Occupation, Work-Related Exposure, and SARS-CoV-2 Transmission

Background: Early evidence from the Coronavirus Disease 2019 (COVID-19) pandemic suggests that workers differ in their risk of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection and adverse outcomes according to their occupation. The direct contribution of occupation to these inequalities in unclear, given a lack of comprehensively-adjusted estimates. Potential work-related mechanisms underlying differential risk are also poorly understood. / Objectives: This thesis aimed to investigate (1) how SARS-CoV-2 infection risk and (2) features of work-related contact varied between occupations and over time, (3) whether work-related contact mediated the relationship between occupation and infection risk, (4) how vaccination uptake varied across occupations overall and according to vulnerability status and work-related exposure, and (5) how implementation and perception of pandemic mitigation methods varied between occupations and over time. / Methods: All analyses were conducted using data from Virus Watch, a community prospective cohort study in England and Wales. Infection outcomes and vaccination status were ascertained based on linkage, weekly participant self-report, and – for infection outcomes – virological and serological testing within the study. Measures were developed to investigate workplace contact patterns and mitigations. / Results: Frontline workers from several sectors had elevated infection risk compared to office-based professional occupations. Differential risk was most marked in early waves, and only teaching, education, and childcare workers demonstrated elevated risk across all waves. Groups with elevated infection risk also tended to demonstrate greater workplace contact and exposure and, often, lower reporting of mitigations. Work-related close contact was a mediator of infection risk. Occupational differences in vaccination uptake emerged primarily amongst non-vulnerable workers. Workers had a high level of agreement with most mitigations. / Conclusions: Occupation is an important factor influencing SARS-CoV-2 infection risk. Workers differed substantially in workplace exposure, vaccination uptake, and work-related mitigations. Evidence-based suggestions for research and practice are made regarding pandemic preparation and endemic SARS-CoV-2 transmission

A case for interfering with freedom of contract? An empirically-informed study of bans of assignment

Do "bans on assignment" of trade receivables cause serious problems with receivables financing? Should Government render them ineffective? Two empirical investigations suggest that though there are good reasons for using BoAs, they cause disproportionate problems to SMEs needing to factor their debts, and there is a good case for interventio

A case for interfering with freedom of contract? An empirically-informed study of bans on assignment

This article is about clauses in the contracts between a business and its customer which prohibit the supplier assigning receivables arising under the contracts. These clauses are sometimes called “prohibitions on assignment”, sometimes “anti-assignment clauses”; but in the industry it seems most common to call them “bans on assignments” or BoAs. This is how we will refer to them in this article. There is an argument that BoAs do little for the customer while posing a serious problem for small suppliers, and only appear when the customer has the bargaining power to dictate the terms of the contract. This paper draws on empirical work to consider whether, notwithstanding English law’s commitment to commercial parties’ freedom to agree their own terms, there is a case for legislation to render BoAs in contracts for the supply of goods and services ineffective

The impact of COVID-19 on different population subgroups: ethnic, gender and age-related disadvantage

Against a background of stalling UK life expectancy, the COVID-19 pandemic is a major crisis for public health with impacts differing markedly by ethnicity, gender, and age. Direct health impacts include mortality and long-term harms among survivors. Social disruption and lockdown measures arising from uncontrolled infection have destabilised healthcare and other essential services. The economic crisis resulting from the pandemic is already triggering job losses, which will in turn have their own adverse health effects. These myriad impacts of the pandemic are not affecting everyone equally. Ethnic minorities, men and older people have disproportionately suffered from COVID-19, including their risk of mortality. However, some indirect impacts – including those on mental health and employment – are more likely to affect women and younger people. The health consequences of the pandemic will affect the lives of people in the UK for decades

The Sustained Effects of CBT Training on Therapist Competence and Patient Outcomes

The continued effectiveness of in-service psychological therapy training requires evaluation. This study assessed therapist competence and patient clinical outcome during cognitive behaviour therapy training and 12+ months post-training. Trainee competence was assessed using audio-recorded sessions rated on the Cognitive Therapy Scale Revised at the beginning (n = 33) and end of training (n = 45), and at least 12 months post-training (n = 45). Pre-to-posttreatment clinical outcome for trainees’ patients during the course (n = 360) and post-training (n = 360) was evaluated using standardised self-report measures. The relationship between therapist competence and patient outcomes was explored. Trainees achieved competence during training (100%, n = 45) and largely maintained competence post-training (84%, n = 38). Patients demonstrated pre-to-posttreatment effect sizes between 1.38 and 1.89 and reliable improvement exceeding 80% during and after training. Competence was not significantly associated with patient outcome. Trainees predominantly maintained competence and achieved good clinical outcomes post-training. Structured training and continued use of regular supervision possibly supported retention of competence

Circadian rhythmicity in murine blood:Electrical effects of malaria infection and anemia

Circadian rhythms are biological adaptations to the day-night cycle, whereby cells adapt to changes in the external environment or internal physiology according to the time of day. Whilst many cellular clock mechanisms involve gene expression feedback mechanisms, clocks operate even where gene expression is absent. For example, red blood cells (RBCs) do not have capacity for gene expression, and instead possess an electrophysiological oscillator where cytosolic potassium plays a key role in timekeeping. We examined murine blood under normal conditions as well as in two perturbed states, malaria infection and induced anemia, to assess changes in baseline cellular electrophysiology and its implications for the electrophysiological oscillator. Blood samples were analyzed at 4-h intervals over 2 days by dielectrophoresis, and microscopic determination of parasitemia. We found that cytoplasmic conductivity (indicating the concentration of free ions in the cytoplasm and related to the membrane potential) exhibited circadian rhythmic behavior in all three cases (control, malaria and anemia). Compared to control samples, cytoplasm conductivity was decreased in the anemia group, whilst malaria-infected samples were in antiphase to control. Furthermore, we identified rhythmic behavior in membrane capacitance of malaria infected cells that was not replicated in the other samples. Finally, we reveal the historically famous rhythmicity of malaria parasite replication is in phase with cytoplasm conductivity. Our findings suggest the electrophysiological oscillator can impact on malaria parasite replication and/or is vulnerable to perturbation by rhythmic parasite activities

Seasonality and immunity to laboratory-confirmed seasonal coronaviruses (HCoV-NL63, HCoV-OC43, and HCoV-229E): results from the Flu Watch cohort study

Background: There is currently a pandemic caused by the novel coronavirus SARS-CoV-2. The intensity and duration of this first wave in the UK may be dependent on whether SARS-CoV-2 transmits more effectively in the winter than the summer and the UK Government response is partially built upon the assumption that those infected will develop immunity to reinfection in the short term. In this paper we examine evidence for seasonality and immunity to laboratory-confirmed seasonal coronavirus (HCoV) from a prospective cohort study in England. Methods: In this analysis of the Flu Watch cohort, we examine seasonal trends for PCR-confirmed coronavirus infections (HCoV-NL63, HCoV-OC43, and HCoV-229E) in all participants during winter seasons (2006-2007, 2007-2008, 2008-2009) and during the first wave of the 2009 H1N1 influenza pandemic (May-Sep 2009). We also included data from the pandemic and �post-pandemic� winter seasons (2009-2010 and 2010-2011) to identify individuals with two confirmed HCoV infections and examine evidence for immunity against homologous reinfection. Results: We tested 1,104 swabs taken during respiratory illness and detected HCoV in 199 during the first four seasons. The rate of confirmed HCoV infection across all seasons was 390 (95% CI 338-448) per 100,000 person-weeks; highest in the Nov-Mar 2008/9 season at 674 (95%CI 537-835). The highest rate was in February at 759 (95% CI 580-975). Data collected during May-Sep 2009 showed there was small amounts of ongoing transmission, with four cases detected during this period. Eight participants had two confirmed infections, of which none had the same strain twice. Conclusion: Our results provide evidence that HCoV infection in England is most intense in winter, but that there is a small amount of ongoing transmission during summer periods. We found some evidence of immunity against homologous reinfection.</ns3:p

A qualitative study of the views and experiences of those working in residential children's homes

Young people in residential children's homes have typically experienced significant child maltreatment and will have likely experienced multiple placement moves; both are associated with a range of poor outcomes and impact on wellbeing. Whilst much is understood about the impact of child maltreatment, little is known about how residential health care workers experience and understand the potential difficulties the children they look after experience. Our study aimed to gain an insight into the views of residential workers, how they understand their role, and what barriers they experience in their work, as well as supportive factors. We used a qualitative design to understand residential workers' perspectives of supporting their young people. Five focus groups were run with a total of 22 participants. Participants were predominantly female and ranged in age and years of experience within the sector. Participants worked in five residential care homes across England and Wales. Three core themes were identified using thematic analysis. Firstly, residential workers feel this is a rewarding profession but not one that is well understood and valued by society. Secondly, factors such as shift demands and managing challenging behaviour can be barriers to residential workers being emotionally available to the children in their care, but factors such as being part of a cohesive team and access to reflective spaces help promote resilience. Thirdly, workers recognise that confidence and skill impact their ability to successfully manage challenging behaviours. The implications of the findings can be used within children's services to promote workers' wellbeing, to reduce staff burnout and secondary trauma, and to improve retention, which can increase positive outcomes for young people in their care and can guide practice within the residential care sector

A rapid review and meta-analysis of the asymptomatic proportion of PCR-confirmed SARS-CoV-2 infections in community settings

Background: Cross-sectional studies indicate that up to 80% of active SARS-CoV-2 infections may be asymptomatic. However, accurate estimates of the asymptomatic proportion require systematic detection and follow-up to differentiate between truly asymptomatic and pre-symptomatic cases. We conducted a rapid review and meta-analysis of the asymptomatic proportion of PCR-confirmed SARS-CoV-2 infections based on methodologically appropriate studies in community settings. Methods: We searched Medline and EMBASE for peer-reviewed articles, and BioRxiv and MedRxiv for pre-prints published before 25/08/2020. We included studies based in community settings that involved systematic PCR testing on participants and follow-up symptom monitoring regardless of symptom status. We extracted data on study characteristics, frequencies of PCR-confirmed infections by symptom status, and (if available) cycle threshold/genome copy number values and/or duration of viral shedding by symptom status, and age of asymptomatic versus (pre)symptomatic cases. We computed estimates of the asymptomatic proportion and 95% confidence intervals for each study and overall using random effect meta-analysis.  Results: We screened 1138 studies and included 21. The pooled asymptomatic proportion of SARS-CoV-2 infections was 23% (95% CI 16%-30%). When stratified by testing context, the asymptomatic proportion ranged from 6% (95% CI 0-17%) for household contacts to 47% (95% CI 21-75%) for non-outbreak point prevalence surveys with follow-up symptom monitoring. Estimates of viral load and duration of viral shedding appeared to be similar for asymptomatic and symptomatic cases based on available data, though detailed reporting of viral load and natural history of viral shedding by symptom status were limited. Evidence into the relationship between age and symptom status was inconclusive. Conclusion: Asymptomatic viral shedding comprises a substantial minority of SARS-CoV-2 infections when estimated using methodologically appropriate studies. Further investigation into variation in the asymptomatic proportion by testing context, the degree and duration of infectiousness for asymptomatic infections, and demographic predictors of symptom status are warranted.</ns4:p

Between-occupation differences in work-related COVID-19 mitigation strategies over time: Analysis of the Virus Watch Cohort in England and Wales

OBJECTIVES: COVID-19 mitigations have had a profound impact on workplaces, however, multisectoral comparisons of how work-related mitigations were applied are limited. This study aimed to investigate (i) occupational differences in the usage of key work-related mitigations over time and (ii) workers' perceptions of these mitigations. METHODS: Employed/self-employed Virus Watch study participants (N=6279) responded to a mitigation-related online survey covering the periods of December 2020-February 2022. Logistic regression was used to investigate occupation- and time-related differences in the usage of work-related mitigation methods. Participants' perceptions of mitigation methods were investigated descriptively using proportions. RESULTS: Usage of work-related mitigation methods differed between occupations and over time, likely reflecting variation in job roles, workplace environments, legislation and guidance. Healthcare workers had the highest predicted probabilities for several mitigations, including reporting frequent hand hygiene [predicted probability across all survey periods 0.61 (95% CI 0.56-0.66)] and always wearing face coverings [predicted probability range 0.71 (95% CI 0.66-0.75) - 0.80 (95% CI 0.76-0.84) across survey periods]. There were significant cross-occupational trends towards reduced mitigations during periods of less stringent national restrictions. The majority of participants across occupations (55-88%) agreed that most mitigations were reasonable and worthwhile even after the relaxation of national restrictions; agreement was lower for physical distancing (39-44%). CONCLUSIONS: While usage of work-related mitigations appeared to vary alongside stringency of national restrictions, agreement that most mitigations were reasonable and worthwhile remained substantial. Further investigation into the factors underlying between-occupational differences could assist pandemic planning and prevention of workplace COVID-19 transmission