COVID-19 Evidence alert - 3rd July 2020
COVID-19 Evidence alert is a weekly update highlighting emerging evidence on the following key topics identified as useful in supporting Covid recovery planning:
  1. Residential settings
  2. Impacts of lifting restrictions
  3. Long term rehabilitation needs
  4. Screening and testing
  5. Broader impacts on health outcomes
  6. Impact on non-Covid care
This update follows on from a series of rapid evidence scans on these key topics, with corresponding evidence trackers providing details of relevant papers. 

The evidence scans and corresponding evidence trackers can be found here: (see ‘Evidence - Helping you to keep up to date’).

Here you will also find details of the evidence that has been used to inform this weekly update. 

We are also working on other key areas of interest such as impacts on inequalities and marginalised groups, which will be added to the alert once completed.

Please note that the alert will now exclude section summaries due to the breadth and volume of evidence covered in the alert.

Analytical Collaboration for COVID-19  

As previously described the collaboration are supporting ad hoc immediate questions raised by national bodies but are also using their expertise to focus on questions that the NHS may lack the immediate resources to look at, which may be more medium-term, cut across sectors, or benefit from independent analysis.  This week the Strategy Unit published analyses on changes in healthcare activity since lockdown, these include:   

Residential facilities

COVID-19 highlights the need for universal adoption of standards of medical care for physicians in nursing homes in Europe. O’Neill D et al, Eur Geriatr Med (2020).

Guidelines for the management of diabetes in care homes during the Covid-19 pandemic. Sinclair A et al. Diabet. Med, 1090-93.

Rapid reviews
COVID-19 related mortality and spread of disease in long-term care: a living systematic review of emerging evidence (updated 29/6/20). Salcher-Konrad et al. MedRXiv,

Mortality associated with COVID-19 outbreaks in care homes: early international evidence (updated 26/6/20). Comas-Herrera A et al, Article in, International Long-Term Care Policy Network, CPEC-LSE, (updated 26 June 2020).

COVID-19 outcomes among people with intellectual and developmental disability living in residential group homes in New York State. Landes SD et al., Disability and Health Journal,

Covid-19 and lack of linked datasets for care homes. Hanratty B et al., BMJ; 369 doi: (Published 24 June 2020)

COVID-19 in jails and prisons: A neglected infection in a marginalized population. Franco-Paredes C et al, PLOS Neglected Tropical Diseases, (22/6/20)

Covid-19: Continued outbreaks in care homes risk extending pandemic, say experts.  Griffin S, BMJ 369:m2530 (24/6/20).

Useful resources
A special issue of the Journal of Aging & Social Policy on the COVID-19 pandemic was just published online, entitled, “Older Adults and COVID-19: Implications for Aging Policy and Practice,” Volume 32, Issue 4/5.

Impacts of lifting restrictions

Ongoing studies
Preliminary analyses from the ongoing COVID-19 Social Study at University College London have been conducted and released weekly since lockdown began. See here for links to weekly reports.

Emerging evidence
Depression, Environmental Reward, Coping Motives and Alcohol Consumption During the COVID-19 Pandemic. McPhee MD et al, (preprint).

Lay Perspectives on Social Distancing and Other Official Recommendations and Regulations in the Time of COVID-19: A Qualitative Study of Social Media Posts. Ölcer S et al. BMC Public Health, 20(1). Doi: 10.1186/s12889-020-09079-5.

Are we all in this together? Longitudinal assessment of cumulative adversities by socioeconomic position in the first 3 weeks of lockdown in the UK. Wright L et al. Epidemiology & Community Health. Doi: 10.1136/jech-2020-214475.

Early assessment of the impact of mitigation measures on the COVID-19 outbreak in Italy. Vincentini C et al. Public Health, 185.

Impact of Lockdown on the Epidemic Dynamics of COVID-19 in France. Roques L et al. Frontiers in Medicine

Evaluation of the Potential Incidence of COVID-19 and Effectiveness of Containment Measures in Spain: A Data-Driven Approach. Aleta A & Moreno Y. BMC Med, 18(1).

Correcting misperceptions of exponential coronavirus growth increases support for social distancing. Lammers J et al, PNAS, first published June 24, 2020

Evidence for transmission of 2 COVID-19 prior to symptom onset. Tindale LC et al, eLife (preprint). 

Asymptomatic transmission and the infection fatality risk for COVID-19: Implications for school reopening. Vermund SH and Pitzer VE.

Older and ‘staying at home’ during lockdown: informal care receipt during the COVID-19 pandemic amongst people aged 70 and over in the UKEvandrou  M et al. (preprint).

Health policy and controlling Covid-19 in England: sociological insights [version 1; peer review: awaiting peer review] Calnan, M, Emerald Open Research.

COVID-19 pandemic and environmental pollution: A blessing in disguise? Muhammed S et al. Sci Total Environ. 728, 133820.

Decline in PM2.5 concentrations over major cities around the world associated with COVID-19. Chauhan A & Singh RP. Environmental Research. 187, 109634

COVID-19 and the Re-Opening of Schools: A Policy Maker's Dilemma. Fantini MP et al. Ital J Paediatr. (published online 09/6/20)

Covid-19: social distancing or social isolation? Gupta R & Dhamija R. BMJ (published online 18/6/20)

Lockdown During COVID-19: The Greek Success. Moris D & Schizas D. In vivo, 34(3).

Is the lockdown important to prevent the COVID-19 pandemic? Effects on psychology, environment and economy-perspective. Atalan A, Annals of Medicine and Surgery, 56, 38-42.

Why lockdown of the elderly is not ageist and why levelling down equality is wrong. Savulesco J and Cameron J, Journal of Medical Ethics, doi: 10.1136/medethics-2020-106336.

Long term rehabilitation needs

Support for Rehabilitation: Self-Management after COVID-19 Related Illness. WHO.

Rapid reviews
Post-viral fatigue and COVID-19: lessons from past epidemics. Islam MF et al., Fatigue: Biomedicine, Health & Behavior, DOI: 10.1080/21641846.2020.1778227.

COVID-19 Cardiac Injury: Implications for Long-Term Surveillance and Outcomes in Survivors. Mitrani RD et al, Heart Rhythm (pre-proof) DOI:

Guillain-Barré syndrome following COVID-19: a newly emerging post-infectious complication (case report). Webb S et al, BMJ Case Reports, 13 (6),

Chronic pain after COVID-19: implications for rehabilitation. Kemp HI et al. British Journal of Anaesthesia, in press.

Personalized recovery of severe COVID19: Rehabilitation from the perspective of patient needs. Bij de Vaate E et al, European Journal of Clinical Investigation,

Screening and testing

Infection prevention and control during health care when coronavirus disease (COVID-19) is suspected or confirmed. Interim guidance. WHO.

Rapid Reviews
Overcoming the Bottleneck to Widespread Testing: A Rapid Review of Nucleic Acid Testing Approaches for COVID-19 Detection. Esbin MN et al. RNA, 26(7).

Meta-analysis of Diagnostic Performance of Serological Tests for SARS-CoV-2 Antibodies Up to 25 April 2020 and Public Health Implications. Caini S et al. Euro Surveill, 25(23).

Diagnostic accuracy of serological tests for covid-19: systematic review and meta-analysis. Bastos ML et al, BMJ, 370 doi: (Published 01 July 2020).

Emerging evidence
Digital contact tracing for COVID-19. Kleinman RA & Merkel C. CMAJ, 192(24).

Identification and Estimation of Undetected COVID-19 Cases Using Testing Data from Iceland.  Aspelund KM et al, MedRxiv preprint.

Establishing prison-led contact tracing to prevent outbreaks of COVID-19 in prisons in Ireland. Clarke M et al, Journal of Public Health,

Chest CT screening for COVID-19 in elective and emergency surgical patients: experience from a UK tertiary centre. Chetan MR et al, Clinical Radiology,

COVID-19 autopsy in people who died in community settings: the first series. Youd E and Moore L, Journal of Clinical Pathology, Published Online First: 30 June 2020. doi: 10.1136/jclinpath-2020-206710.

Wastewater surveillance for population-wide Covid-19: The present and future. Daughton CG. Sci Total Environ, 736, 139631.

Measuring the Effectiveness of an Automated Text Messaging Active Surveillance System for COVID-19 in the South of Ireland, March to April 2020. Barrett PM et al. Euro Surveill, 25(23).

Preoperative SARS-CoV-2 screening: Can it really rule out COVID-19? Lother SA, Canadian Journal of Anesthesia.

An urgent need to institute COVID-19 testing in patients with IBD experiencing flares. Quraishi MN et al, Frontline Gastroenterology, 1–2. doi:10.1136/flgastro-2020-101477

How Northern Ireland relaunched contact tracing for covid-19 a month before the rest of the UK. Baraniuk C, BMJ, 369:m2373.

Case isolation, contact tracing, and physical distancing are pillars of COVID-19 pandemic control, not optional choices. MacIntyre CR, Lancet Infectious Diseases, S1473-3099(20)30512-0.

Lessons in contact tracing from Germany. Reintjes R, BMJ, 369 doi: (Published 25 June 2020).

How countries are using genomics to help avoid a second coronavirus wave. Watson C. Nature. (27/5/20).

Real-Time Smart Patient Monitoring and Assessment Amid COVID-19 Pandemic – an Alternative Approach to Remote Monitoring. Naik NB et al. J Med Syst, 44(7).

Wastewater Monitoring of SARS-CoV-2: Lessons From Illicit Drug Policy. Lancaster K & Rhodes T. Lancet Gastroenterol Hepatol, 5(7) (published online 15/6/20).

Useful resources
COVID-19 antibody testing: What coding and CDI professionals need to know. McCall S. Briefings on APCs, 21(6). (published online May 2020).

Making the Best Use of Test Kits for COVID-19. Weinberg CR. Am J Epidemiol, 189(5). (published online 07/05/20).

Broader impacts on health outcomes

Commentary from the collaboration
How are changes to employment and finances impacting mental health during lockdown? Finch D & Eastaugh A. The Health Foundation. (published online 25/06/20).

Caring for our carers: what can COVID-19 teach us about NHS staff wellbeing? Wood S. The Health Foundation. (published online 26/06/20)

Urgent steps need to be taken to avoid future COVID-19 deaths. Dixon J. The Health Foundation. (published online 26/06/20).

Ongoing studies
Preliminary analyses from the ongoing COVID-19 Social Study at University College London have been conducted and released weekly since lockdown began. See here for links to 14 weekly reports.

Rapid Reviews
The impact of the COVID-19 pandemic on the mental health of healthcare professionals . Braquehais MD et al, QJM, hcaa207,

A rapid review of the impact of quarantine and restricted environments on children’s play and health outcomes. Graber K et al. PsyArXiv (pre-print).

Emerging Evidence
Mental health - General public
How are adversities during COVID-19 affecting mental health? Differential associations for worries and experiences and implications for policy. Wright L et al. MedRxiv. Doi: 10.1101/2020.05.14.20101717 (preprint).

Years of life lost due to the psychosocial consequences of COVID-19 mitigation strategies based on Swiss data. Moser DA et al. European Psychiatry, 63(1).

The psychological impact of COVID-19 on the mental health in the general population. Serafini G et al, QJM, hcaa201,  

Loneliness in the UK during the COVID-19 pandemic: Cross-sectional results from The COVID-19 Psychological Wellbeing Study. Groarke JM et al, preprint.

Grief and the COVID-19 Pandemic in Older Adults. Goveas JS and Shear MK, American Journal of Geriatric Psychiatry, DOI:

Mental health - Health care workers
Provider Burnout and Fatigue During the COVID-19 Pandemic: Lessons Learned From a High-Volume Intensive Care Unit. Sasangohar F et al. Anesth Analg.

Trauma and orthopaedic team members’ mental health during the COVID-19 pandemic. Thakrar A et al, Bone Joint Open, 1-6:316–325.

Pre-existing conditions
Trajectories of depression and anxiety during enforced isolation due to COVID-19: longitudinal analyses of 59,318 adults in the UK with and without diagnosed mental illness. Fancourt D et al. MedRxiv. Doi: 10.1101/2020.06.03.20120923 (preprint).

Early Life Stress Predicts Depressive Symptoms in Adolescents During the COVID-19 Pandemic: The Mediating Role of Perceived Stress. Gotlib IH et al, (preprint).

The impact of the COVID-19 pandemic on patients with OCD: Effects of contamination symptoms and remission state before the quarantine in a preliminary naturalistic study. Davide P et al, Psychiatry Research, 291, 113213.

Public health
COVID-19, smoking, and inequalities: a cross-sectional survey of adults in the UK. Jackson SE et al. MedRxiv.

Eating habits and lifestyle changes during COVID-19 lockdown: an Italian survey. Di Renzo et al. J Transl Med. 18, 229.

Insomnia During COVID-19 Pandemic and Lockdown: Prevalence, Severity, and Associated Risk Factors in French Population. Kokou-Kpolou CK et al., Psychiatry Res, 26:290:113128.

Delayed Presentation of Acute Ischemic Strokes During the COVID-19 Crisis. Schirmer CM et al. J Neurointerv Surg, 12(7).

Mental health
Dementia in the COVID-19 Period. Korczyn AD. Journal of Alzheimer’s Disease. DOI 10.3233/JAD-200609 (published online 15/06/20)

Emotional Health in the Midst of the Coronavirus Disease 2019 (COVID-19) Pandemic. Benzel E. World Neurosurg, 138.

The Urgent Need to Address Violence Against Health Workers During the COVID-19 Pandemic. Rodríguez-Bolaños R et al. Med Care, 11(58). (published online 11/5/20).

Maternal Mental Health in the Time of the COVID-19 Pandemic. Thapa SB et al. Acta Obstet Gynecol Scand. (published online 05/20).

Health anxiety and behavioural changes of pregnant women during the COVID-19 pandemic. Corbett GA et al. Eur J Obstet Gynecol Reprod Biol.(published online 13/04/20).

COVID-19 Impacts on Child and Youth Anxiety and Depression: Challenges and Opportunities. Courtney D et al, Canadian Journal of Psychiatry, (22/6/20)

Potential effects of “social” distancing measures and school lockdown on child and adolescent mental health. Clemens V et al. European Child & Adolescent Psychiatry, 29,739-742.

Public health
COVID-19: the great unequaliser. Devakumar D et al. J Royal Soc Med. Doi:10.1177/0141076820925434

Coronavirus disease 2019 (COVID‐19 ): not one epidemic but four. Wooley I. Int Med J, 50(6). Doi: 10.1111/imj.14866. (published online 14/06/20)

The Challenge of Maintaining Metabolic Health During a Global Pandemic. King AJ et al. Sports Medicine, 50:1233-1241.

The consequences of the COVID‐19 pandemic. Chien P. BJOG, 127(8). (published 11/6/20).

Sleepless in COVID-19: How Not to Lose Sleep in Lockdowns. Yadav SR, Kumar R, Kumar A et al. Moaldi Arch Chest Dis, 90(2). (published 12/6/20).

Child abuse: a hidden crisis during COVID-19 quarantine. Andreas Storz M. J Paediatr Child Health, 56(6). (published online 9/6/20).

Drinking alone: COVID-19, lockdown, and alcohol-related harm. The Lancet Gastroenterology and Hepatology. (published online May 2020).

Useful resources
Battle Buddies: Rapid Deployment of a Psychological Resilience Intervention for Health Care Workers During the COVID-19 Pandemic. Albott CS et al. Anesth Analg, 131(1).

Impact on non-Covid care

Coronavirus: health and social care key issues and sources.  Briefing paper Number CBP 8887, 30 June 2020.  House of Commons Library.

Clinical guidance for healthcare professionals on maintaining immunisation programmes during COVID-19. Public Health England, Royal College of General Practitioners and Royal College of Paediatrics and Child Health (published June 2020).

Guidance for maternal medicine services in the evolving coronavirus (COVID-19) pandemic. Royal College of Obstetricians and Gynaecologists (published 26/06/20).

Restoration and Recovery: Priorities for Obstetrics and Gynaecology. A prioritisation framework for care in response to COVID-19. Royal College of Obstetricians and Gynaecologists (published 26/06/20).

Joint BMS / RCOG / RCGP / FSRH framework for restoration of menopause services in response to COVID-19. Royal College of Obstetricians & Gynaecologists (published 26/06/20).

Rapid reviews
Mental Health Services
Ensuring Mental Health Care During the SARS-CoV-2 Epidemic in France: A Narrative Review. Chevance A et al. Encephale, 46(3).

Cancer services
Impact of the COVID-19 Outbreak on the Management of Patients With Cancer. Raymond E et al. Target Oncol, 15(3).

Maternity services
Considerations for Obstetric Care during the COVID-19 Pandemic. Dotters-Katz & Hughes BL.

Emerging evidence
Primary Care
The first six weeks - setting up a UK urgent dental care centre during the COVID-19 pandemic. Carter E et al, British Dental Journal, 228, 842-8.

Outpatient Care 
The Italian Fight Against the COVID-19 Pandemic in the Second Phase: The Renewed Opportunity of Telemedicine. Giansanti, D.  Telemedicine and eHealth (preprint).

Elective Care
Change in practice due to COVID-19 – Early experiences of a United Kingdom district general hospital in trauma & orthopaedics. Faria G et al, Journal of Orthopaedics, 22, 288-90.

Response of UK interventional radiologists to the COVID-19 pandemic – survey findings. Rostampour S et al,  CVIR Endovasc 3, 41 (2020).

Emergency Care
Impact of the COVID-19 pandemic on orthopedic trauma workload in a London level 1 trauma center: the “golden month”. Park C et al, Acta Orthopaedica,  DOI: 10.1080/17453674.2020.1783621.

Secondary Care
Recovery Position: What next for the NHS? NHS Providers.

Returning the NHS to an even keel. Parliamentary Briefing. Royal College of Physicians (29 June 2020).

Forecasting spatial, socioeconomic and demographic variation in COVID-19 health care demand in England and Wales. Verhagen MD et al, BMC Medicine, 18, Article number: 203 (2020).

Cancer services
Changes in Breast Cancer Management During the Corona Virus Disease 19 Pandemic: An International Survey of the European Breast Cancer Research Association of Surgical Trialists (EUBREAST). Gasparri ML et al. Breast, 52.

A Practical Approach to the Management of Cancer Patients During the Novel Coronavirus Disease 2019 (COVID‐19) Pandemic: An International Collaborative Group. Al-Shamsi et al. Oncologist, 25(6).

Primary care
The primary care response to COVID-19 in England's National Health Service.  Majeed A Et al. J Royal Soc Med. 113(6).

Long Term Conditions Management   
Twin epidemics of covid-19 and non-communicable disease. Sheldon T and Wright J, BMJ, 369 m2618.
Elective care
Cardiac surgery in the time of the coronavirus. Fudulu DP & Angelini GD. J Card Surg. (published online (04/20).

Covid-19: Doctors feel shut out of plans for dealing with backlog of missed care. Rimmer A, BMJ, 369 doi: (Published 24 June 2020).

Cancer services
Cancer Patient Care during COVID-19. Harky A et al. Cancer Cell, 37(6). (published online 08/6/20).

Cancer Treatment During the Coronavirus Disease 2019 Pandemic: Do Not Postpone, Do It!. Omarini C et al. Eur J Cancer, 133. (published online 12/05/20).

Cancer care during and after the pandemic. Neal RD et al, BMJ, 370, doi: (Published 02 July 2020).

Mental Health Services
“You Have to Wait a Little Longer”: Transgender (Mental) Health at Risk as a Consequence of Deferring GenderAffirming Treatments During COVID19. Van der Miesen et al. Archives of Sexual Behaviour. 

Patient and Public Involvement
Patient and public involvement in covid-19 policy making. Richards T and Scowcroft H, BMJ, 370,

Useful resource
Recommendations for policy and practice of telepsychotherapy and e-mental health in Europe and beyond. Van Daele T et al. Journal of psychotherapy integration, 30(2).

This update forms part of a national evidence update service, provided by the Strategy Unit, as part of a collaboration to provide analytical support to the health and care system to help in the fight against COVID-19. For more information, visit: or 
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