Is England's public health nutrition system in crisis? A qualitative analysis of the capacity to feed all in need during the COVID-19 pandemic

Methodology: An exploratory methodology was adopted to examine experiences relating to capability and capacity among formal and informal helpers within the PHN domain. An online survey, mainly open-ended questions, was used to capture experiences over the period 2010 - 2020. A mixed sampling strategy, including snowball and convenience sampling, via social media and social network contact-sharing approaches, was adopted. Data was analysed using an inductive thematic approach. Results: A total of 89 participants representing the PHN system in England were recruited over two months. Three main themes and eight sub-themes were identified. The first reflected unequivocal accounts of the impact of austerity and the inability of PHN services to meet demand for food security. The second articulated capacity and capability issues within the system, with geographical variations in service delivery, and a lack of connectivity between central, local government, and third sector providers. These were attributed to widening nutrition and health inequalities. Participants felt that the government needed to invest more technical and financial resources to support public health nutrition. They also felt that schools could play a larger role at local level, but there was a need for a clear national recovery plan, setting out a comprehensive and fully supported national strategy to eradicate food insecurity in England Conclusions: Further in-depth research is needed to continue to track the impact of recovery strategies on food insecure people and the capacity of the PHN system. Urgent investment in the capacity and coordination of PHN services is needed to support food insecure people in England. The UK could include the ratification of the right to food in national laws, in line with global commitments already agreed to by the UK State Party

'In the wake of a pandemic': dietary patterns and impact on child health after COVID-19

INTRODUCTION Our companion Report: ‘Emerging Dietary Patterns: Impact on Child Health’ discussed ways in which traditional dietary patterns in both the UK and internationally were changing. In concluding we argued that: ‘The interconnected nature of food, climate and health is the biggest challenge we face, but therein also lies its strength and boundless potential should we act with the necessary urgency, creativity and commitment. It is at the local level – supported by national policy – that the largest returns from such pro-activity will accrue.’ We continued: ‘The food that we eat here and now can change the world.’ adding: ‘If we are serious about protecting and restoring natural environments, safeguarding the health and wellbeing of our children today and restoring and protecting that of future generations, then there is only one solution. We must change it.’ Then came Covid-19 and change was imposed – with the arrival and experience of a pandemic. The full outcome of Covid-19; its effects and repercussions not just for the present generations but for the many that will succeed it cannot be estimated now. In the 102 years since Spanish ‘flu devastated an older world order, we are still learning its lessons today. But what has become immediately apparent is that what we eat and how we eat has undergone a revolution in four short months. 6 ‘Coronavirus pandemic will change the food industry and eating habits forever, says CEO of Food and Drink Federation, Ian Wright.’ ([email protected] 7 April 2020) ‘To prevent the next pandemic we must take on factory farming.’ (Jonathan Safran Foer and Aaron Gross, The Guardian, 21 April 2020.) ‘Covid-19 will definitely be an accelerator on the conscious consumer patterns that we see unfolding. As the consumer gets more conscious, we also see more interest in sustainable, locally produced food systems solutions.’ (David Brandes, Food Navigator, 17 April 2020.) ‘The virus is a warning that Britain’s food system must change,’ (‘The Guardian,’ 18th April 2020). It would also be unjust to address the Covid-19 pandemic in isolation without highlighting its interactions with another global force to become manifest in the same era in response to an incident in the US; namely, the police killing of George Floyd and the Black Lives Matter Movement. Pandemics, poor health, systemic inequalities and a lack of environmental protections harm black, ethnic minority and disadvantaged communities in all countries more than any other groups, and the two events have shed a harsh light on those realities and their frightening interconnections – such as the higher death rate in BAME communities including healthcare workers on the frontline (Public Health England, June 2020, ‘Beyond the data: Understanding the impact of COVID-19 on BAME groups’): https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/892376/COVID_stakeholder_engagement_synthesis_beyond_the_data.pdf Therefore, to address fall-out from the pandemic without considering these marginalised groups would be inappropriate; to address the environmental crisis without considering its impact on such groups would be pointless and the separation of civil rights from health and environmental policy is delusional. The silos in which policy-making still exists in these fields are stubborn obstacles to change. Both within and without the UK’s boundaries, the diverse spectrum of peoples requires a similar diversity and inclusion in the systems that sustain life – and the production of the food that is eaten in order to live. Sometimes change is immediate and imposed rather than incremental and the pandemic has seen an abrupt conclusion to familiar and traditional ways of living. As we offer our thoughts about the many ways in which Covid-19 has changed our dietary patterns, we must remember that the ‘brave new world’ of our future ambition ‘has such people in it’, (‘The Tempest’, William Shakespeare). Those who would construct better dietary patterns in the wake of this pandemic must ensure that people rather than systems prevail…

Impact of Trauma System Structure on Injury Outcomes : A Systematic Review and Meta-Analysis

The effectiveness of trauma systems in decreasing injury mortality and morbidity has been well demonstrated. However, little is known about which components contribute to their effectiveness. We aimed to systematically review the evidence of the impact of trauma system components on clinically important injury outcomes. We searched MEDLINE, EMBASE, Cochrane CENTRAL, and BIOSIS/Web of Knowledge, gray literature and trauma association Web sites to identify studies evaluating the association between at least one trauma system component and injury outcome. We calculated pooled effect estimates using inverse-variance random-effects models. We evaluated quality of evidence using GRADE criteria. We screened 15,974 records, retaining 41 studies for qualitative synthesis and 19 for meta-analysis. Two recommended trauma system components were associated with reduced odds of mortality: inclusive design (odds ratio [OR] = 0.72 [0.65-0.80]) and helicopter transport (OR = 0.70 [0.55-0.88]). Pre-Hospital Advanced Trauma Life Support was associated with a significant reduction in hospital days (mean difference [MD] = 5.7 [4.4-7.0]) but a nonsignificant reduction in mortality (OR = 0.78 [0.44-1.39]). Population density of surgeons was associated with a nonsignificant decrease in mortality (MD = 0.58 [-0.22 to 1.39]). Trauma system maturity was associated with a significant reduction in mortality (OR = 0.76 [0.68-0.85]). Quality of evidence was low or very low for mortality and healthcare utilization. This review offers low-quality evidence for the effectiveness of an inclusive design and trauma system maturity and very-low-quality evidence for helicopter transport in reducing injury mortality. Further research should evaluate other recommended components of trauma systems and non-fatal outcomes and explore the impact of system component interactions.Peer reviewe

Impact of Trauma System Structure on Injury Outcomes : A Systematic Review and Meta-Analysis

The effectiveness of trauma systems in decreasing injury mortality and morbidity has been well demonstrated. However, little is known about which components contribute to their effectiveness. We aimed to systematically review the evidence of the impact of trauma system components on clinically important injury outcomes. We searched MEDLINE, EMBASE, Cochrane CENTRAL, and BIOSIS/Web of Knowledge, gray literature and trauma association Web sites to identify studies evaluating the association between at least one trauma system component and injury outcome. We calculated pooled effect estimates using inverse-variance random-effects models. We evaluated quality of evidence using GRADE criteria. We screened 15,974 records, retaining 41 studies for qualitative synthesis and 19 for meta-analysis. Two recommended trauma system components were associated with reduced odds of mortality: inclusive design (odds ratio [OR] = 0.72 [0.65-0.80]) and helicopter transport (OR = 0.70 [0.55-0.88]). Pre-Hospital Advanced Trauma Life Support was associated with a significant reduction in hospital days (mean difference [MD] = 5.7 [4.4-7.0]) but a nonsignificant reduction in mortality (OR = 0.78 [0.44-1.39]). Population density of surgeons was associated with a nonsignificant decrease in mortality (MD = 0.58 [-0.22 to 1.39]). Trauma system maturity was associated with a significant reduction in mortality (OR = 0.76 [0.68-0.85]). Quality of evidence was low or very low for mortality and healthcare utilization. This review offers low-quality evidence for the effectiveness of an inclusive design and trauma system maturity and very-low-quality evidence for helicopter transport in reducing injury mortality. Further research should evaluate other recommended components of trauma systems and non-fatal outcomes and explore the impact of system component interactions.Peer reviewe

SARS-CoV-2-specific nasal IgA wanes 9 months after hospitalisation with COVID-19 and is not induced by subsequent vaccination

BACKGROUND: Most studies of immunity to SARS-CoV-2 focus on circulating antibody, giving limited insights into mucosal defences that prevent viral replication and onward transmission. We studied nasal and plasma antibody responses one year after hospitalisation for COVID-19, including a period when SARS-CoV-2 vaccination was introduced. METHODS: In this follow up study, plasma and nasosorption samples were prospectively collected from 446 adults hospitalised for COVID-19 between February 2020 and March 2021 via the ISARIC4C and PHOSP-COVID consortia. IgA and IgG responses to NP and S of ancestral SARS-CoV-2, Delta and Omicron (BA.1) variants were measured by electrochemiluminescence and compared with plasma neutralisation data. FINDINGS: Strong and consistent nasal anti-NP and anti-S IgA responses were demonstrated, which remained elevated for nine months (p < 0.0001). Nasal and plasma anti-S IgG remained elevated for at least 12 months (p < 0.0001) with plasma neutralising titres that were raised against all variants compared to controls (p < 0.0001). Of 323 with complete data, 307 were vaccinated between 6 and 12 months; coinciding with rises in nasal and plasma IgA and IgG anti-S titres for all SARS-CoV-2 variants, although the change in nasal IgA was minimal (1.46-fold change after 10 months, p = 0.011) and the median remained below the positive threshold determined by pre-pandemic controls. Samples 12 months after admission showed no association between nasal IgA and plasma IgG anti-S responses (R = 0.05, p = 0.18), indicating that nasal IgA responses are distinct from those in plasma and minimally boosted by vaccination. INTERPRETATION: The decline in nasal IgA responses 9 months after infection and minimal impact of subsequent vaccination may explain the lack of long-lasting nasal defence against reinfection and the limited effects of vaccination on transmission. These findings highlight the need to develop vaccines that enhance nasal immunity. FUNDING: This study has been supported by ISARIC4C and PHOSP-COVID consortia. ISARIC4C is supported by grants from the National Institute for Health and Care Research and the Medical Research Council. Liverpool Experimental Cancer Medicine Centre provided infrastructure support for this research. The PHOSP-COVD study is jointly funded by UK Research and Innovation and National Institute of Health and Care Research. The funders were not involved in the study design, interpretation of data or the writing of this manuscript

Large-scale phenotyping of patients with long COVID post-hospitalization reveals mechanistic subtypes of disease

One in ten severe acute respiratory syndrome coronavirus 2 infections result in prolonged symptoms termed long coronavirus disease (COVID), yet disease phenotypes and mechanisms are poorly understood1. Here we profiled 368 plasma proteins in 657 participants ≥3 months following hospitalization. Of these, 426 had at least one long COVID symptom and 233 had fully recovered. Elevated markers of myeloid inflammation and complement activation were associated with long COVID. IL-1R2, MATN2 and COLEC12 were associated with cardiorespiratory symptoms, fatigue and anxiety/depression; MATN2, CSF3 and C1QA were elevated in gastrointestinal symptoms and C1QA was elevated in cognitive impairment. Additional markers of alterations in nerve tissue repair (SPON-1 and NFASC) were elevated in those with cognitive impairment and SCG3, suggestive of brain–gut axis disturbance, was elevated in gastrointestinal symptoms. Severe acute respiratory syndrome coronavirus 2-specific immunoglobulin G (IgG) was persistently elevated in some individuals with long COVID, but virus was not detected in sputum. Analysis of inflammatory markers in nasal fluids showed no association with symptoms. Our study aimed to understand inflammatory processes that underlie long COVID and was not designed for biomarker discovery. Our findings suggest that specific inflammatory pathways related to tissue damage are implicated in subtypes of long COVID, which might be targeted in future therapeutic trials