In this project we modelled for the first time excess mortality during the COVID-19 pandemic at subnational level first in Italy, and then across several European countries. We predicted the weekly mortality rates at high spatial resolution for 2020 based on the modelled spatio-temporal trends (i.e. in the absence of the pandemic) and estimated the excess mortality and the uncertainty surrounding it.
The first phase of the project has concluded and methodology/results have been published. We are now working on using the same framework to study excess mortality across longer periods in order to capture heatwave effects, impact of policies (e.g. electricity/gas increases) etc.

Publications:

• Blangiardo M, Cameletti M, Pirani M, et al. Estimating weekly excess mortality at sub-national level in Italy during the COVID-19 pandemic. PLoS One. 2020 Oct 9;15(10):e0240286. doi: 10.1371/journal.pone.0240286. PMID: 33035253

• Konstantinoudis G, Cameletti M, Gómez-Rubio V, Gómez IL, Pirani M, Baio G, Larrauri A, Riou J, Egger M, Vineis P, Blangiardo M. Regional excess mortality during the 2020 COVID-19 pandemic in five European countries. Nature communications. 2022 Jan 25;13(1):482.

The COVIDENCE UK Research Study has been developed in response to the outbreak of coronavirus disease (COVID-19). This national study is being carried out by a team of doctors, scientists, public health specialists and health economists based at the following universities in England, Scotland, Wales and Northern Ireland: Queen Mary University of London, King’s College London, The London School of Hygiene and Tropical Medicine, The University of Edinburgh, Swansea University, Queen's University Belfast.
We are asking people aged 16 years or older, from all parts of the UK and from all walks of life, to sign up and fill in an online questionnaire with details about their lifestyle and health. Participants will then be contacted every month to check if they have developed any symptoms of coronavirus disease, and to ask some follow-up questions about participants' more general health and social circumstances.

The data we collect will be analysed in order to:

• advance understanding of risk factors for coronavirus disease among UK adults

• find out how quickly people recover from coronavirus disease and whether there are any long-term complications of this illness

• evaluate the impact of coronavirus disease on the physical, mental and economic wellbeing of the UK population establish a platform for future research on coronavirus disease in the UK.

Multiple publications and media coverage are already out - please check COVIDENCE UK website for more

The REACT programme is a large-scale assessment of COVID-19 home testing, to evaluate different testing assays and inform the future deployment of self-testing, and to provide estimate levels of SARS-CoV-2 infection in the population (including asymptomatic cases). The programme comprises two main arms:
- REACT 1: a rapid, large-scale study of SARS-CoV-2 antigen prevalence in England, involving the collection and analysis of swab samples for a large sample of the population (100,000 randomly selected people from 315 local authorities across England) to identify rates of active SARS-CoV-2 infection.
- REACT 2: is the largest COVID-19 surveillance study undertaken in England examining the prevalence of SARS-CoV-2 antibodies in the community. It consists of a series of studies evaluating the accuracy, usability and acceptability of different home-use, self-administered Lateral Flow Tests (LFTs) to detect COVID-19 antibodies and prior infection, together with a large-scale study (up to 200,000 randomly selected members of the public in England) to quantify the cumulative community seroprevalence since the beginning of the SARS-CoV-2 epidemic and characterise geographical and socioeconomic variations.

Publications:
• Flower B, Brown JC, Simmons B, et al. for the REACT Study group. Clinical and laboratory evaluation of SARS-CoV-2 lateral flow assays for use in a national COVID-19 seroprevalence survey. Thorax. 2020 Dec;75(12):1082-1088. doi: 10.1136/thoraxjnl-2020-215732. Epub 2020 Aug 12. PMID: 32796119.
• Graham NSN, Junghans C, Downes R, et al. for the REACT Study group. SARS-CoV-2 infection, clinical features and outcome of COVID-19 in United Kingdom nursing homes. J Infect. 2020 Sep;81(3):411-419. doi: 10.1016/j.jinf.2020.05.073. Epub 2020 Jun 3. PMID: 32504743.
• Atchison C, Pristerà P, Cooper E, et al. for the REACT Study group. Usability and acceptability of home-based self-testing for SARS-CoV-2 antibodies for population surveillance. Clin Infect Dis. 2021 May 4;72(9):e384-e393. doi: 10.1093/cid/ciaa1178. PMID: 32785665.
• Ward H, Atchison CJ, Whitaker M, et al. for the REACT Study group. Antibody prevalence for SARS-CoV-2 in England following first peak of the pandemic: REACT2 study in 100,000 adults. Nat Commun. 2021 Feb 10;12(1):905. doi: 10.1038/s41467-021-21237-w. PMID: 33568663.
• Moshe M, Daunt A, Flower B, et al. For the React Study group. SARS-CoV-2 lateral flow assays for possible use in national covid-19 seroprevalence surveys (React 2): diagnostic accuracy study. BMJ. 2021 Mar 2;372:n423. doi: 10.1136/bmj.n423. PMID: 33653694.
• Riley S, Atchison C, Ashby D, et al. for the REACT Study group. REal-time Assessment of Community Transmission (REACT) of SARS-CoV-2 virus: Study protocol. Wellcome Open Res. 2021 Apr 21;5:200. doi: 10.12688/wellcomeopenres.16228.2. PMID: 33997297.

• Riley S, Ainslie KEC, Eales O, et al. for the REACT Study group. Transient dynamics of SARS-CoV-2 as England exited national lockdown. [Preprint] medRxiv - doi: 10.1101/2020.08.05.20169078
• Riley S, Ainslie KEC, Eales O, et al. for the REACT Study group. Community prevalence of SARS-CoV-2 virus in England during May 2020: REACT study. [Preprint] medRxiv - doi:10.1101/2020.07.10.20150524
• Riley S, Ainslie KEC, Eales O, et al. for the REACT study group. Resurgence of SARS-CoV-2 in England: detection by community antigen surveillance. [Preprint] medRxiv 2020.09.11.20192492; doi: https://doi.org/10.1101/2020.09.11.20192492
• Ward H, Cooke G, Atchison C, et al. for the REACT Study group. Declining prevalence of antibody positivity to SARS-CoV-2: a community study of 365,000 adults. [Preprint] medRxiv 2020.10.26.20219725; doi: https://doi.org/10.1101/2020.10.26.20219725
• Riley S, Ainslie KEC, Eales O, et al. for the REACT Study group. High prevalence of SARS-CoV-2 swab positivity in England during September 2020: interim report of round 5 of REACT-1 study. [Preprint] medRxiv 2020.09.30.20204727; doi: https://doi.org/10.1101/2020.09.30.20204727
• Riley S, Ainslie KEC, Eales O, et al. for the REACT Study group. High and increasing prevalence of SARS-CoV-2 swab positivity in England during end September beginning October 2020: REACT-1 round 5 updated report. [Preprint] medRxiv 2020.10.12.20211227; doi: https://doi.org/10.1101/2020.10.12.20211227
• Riley S, Ainslie KEC, Eales O, et al. for the REACT Study group. High prevalence of SARS-CoV-2 swab positivity and increasing R number in England during October 2020: REACT-1 round 6 interim report. [Preprint] medRxiv 2020.10.30.20223123; doi: https://doi.org/10.1101/2020.10.30.20223123
• Riley S, Ainslie KEC, Eales O, et al. for the REACT Study group. REACT-1 round 6 updated report: high prevalence of SARS-CoV-2 swab positivity with reduced rate of growth in England at the start of November 2020. [Preprint] medRxiv 2020.11.18.20233932; doi: https://doi.org/10.1101/2020.11.18.20233932
• Riley S, Eales O, Walters CE, et al. for the REACT Study group. REACT-1 round 7 interim report: fall in prevalence of swab-positivity in England during national lockdown. [Preprint] medRxiv 2020.11.30.20239806; doi: https://doi.org/10.1101/2020.11.30.20239806
• Riley S, Walters CE, Wang H, et al. for the REACT Study group. REACT-1 round 7 updated report: regional heterogeneity in changes in prevalence of SARS-CoV-2 infection during the second national COVID-19 lockdown in England. [Preprint] medRxiv 2020.12.15.20248244; doi: https://doi.org/10.1101/2020.12.15.20248244
• Riley S, Wang H, Eales O, et al. for the REACT Study group. REACT-1 round 8 interim report: SARS-CoV-2 prevalence during the initial stages of the third national lockdown in England. [Preprint] medRxiv 2021.01.20.21250158; doi: https://doi.org/10.1101/2021.01.20.21250158
• Riley S, Eales O, Walters CE, et al. for the REACT Study group. REACT-1 round 8 final report: high average prevalence with regional heterogeneity of trends in SARS-CoV-2 infection in the community in England during January 2021. [Preprint] medRxiv 2021.01.28.21250606; doi: https://doi.org/10.1101/2021.01.28.21250606
• Riley S, Walters CE, Wang H, et al. for the REACT Study group. REACT-1 round 9 interim report: downward trend of SARS-CoV-2 in England in February 2021 but still at high prevalence. [Preprint] medRxiv 2021.02.18.21251973; doi: https://doi.org/10.1101/2021.02.18.21251973
• Ward H, Cooke G, Whitaker M, et al. for the REACT Study group. REACT-2 Round 5: increasing prevalence of SARS-CoV-2 antibodies demonstrate impact of the second wave and of vaccine roll-out in England. [Preprint] medRxiv 2021.02.26.21252512; doi: https://doi.org/10.1101/2021.02.26.21252512
• Riley S, Wang H, Eales O, et al. for the REACT Study group. REACT-1 round 9 final report: Continued but slowing decline of prevalence of SARS-CoV-2 during national lockdown in England in February 2021. [Preprint] medRxiv 2021.03.03.21252856; doi: https://doi.org/10.1101/2021.03.03.21252856
• Riley S, Eales O, Haw D, et al. for the REACT Study group. REACT-1 round 10 report: Level prevalence of SARS-CoV-2 swab-positivity in England during third national lockdown in March 2021. [Preprint] medRxiv 2021.04.08.21255100; doi: https://doi.org/10.1101/2021.04.08.21255100
• Riley S, Haw D, Walters CE, et al. for the REACT Study group. REACT-1 round 11 report: low prevalence of SARS-CoV-2 infection in the community prior to the third step of the English roadmap out of lockdown. [Preprint] medRxiv 2021.05.13.21257144; doi: https://doi.org/10.1101/2021.05.13.21257144

This study aims to address some of the major gaps in our understanding of SARS-CoV-2 infection and disease, in particular with respect to differences in disease susceptibility, severity of infection and disease mechanisms. We will apply a multi-omics approach - encompassing whole genome sequencing, proteomic, transcriptomic and metabolomic analyses - to mild/asymptomatic cases, to identify biological pathways that are protective of or deleterious to the response to SARS-CoV-2 infection. In a partnership between the DHSC-funded GenOMICC programme (led by Genomics England) and the REACT programme, we propose to recruit c.8000 mild/asymptomatic REACT participants for which we will obtain a multi-omic profile to sit alongside the whole genome sequencing already funded, creating an unparalleled resource for identifying novel targets for disease prevention or drug discovery.

The REACT-Long COVID (REACT-LC) programme aims to characterise the genetic, biological, social and environmental signatures and pathways that underpin progression to Long COVID, and to understand the natural history and long-term sequelae post-SARS-CoV-2 infection, to inform new approaches to diagnosis, treatment and support. This study will involve 120,000 people in the community who have taken part in the REACT study - over 30,000 that have had positive test results, plus a sample of 90,000 who tested negative. Participants will be sent regular surveys about their health, symptoms and experiences since the test, and a subset of 8,000 participants with positive tests, including at least 4,000 with Long COVID, will undergo detailed clinical phenotyping and provide samples for multi-omic analyses to identify genetic and other biological markers.

Siemens Healthineers markets a range of tests supporting the diagnosis and management of COVID-19. This industrial partner is interested in collaborating with the REACT team to assess the performance of its antibody tests and to evaluate the extent to which unsupervised subjects can self-collect samples to support testing.

The CO-CONNECT project brings together 29 different UK organisations to create a single information resource linking 44 cohort, serology and other health and non-health data sources on SARS-CoV-2 in the UK. This project addresses a major data engineering challenge, enabled by Health Data Research (HDR) UK, to create a ‘one-stop’ resource that will catalyse trustworthy, multi-stakeholder utilisation of curated COVID-19 data for public, private and third sector benefit.

This project aims to characterise and quantify the biological, social and environmental drivers of medium-term health outcomes following infection with SARS-CoV-2, through linkage of national primary and secondary healthcare data to the REACT national community prevalence programme, and further enhance this cohort through the addition of contextual geo-referenced environmental data.

This project, funded by a philanthropic donation form the Huo Family Foundation, includes a series of studies on the etiology of SARS-CoV-2 infection and on testing and surveillance technologies, to help identify at-risk populations and inform infection control measures. It includes research on: establishment and linkage of COVID-19 research databases; analyses of multi-omic signatures of individuals that have tested positive for SARS-CoV-2 in the REACT community programme to further our understanding the biology underpinning SARS-CoV-2 infection; evaluating the implementation of asymptomatic testing and follow-up contact tracing/ isolation; testing the accuracy and usability of COVID-19 diagnostic tests not included within the scope of the government-funded REACT-1 study.

Analysis of UK Biobank data identifying risk factors for testing positive or negative for SARS-CoV-2 infection up to 18 May 2020, as well as those discriminating test positive vs test negative individuals using a test negative design approach.

Publications:
• Chadeau-Hyam M, Bodinier B, Elliott J, et al. Risk factors for positive and negative COVID-19 tests: a cautious and in-depth analysis of UK biobank data. Int J Epidemiol. 2020 Oct 1;49(5):1454-1467. DOI: 10.1093/ije/dyaa134; PMID: 32814959.
• Elliott J, Bodinier B, Whittaker M, et al. COVID-19 mortality in the UK Biobank cohort: revisiting and evaluating risk factors. Eur. J. Epidemiol. 2021 36(3), pp. 299-309. DOI: 10.1007/s10654-021-00722-y; PMID: 33587202

Studying the cardiovascular complications related to SARS-CoV-2 infection through the Covidity cohort consortium as well as NHS digital datasets

Publications:
• Bellou V, Tzoulaki I, Evangelou E, Belbasis L Risk factors for adverse clinical outcomes in patients with COVID-19: A systematic review and meta-analysis. medRxiv 2020.05.13.20100495; doi: https://doi.org/10.1101/2020.05.13.

This study will investigate the impacts of the COVID-19 pandemic and public health measures on adolescent mental health and wellbeing, amongt a large adolescent cohort SCAMP (Study of Cognition Adolescents and Mobile Phones). This research will investigate questions such as:
- risk factors for mental health problems due to COVID-19 public health measures and their profound disruption to adolescent education and social networks and find out what factors can be changed to boost resilience;
- whether changes in use of digital technology have a positive or negative impact on adolescent mental health;
- who is most at-risk of negative outcomes, such as those experiencing more family stress, lack of access to healthy food and outdoor/green space.

Study evaluating the impact of the COVID-19 pandemic on non-COVID-19 morbidity and mortality including impacts of health inequalities. We used over 10 years of national level routine health data, at high spatial and temporal resolution, to dynamically track how trends are deviating from the expected patterns during the pandemic. Impacts on health inequalities were identified and findings will inform health policy and resource allocation decisions at local and national level.

Publications:
Davies B, Parkes BL, Bennett J, et al. Community factors and excess mortality in first wave of the COVID-19 pandemic. medRxiv 2020.11.19.20234849; doi: https://doi.org/10.1101/2020.11.19.20234849

Recent studies suggested a link between long-term exposure to air-pollution and COVID-19 mortality. However, due to their ecological design, based on large spatial units, they neglect the strong localised air-pollution patterns, and potentially lead to inadequate confounding adjustment. We investigated the effect of long-term exposure to NO2 and PM2.5 on COVID-19 deaths up to June 30, 2020 in England using high geographical resolution.
The first phase of the project has concluded and methodology/results have been published. We are planning to extend the analyses to incorporate additional data on comorbidities using new data on GP prescriptions from NHS digital as well as to update the analyses for the first vs second wave.

Publications:
• Konstantinoudis G, Padellini T, Bennett J, Davies B, Ezzati M, Blangiardo M. Long-term exposure to air-pollution and COVID-19 mortality in England: A hierarchical spatial analysis. Environ Int. 2021 Jan;146:106316. doi: 10.1016/j.envint.2020.106316. Epub 2020 Dec 7. PMID: 33395952

This is the first subnational study on excess mortality during the COVID-19 pandemic in Italy, one of the worst-hit countries. We predicted the weekly mortality rates at municipality level for 2020 based on the modelled spatio-temporal trends (i.e. in the absence of the pandemic) and estimated the excess mortality and the uncertainty surrounding it. This study showed strong evidence of excess mortality for Northern Italy from the end of February 2020, with marked geographical spatio-temporal differences at municipality level. After discounting for the number of COVID-19-confirmed deaths, 10,197 (9,264 to 11,037) excess deaths were registered in the Lombardy region alone, with the city of Bergamo showing the largest percent excess (88.9% - 81.9% to 95.2%) at the peak of the pandemic.
The first phase of the project has concluded and methodology/results have been published. We are planning to extend the analyses to incorporate the entire 2020 as soon as mortality data become available.

Publications:
• Blangiardo M, Cameletti M, Pirani M, et al. Estimating weekly excess mortality at sub-national level in Italy during the COVID-19 pandemic. PLoS One. 2020 Oct 9;15(10):e0240286. doi: 10.1371/journal.pone.0240286. PMID: 33035253

In this collaborative study with the University of Toronto (Canada), we investigate whether long-term average exposure to air pollution (PM2.5 and NO2) increases the risk of COVID-19 infection in Canada, England, Italy and the United States. Data are collected for areal units in each country and the spatial areal unit design is employed to produce estimates of health effects on a population level. We estimate a population attributable fraction for each country, then derive from these a combined global estimate of exposure health effects.
Paper submitted for publication:
Huang G, Pirani M, Blangiardo M, Brown P. Long-term exposure to air pollution and COVID-19 incidence∶ a multi-country study.

This large collaboration across several institutions has been created to advise the UKHSA during the pandemic on the best statistical and machine learning methods to answer specific questions related to policies. The work carried out as part of this lab has covered the following areas:

• Health inequalities: investigating how ethnicity and socio-economic deprivation have affected chances of becoming infected with COVID-19 for people in England (socio-economic deprivation is the disadvantage an individual or group experiences in terms of access and control over money, material or social resources and opportunities).
Publications:
Padellini T, Jersakova R, Diggle PJ, Holmes C, King RE, Lehmann BC, Mallon AM, Nicholson G, Richardson S, Blangiardo M. Time varying association between deprivation, ethnicity and SARS-CoV-2 infections in England: A population-based ecological study. The Lancet Regional Health–Europe. 2022 Apr 1;15.

• Interoperability: it is a guiding framework for statistical thinking to assist policy-makers asking multiple questions, using combinations of different datasets, when decisions need to be made fast in response to the current and future pandemics. The framework allows us to build statistical models for quick analysis of data and urgent action; such models are mathematical representations of data that enable conclusions to be drawn and decisions to be made in the real world. Our interoperable approach provides an important set of principles for future pandemic preparedness. It does this through the design and deployment of multiple models at the same time (joint design) and the use of a modular system that means each model can be easily adapted for use in future disease monitoring in tandem with other models.
Publications:
Nicholson G, Blangiardo M, Briers M, Diggle PJ, Fjelde TE, Ge H, Goudie RJ, Jersakova R, King RE, Lehmann BC, Mallon AM. Interoperability of statistical models in pandemic preparedness: principles and reality. Statistical science: a review journal of the Institute of Mathematical Statistics. 2022 May;37(2):183. can be easily adapted for use in future disease monitoring in tandem with other models.

• Wastewater: the Environmental Monitoring for Health Protection (EMHP) wastewater monitoring program led by the UK Health Security Agency, tests wastewater on a daily basis. This started in mid-2020 and carries on gathering data across 270 sites across England. This project seeks to use these data to address research questions such as: How determining the frequency of disease using wastewater data at specific points in time can be used with more commonly used health monitoring data? Does wastewater data add value to monitoring diseases? And how can we best design wastewater sampling schemes for real-time monitoring, either using only wastewater data, or combined with traditional monitoring data in a cost-effective manner?
Publications:
Li G, Denise H, Diggle P, Grimsley J, Holmes C, James D, Jersakova R, Mole C, Nicholson G, Smith CR, Richardson S. A spatio-temporal framework for modelling wastewater concentration during the COVID-19 pandemic. Environment international. 2023 Feb 1;172:107765.

Based on first genome-wide association studies of COVID-19 severity we can use the MR paradigm to identify likely causal cardiometabolic risk factors for COVID-19 severity [1]. We have also looked at how cardiometabolic risk factors impact genetic predisposition to increased angiotensin-converting enzyme (ACE) expression and have provided genetic evidence that ACE inhibitor antihypertensive drugs may not affect lung ACE2 and TMPRSS2 expression [2]. These findings do not support a change in ACE inhibitor medication use without clinical justification

Publications:
• Ponsford MJ, Gkatzionis A, Walker VM, et al. Cardiometabolic Traits, Sepsis, and Severe COVID-19: A Mendelian Randomization Investigation. Circulation. 2020 Nov 3;142(18):1791-1793. doi: 10.1161/CIRCULATIONAHA.120.050753. Epub 2020 Sep 23. PMID: 32966752.
• Gill D, Arvanitis M, Carter P, et al. ACE inhibition and cardiometabolic risk factors, lung ACE2 and TMPRSS2 gene expression, and plasma ACE2 levels: a Mendelian randomization study. R Soc Open Sci. 2020 Nov 18;7(11):200958. doi: 10.1098/rsos.200958. PMID: 33391794.

This study within the CHILL cohort aims to examine the impact of Sars-Cov-2 infection / air pollution changes (both policy and lockdown driven) on the cognitive development of children. We trialled cognitive testing in tis cohort last year and the proposal will expand on this work and establish more formal links with the Born in Bradford group, whose methodology is used.

Publications:
• Colligan G, Tsocheva I, Scales J, et al. Investigating the impact of London’s Ultra Low Emission Zone on children’s health: Children’s Health in London and Luton (CHILL): Protocol for a prospective parallel cohort study. medRxiv 2021.02.04.21251049; doi: https://doi.org/10.1101/2021.02.04.21251049

High time resolution aerosol size distribution measurements in an ICU ward at Medway Hospital in association with Dr Rahuldeb Sarkar, Consultant in Respiratory Medicine & Critical Care Medway NHS Foundation Trust.
- Measuring aerosol generation from patient under different ventilation methodologies and different procedures
- Aim to assess aerosol exposure of staff working in close proximity to COVID patients
- Paper describing early results submitted to the British Journal of Anaesthesia.

The change in emissions associated with the pandemic provides a ‘real world’ opportunity to assess emission reduction impacts on population exposure and atmospheric chemistry at a time when there is concerted policy effort to reduce the UK’s air pollution health burden. Defra’s Air Quality Evidence Group issued a call for evidence and ERG members are undertaking analyses to inform this and prepare potential future funding applications:
- Spatial and temporal analysis of LAQN monitoring sites to establish changes in concentration between pre lockdown and lockdown periods; including accounting for the effects of changes to meteorology and dispersion to estimate emission changes.
- Estimation of the changes to the toxic mixture of air pollutants, and in particular the combined toxicity of different pollutants.
- Quantifying changes to personal exposure of people in London, indoors and outdoors, including school children, professional drivers, medics and tube users.
- This is also an ideal opportunity to study the air pollution impacts of a world working towards 'net-zero' CO2 emissions, improving our understanding of model uncertainties and the reliability of policy analysis and air pollution predictions for net zero scenarios.
- Initial analysis undertaken and reported to Defra’s Air Quality Expert Group. More detailed analytical project in planning.

The Covid-19 lockdown is the largest ‘natural experiment’ of global emissions reductions of a generation. The aim of this study is to assess the change in personal exposure of the whole London population to PM2.5 and NO2 brought about by both the change in indoor, in-vehicle and outdoor concentrations, as a consequence of the Covid-19 lockdown, and due to behaviour change such as spending more time at home and changing mode of transport. London has a diverse population so we will undertake this analysis for different population subgroups, by age, focusing on the vulnerable such as the over 70s, gender and ethnicity (e.g. BAME). We will assess the health impacts of past long-term exposures, changes in exposure during the pandemic interventions and their interactions with Covid-19 transmission and mortality.

The impact of the COVID-19 has disproportionately affected those with pre-existing disease, including those with diabetes, the obese, as well as old people, males and Black and Asian ethnic groups. Air pollution has been cited as a potential additional risk factor for COVID-19 disease. This study aims to significantly improve our understanding of the exposure to air pollution indoors and outdoors, of different vulnerable sub-populations in London during the COVID-19 lockdown. We will use the novel NERC-funded London Hybrid Exposure Model (LHEM) which is unique in the UK, and in analysis for Defra's Air Quality Expert Group has already given some important insights into the potential exposures during the COVID-19 lockdown period. During the COVID-19 lockdown and subsequent easing of the restrictions, we will assess the change in personal exposure of all Londoners to PM2.5, NO2 and O3, split by age, gender, ethnicity, socioeconomic status, and by occupation, such as professional drivers, tube users, medical staff and children. Improving our understanding of the sources of exposure will lead to policy advice on exposure reduction and provide a unique exposure dataset that will allow epidemiologists to better assess whether air pollution is a risk factor for COVID-19.

Though air pollution is a problem faced by everybody, research has shown that those living in neighbourhoods of low social economic status are more likely to be exposed to higher air pollution levels. In addition, those with underlying health conditions, including diabetes, heart and lung disease are more susceptible to its health effects. This equity gap has recently become more apparent with the COVID-19 pandemic, as air pollution has been linked to poor health outcomes of COVID-19, with a disproportionately high impact within the Black, Asian and Minority Ethnic (BAME) population. The reasons for this are not yet known but are likely to relate to existing vulnerabilities including health complications, low social economic status, absence of choice and awareness. This study’s aim is to investigate vulnerable and minority ethnic groups’ perceptions of the relationship between air pollution and health and how this relationship has been impacted by the coronavirus (COVID-19) crisis.

MAP-C19 will aim to explore the impact of atmospheric conditions on COVID in the UK, by bringing together experts responsible for the London Air Quality Network which has collected detailed data about atmospheric environmental hazards in the captial, with experts in COVID surveillance from the English Sentinel Surveillance network run by the Oxford- RCGP RSC. Together we will look to map COVID-19 occurrence rates against data from the London Air Quality Network. We will use these examples together with other data collected nationally, to understand how atmospheric conditions could affect COVID in other cities including Liverpool Manchester, Bristol, Leeds, Birmingham, Newcastle, Cardiff, Glasgow, Edinburgh and what mitigation measures may be put in place.

The aim of this project is to measure SARS-CoV-2 and pharmaceuticals in urban wastewater using mass spectrometry, to accurately monitor large population activity in near-real time. The methods developed will be applied to pre-pandemic urban wastewater samples for pharmaceuticals (collected in Dec 2019).

Via COMEAP, involved in commenting on papers on air pollution and COVID19 published by others. Via COMEAP, in discussions with UKHSA and ONS on possible links between air pollution and Covid-19; ONS report published in early August.

• Chadeau-Hyam M et al. SARS-CoV-2 infection and vaccine effectiveness in England (REACT-1): A series of cross-sectional random community surveys. Lancet Respir Med 2022;10(4):355-66. doi: 10.1016/s2213-2600(21)00542-7
• Elliott P et al. Rapid increase in omicron infections in England during December 2021: REACT-1 study. Science 2022;375(6587):1406-11. doi: 10.1126/science.abn8347
• Whitaker M et al. Persistent COVID-19 symptoms in a community study of 606,434 people in England. Nat Commun. 2022;13(1):1957. doi: 10.1038/s41467-022-29521-z.
• Elliott P et al, Twin peaks: The omicron SARS-CoV-2 BA.1 and BA.2 epidemics in England. Science 2022;376(6600). doi: 10.1126/science.abq4411
• Bachtiger P, Adamson A, Chow JJ, et al. The Impact of the Covid-19 Pandemic on Uptake of Influenza Vaccine: A UK-Wide Observational Study. medRxiv doi: 10.1101/2020.10.01.20205385
• Bachtiger P, Adamson A, Quint JK, Peters NS. Belief of having had unconfirmed Covid-19 infection reduces willingness to participate in app-based contact tracing. NPJ Digit Med. 2020 Nov 6;3(1):146. doi: 10.1038/s41746-020-00357-5. PMID: 33299071.
• Bachtiger P, AdamsonA, Maclean WA, et al. Inadequate intention to receive Covid-19 vaccination: indicators for public health messaging needed to improve uptake in UK. medRxiv doi: 10.1101/2020.12.07.20243881
• Barouki R, Kogevinas M, Audouze K, et al. for the HERA-COVID-19 working group. The COVID-19 pandemic and global environmental change: Emerging research needs. Environ Int. 2021 Jan;146:106272. doi: 10.1016/j.envint.2020.106272. Epub 2020 Nov 19. PMID: 33238229.
• Buizza R, Capobianco E, Moretti PF, Vineis P. How can we weather a virus storm? Health prediction inspired by meteorology could be the answer. J Transl Med. 2021 Mar 9;19(1):102. doi: 10.1186/s12967-021-02771-z. PMID: 33750382.
• Caini S, Bellerba F, Corso F, et al. Meta-analysis of diagnostic performance of serological tests for SARS-CoV-2 antibodies up to 25 April 2020 and public health implications. Euro Surveill. 2020 Jun;25(23):2000980. doi: 10.2807/1560-7917.ES.2020.25.23.2000980. PMID: 32553061.
• Drake TM, Docherty AB, Harrison EM, et al. for ISARIC4C Investigators. Outcome of Hospitalization for COVID-19 in Patients with Interstitial Lung Disease. An International Multicenter Study. Am J Respir Crit Care Med. 2020 Dec 15;202(12):1656-1665. doi: 10.1164/rccm.202007-2794OC. PMID: 33007173.
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