% of people who never wore spectacles for general use had COVID-19, only 15.63% of those who constantly wore spectacles for regular use were SARS-CoV-2-infected. The multivariate regression model controlled for gender, income, age, and occupation and depicted a 15% lower chance of COVID-19 for individuals who reported wearing spectacles constantly for general usage than people who had never worn spectacles. A similar observation was found in those using spectacles always for reading and other particular activities.

The study findings demonstrated that individuals who use spectacles had a lower chance of SARS-CoV-2 infection than non-spectacle users. However, the protective effect against COVID-19 was not observed in contact lens users. 

Overall, the present research indicates the relevance of the eye as a portal for SARS-CoV-2 infection. The authors found a moderate decline in the chance of COVID-19 in individuals who wore spectacles. This research extrapolated the existing evidence of the SARS-CoV-2 infection through the eyes in the hospital setting to a community context. 

This work has been reported on here:

https://www.news-medical.net/news/20220407/Study-finds-a-significant-reduction-in-the-risk-of-COVID-19-infection-among-those-who-always-wear-glasses.aspx

For a link to the full article please see: https://www.medrxiv.org/content/10.1101/2022.03.29.22272997v1 

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Inequalities in access to paid sick leave among workers in England and Wales

A London waiter setting a table.
Photograph: Damien Eagers/PA

It is poorly understood which workers lack access to sick pay in England and Wales. This evidence gap has been of particular interest in the context of the Covid-19 epidemic given the relationship between presenteeism and infectious disease transmission.

Using a Virus Watch study sub-cohort of 8,874 workers, we found stark inequalities in access to paid sick leave among workers in England and Wales. Older workers, workers from certain minority ethnic backgrounds, workers in low-income households and those in working class occupations are more likely to lack access to paid sick leave.

Policymakers should consider expanding access to sick pay to mitigate transmission of Covid-19 and other infectious disease epidemics in the community as we ‘learn to live with Covid’.

This work has been extensively reported by the media:

Online: The Guardian, The Morning Star, Working Wise, People Management, HR Review, London News Time, The Big Issue 

Broadcast: Sky News, Times Radio, GB News, syndicated to LBC 

Print coverage: The Guardian (editorial p2); Yorkshire Post (p4); The Metro (London), Lancashire Evening Post, Blackpool Gazette, Newcastle Evening Chronicle, The Courier, Belfast Newsletter, Big Issue

Political: SNP work and pensions spokesperson calls on government to improve sick pay after ‘damning report from IPPR’; press response from Unison chief executive; press response from USDAW union; response from TUC; response shadow DWP minister Jon Ashworth; Labour’s Andy McDonald shares IPPR’s tweet

For a link to the full article please see:

https://www.medrxiv.org/content/10.1101/2022.01.30.22270112v1

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Comparative effectiveness of booster vaccines

Photograph: Corona Borealis Studio/Shutterstock

The Omicron variant has increased SARs-CoV-2 infections in double vaccinated individuals globally. People that had received a double dose of the Oxford/AstraZeneca vaccine, had a 35% (95%CI: 15% – 58%) increase in SARs-CoV-2 infections when compared to people that received two doses of BioNTech/Pfizer. To tackle rising infections, the UK accelerated booster vaccination programmes used mRNA vaccines (BioNTech/Pfizer & Moderna) irrespective of an individual’s first two vaccine types.

We analysed a total of 19,692 participants who received their booster vaccination between September 16th 2021 and January 5th 2022.

After adjusting for age, sex, clinical vulnerability status, and socioeconomic status, we found no difference between the risk of infection of SARs-CoV-2 between those who received different COVID-19 vaccines as their primary course in addition to an mRNA-based booster vaccine.

Our findings demonstrate the importance of booster (third) doses to maintain protection and suggest that these should be prioritised to those who received Oxford/AstraZeneca as their primary course.

This work has been reported on here:

https://www.news-medical.net/news/20220208/Study-highlight-benefit-of-mRNA-boosters-for-SARS-CoV-2-following-different-initial-vaccine-types.aspx

For a link to the full article please see:

https://www.medrxiv.org/content/10.1101/2022.02.04.22270479v1

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Observational analysis of nucleocapsid and spike antibody responses post-SARS-CoV-2 infection

A computer rendering of a SARS-CoV-2 particle
Image Credit: Kateryna Kon/Shutterstock

In the early stages of the pandemic, it was thought that antibodies produced post-infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) provide a certain degree of protection against reinfection for at least six months.

COVID-19 vaccines only stimulate anti-S antibodies. Measurement of both anti-S and anti-N antibodies is required to distinguish antibodies derived from natural infection and vaccination.

This study investigated anti-S and anti-N trends in individuals with antibody results from 1 to 540 days since PCR confirmed infection. Researchers observed that approximately 4 out of 5 individuals were seropositive for anti-N at any point between 0 to 269 days after testing positive for COVID-19. 35-49-year-olds showed higher odds of a positive anti-N result than individuals aged 18 and 34 years.

Scientists stated that antibody positivity could be influenced by the viral load during infection. The data presented here are from a community cohort study, which means that the symptom profiles could be less severe among the participants when contrasted with hospital-based longitudinal studies.

Individuals aged 18-49 years had an earlier peak and antibody waning. Anti-N positivity was observed longer in older people who had significantly more comorbidities and, therefore, had a higher likelihood of experiencing the severe disease.

The proportion of seropositive anti-N samples was 42.6% between days 0-29. This increased to 80% from day 30 onwards. These numbers are lower than other studies that considered hospitalized patients for the study. The difference in anti-N as observed in the data was disaggregated by sex, with earlier peak and waning in females. A meta-analysis showed that men were 2.41 times more at risk of developing severe disease than women.

Scientists concluded that seroprevalence studies on anti-N alone may underestimate the true cumulative incidence of infection. They showed a decline in anti-N levels from 120 days onwards and, therefore, provided new insights into the limitations of seroprevalence studies. As the duration of anti-N positivity is influenced by age and sex, serosurveillance might require shorter time windows of testing post-SARS-CoV-2 infection.

This work has been reported on here: 

https://www.news-medical.net/news/20220204/Observational-analysis-of-nucleocapsid-and-spike-antibody-responses-post-SARS-CoV-2-infection.aspx

For a link to the full article please see: 

https://www.ijidonline.com/article/S1201-9712(22)00449-0/fulltext

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Vaccine antibody levels start to wane at around 2-3 months

Image: “Vaccine, covid-19, vials, vaccination”: Credit torstensimon on Pixabay, CC BY 2.0

Total antibody levels appear to start declining at 2-3 after complete vaccination and can reduce by more than 50% over 10 weeks, according to new data from Virus Watch.

The clinical implications of waning antibody levels are not yet clear, but some decline was expected and current research shows that vaccines remain effective against severe disease. 

The findings, published as a research letter* in The Lancet, include data from over 600 people taking part in Virus Watch.

You can read details of this analysis here:

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01642-1/fulltext

This work was reported on by multiple print and online media see links below. 

https://www.ucl.ac.uk/news/2021/jul/vaccine-antibody-levels-start-wane-around-2-3-months

https://www.theguardian.com/world/2021/jul/22/uk-scientists-back-covid-boosters-as-study-finds-post-jab-falls-in-antibodies

https://www.nature.com/articles/d41586-021-02158-6

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What Virus Watch Helped Us Learn About COVID-19 In The Last Year

June marks 12 months since we launched Virus Watch to undertake research to help stop the spread of COVID-19. Our last research study carried out during the influenza pandemic in 2009 had 1,460 households and 3,552 people take part, so when we launched Virus Watch with the aim of recruiting 25,000 people we worried we had set an overly ambitious target.  As of the 21st June 2021, we are proud to say that 50,759 people across England and Wales have joined the study.  Thank you for being a part of that support, the larger size of the study really improves the quality of the work we can do! 

The vaccination rollout has been a great success, but we know that Covid-19 will continue to circulate in society. So while this is the case, it remains really important to increase our understanding of the virus as there remains quite a lot of uncertainty about what will happen with COVID-19 in England and Wales over the next 12 months. With your help, we are going to continue the study and provide vital research that can continue to help stop its spread in the UK and elsewhere around the world. You’ll continue to receive our weekly and monthly surveys and we would be extremely grateful if you carry on participating in Virus Watch by filling them in. 

This one-year milestone is a good time to reflect on what your contributions to Virus Watch have helped us understand. We’ve been regularly publishing updates about our findings on the study website, in scientific journals, and sharing them with policymakers – so these are having a direct effect on how the UK research community understands the virus and how the government has responded.

Here are just a few highlights from our research over the last year that have only been possible because of your participation:

  • We understand how levels of cough, fever, and loss or change to a sense of smell and/or taste have changed across the year as well as the timing and severity of COVID-19 symptoms. We found that common symptoms such as cough, headache, fatigue, muscle aches and loss of appetite occurred early in the course of a COVID-19 illness but were also very common in COVID-19-negative illnesses. Rarer symptoms such as fever or loss or altered sense of smell or taste were often not present but were markedly more common in COVID-19 positive compared to COVID-19 negative cases.
  • We’ve been undertaking regular analyses of the contact and activities data we ask you to tell us about each month. By November 2020 we were able to understand the number and type of contacts people had just prior to developing symptoms. 
  • In January 2021 we used the latest data you sent us to look at the levels of essential activities (like food shopping) people had to carry out during lockdown.
  • We’ve been using the results from the vaccine evaluation study (monthly finger prick antibody blood tests) to understand responses following first and second doses of AstraZeneca and Pfizer vaccines. We observed some differences in antibody levels after the first dose by vaccine type, age, and health conditions, but found high antibody positivity rates for nearly all individuals after a second dose. These results really helped reinforce the importance of everyone getting the second dose of the vaccine and this research was widely covered in the news.
  • We asked you ‘Would you accept a COVID-19 vaccine if offered?’ in December 2020 and again in February 2021 and used this data to show that the majority of people who were uncertain about taking, or intended to refuse, a COVID-19 vaccine in Dec 2020 had changed their mind in March 2021 – this was incredibly helpful to demonstrate the changing public opinion. 
  • We’ve examined the important topic of long COVID in children and found that the risk of reporting persistent symptoms was twice as high in children who had tested positive for COVID-19 virus than in children who had not, although the actual proportion of children reporting persistent symptoms was low. 
  • We’ve asked people in Virus Watch that have had COVID-19 “Where do you think you caught Covid-19?” and the findings illustrate the importance of home, work and place of education as venues for the spread of COVID-19.
  • Finally, we’ve recently published some results using data collected from Virus Watch participants who volunteered to use a mobile tracking app as part of our research. Using these data we looked to see if having the first dose of the vaccination had an effect on travel behaviour, but did not find any change in travel patterns after vaccination. 

These findings represent just a small fraction of the work we’ve been doing over the last year thanks to all of your contributions. We’re extremely grateful for all the time and effort of all participants.

We look forward to continuing this crucial research over the coming 12 months.

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B.1.1.7 (Kent Variant) not associated with change in serial interval of COVID-19

Image Credit: NIAID-RML

The Virus Watch study in England and Wales, found that the serial interval of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is broadly similar to estimates from previous studies and there is no evidence that the B.1.1.7 variant first detected in the U.K. (locally known as the Kent Variant) is associated with any change.

Serial interval is an estimation of the spread of the disease and is often measured as the time interval between symptom onset in a primary case and the onset of symptoms in the secondary cases infected by the primary case. Serial interval is an important parameter used in disease transmission models and can help guide control strategies.

Apart from the serial interval, the doubling time of disease also depends on the reproduction number (R). Diseases that have a shorter serial interval but similar R values will have shorter doubling times.

This work has been reported on here:

https://www.news-medical.net/news/20210519/B117-not-associated-with-change-in-serial-interval-of-COVID-19.aspx

For a link to the full article please see:

https://www.medrxiv.org/content/10.1101/2021.05.17.21257223v1

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Covid vaccine: 96% of Britons develop antibodies after one jab, study finds

Results show Pfizer/BioNTech and Oxford/AstraZeneca jabs are proving highly effective

The findings, based on a study of 8,517 people in England and Wales, are the latest evidence to show that the two mainstays of Britain’s vaccine drive are proving highly effective.

The research found that 96.42% of people who had either vaccine had developed antibodies 28 to 34 days after their first dose. That rose to 99.08% within seven to 14 days of the second jab.

The UCL Virus Watch data shows that for older adults and for people with underlying health conditions, the antibody response is a bit weaker after the first dose of the vaccine, but strong after the second dose.

This work was reported on by multiple print and online media see links below.  You can read details of this analysis here: https://www.medrxiv.org/content/10.1101/2021.05.12.21257102v2

https://www.theguardian.com/world/2021/may/18/96-of-britons-develop-antibodies-after-one-covid-jab-study-finds?CMP=Share_iOSApp_Other

https://metro.co.uk/2021/05/18/covid-uk-george-eustice-says-local-lockdowns-cant-be-ruled-out-14599192/

https://www.standard.co.uk/news/uk/antibodies-covid-vaccine-uk-first-dose-pfizer-astrazeneca-b935709.html

https://www.forbes.com/sites/roberthart/2021/05/18/96-of-people-develop-covid-antibodies-after-just-one-shot-of-pfizer-or-astrazeneca-vaccine-uk-study-finds/?sh=6239aec9699b

https://www.dailymail.co.uk/news/article-9590883/More-96-Britons-develop-Covid-antibodies-one-dose-vaccine.html?ns_mchannel=rss&ns_campaign=1490&ito=1490