Understanding how COVID-19 impacted on people who use drugs

Authors

Dr Joanna Kesten, Research Fellow, Bristol Medical School, Bristol Population Health Science Institute, Health Protection Research Unit. 

Professor Catriona Matheson, Professor at the University of Stirling, and Chair of the Ministerial Drug Death Task Force for Scotland.

When the COVID-19 pandemic hit the UK in early 2020, there was concern about its impact on vulnerable groups in society. In this blog, Jo Kesten, Research Fellow at the NIHR Health Protection Research Unit in Behavioural Science and Evaluation at University of Bristol and Catriona Matheson, Professor at the University of Stirling and Chair of the Ministerial Drug Death Task Force for Scotland, discuss the findings and wider policy implications of two independent research projects to investigate how people who inject drugs were affected. Both studies interviewed people who use drugs in the first national lockdown in 2020 to understand how the pandemic impacted on them. In Scotland, data from online forums, surveys and the police were also used to examine changes in the drugs market.

 Key points

  • Service innovation can happen quickly in a crisis
  • Digital inclusion is important if services are to continue with remote contact
  • Many people struggled with the loss of connection with others
  • There were fewer infections among interviewees than may have been predicted
  • Drug markets were more resilient than we had thought
  • More research needs to be carried out on changes to drug treatment medication policies as our studies recorded slightly different experiences

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Modernising the Mental Health Act: Will more rights lead to less wrongs?

This blog post was written by Judy Laing, Professor of Mental Health Law, Rights and Policy, University of Bristol Law School. 

The government published a White Paper in January 2021 outlining proposals to reform the Mental Health Act in England and Wales.  The government has consulted on these proposals and the consultation period closed a few weeks ago on 21st April 2021. We now await further announcements on the government’s plans following this consultation process. I am currently engaged in a parliamentary academic fellowship, working with Lizzie Parkin (a University of Bristol alumna) in the House of Commons Library Social Policy section. The Library offers an impartial research and information service for MPs and their staff. Part of my role involves working on research briefings to inform Members of Parliament on business in the House of Commons. Mental health law reform will no doubt be debated in parliament in the coming months and I have developed a detailed research briefing on the proposals in the White Paper to assist parliamentarians with that process.

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To make science reproducible, focus on prevention not cure

This post was written by Marcus Munafò, University of Bristol, Malcolm Macleod, University of Edinburgh, they are on the steering group of the UK Reproducibility Network and Malcolm Skingle, director of academic liaison at GlaxoSmithKline. 

Improved upstream quality control can make research more effective, say Marcus Munafò and his colleagues.

Science relies on its ability to self-correct. But the speed and extent to which this happens is an empirical question. Can we do better?

The Covid pandemic has highlighted existing fault lines. We have seen the best of scientific research in the incredible speed at which vaccines have been developed and trialled. But we have also seen a deluge of Covid-related studies conducted in haste, often reflected in their less-than-ideal quality.

Peer review, the traditional way of assessing academic research, occurs only after work has been done. Can we identify indicators of research quality earlier on in the process when there is more opportunity to fix things? And if we did, could scientific knowledge be translated into societal benefit more rapidly and efficiently?

In many ways, the cultures and working practices of academia are still rooted in a 19th-century model of the independent scientist. Many research groups are effectively small, artisanal businesses using unique skills and processes.

This approach can yield exquisitely crafted output. But it also risks poor reproducibility and replicability—through, for instance, closed workflows, closed data and the use of proprietary file formats. Incentive structures based around assessing and rewarding individuals reinforce this, despite the welcome shift to team-based research activity, management, dissemination and evaluation.

Lessons from industry 

Research needs a more coherent approach to ensuring quality. One of us has previously argued that one way to achieve this would be to take the concept of quality control used in manufacturing and apply it to scientific research.

Pharmaceuticals are one R&D-intensive industry that has worked hard to improve quality control and ensure data integrity. Regulatory frameworks and quality-assurance processes are designed to make the results generated in the early stages of drug development more robust.

Indeed, some of the early concerns about the robustness of much academic research—described by some as the ‘reproducibility crisis’—emerged from pharmaceutical companies.

For regulated work, major pharmaceutical companies must be able to demonstrate the provenance of their data in fine detail. Standard operating procedures for routine work, and extended description of less common methods and experiments, makes comparisons between labs easier and improves traceability.

Data constitute the central element of robust research. The integrity of the systems through which data are collected, curated, analysed and presented is at the heart of research quality. National measurement institutes, including the UK’s National Physical Laboratory and National Institute for Biological Standards and Control have a role to play, sharing best practice and developing protocols that contribute to international standards.

How well these systems perform depends on many factors: training in data collection and management; transparency to allow scrutiny and error detection; documentation, so that work can be replicated; and standard operating procedures to ensure a consistent approach.

Red-tape review

Academic researchers are increasingly keen to learn from industry, and vice versa—to identify best practice and ways to implement higher standards of data integrity. University and industrial research are very different, but academia can learn lessons and adopt working practices that might serve to improve the quality of academic research in the biomedical and life sciences.

Learning from other sectors and organisations is a central theme of the UK Reproducibility Network. The network, established in 2019 as a peer-led consortium, aims to develop training and shape incentives through linked grassroots and institutional activity, and coordinated efforts across universities, funders, publishers and other organisations. This multilevel approach reduces the cost of development and increases interoperability, for example, as researchers move across groups and institutions.

Given the likely future pressures on the UK’s R&D budget, effective and efficient ways to bolster research quality will be essential to maximising the societal return on investment. Simply encouraging, or even mandating, new ways of working is not sufficient—many funders and journals have data-sharing policies, for example, but adherence is uneven and often unenforced.

A coordinated approach will require a clear model of research quality; buy-in from institutions, funders and journals; infrastructure; training; the right incentives; and ongoing evaluation. Coordinating all these elements will be challenging, but it is essential to improving research quality and efficiency. We need to take a whole-system approach.

This also applies to the independent review into research bureaucracy recently announced by the UK government, charged with identifying how to liberate researchers from admin. This is laudable—academia should certainly not be regulated in the same way as the pharmaceutical industry—but the review should recognise that an ounce of prevention can save a pound of cure.

Developing and deploying systems that improve research quality might increase efficiency and reduce research waste, as well as securing greater value for our national research effort.

This blog post was originally posted on Research Fortnight, you can read the original article here.

Management consultants in healthcare do more harm than good, but keep getting rehired – new research

This blog post was written by Andrew Sturdy, Chair in Organisation and Management, University of Bristol and Ian Kirkpatrick, Chair in Management, University of York. This article is republished from The Conversation under a Creative Commons license, read the original article here.

The use of management consultants has grown enormously in recent years. In the UK, consultancy brings in around £10 billion a year in fees across the public and private sectors. And while not totally recession-proof, the numbers grew in the run-up to Brexit and then COVID-19. (Remember test and trace? Consultants played a major role.)

Consulting firms can provide advice and extra resources at short notice and can be very effective for the right task and client. But their use often brings controversy, especially when public money is at stake, over the value of outsourcing, for instance. This raises a number of questions. Does consultancy bring improvements such as increased efficiency? If not, how can we explain its huge growth?

In the NHS, there is a remarkable lack of clarity and transparency over how much consultancy is used and with what effects. This falls within broader concerns noted in a recent National Audit Office report on procurement across public services.

In our ongoing research on management consultancy in the NHS, we have started to address these issues.

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Coronavirus: have we already missed the opportunity to build a better world?

Martin Parker Professor of Organisation Studies University of Bristol

Many people like to say that the coronavirus is teaching us a lesson, as if the pandemic were a kind of morality play that should lead to a change in our behaviour. It shows us that we can make big shifts quickly if we want to. That we can build back better. That social inequality is starkly revealed at times of crisis. That there is a “magic money tree”. The idea that crisis leads to change was also common during the financial crunch over a decade ago, but that didn’t produce any lasting transformations. So will post-COVID life be any different?

At the start of lockdown, in the middle of the anxiety and confusion, I started to notice that I was enjoying myself. I was cooking and gardening more; the air was cleaner, my city was quieter and I was spending more time with my partner. Lots of people started to write about the idea that there should be #NoGoingBack. It seemed that we had taken a deep collective breath, and then started to think about coronavirus as a stimulus to encourage us to think how we might address other big issues – climateinequalityracism and so on.

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Maximum cigarette pack size: a neglected aspect of tobacco control

Written by Anna Blackwell, Senior Research Associate

Follow Bristol Tobacco and Alcohol Research Group (TARG) on twitter

The manufacturing or importing of packs of cigarettes with fewer than 20 cigarettes per pack was prohibited in the UK when the EU Tobacco Products Directive and standardised packaging legislation were fully implemented in May 2017. This change was aimed at reducing the affordability of cigarettes and thereby discouraging young people from smoking. This directive also required the removal of branding and established a standard shape and dark green colour for packaging, including pictorial health warnings, which prevented the use of packaging for promotion and reduced its appeal.

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The ties that bind: what the killing of George Floyd can tell us about ethnic inequalities in COVID-19 (and why we should listen)

 

This blog post was written by Dr Saffron Karlsen, (Senior Lecturer in Social Research, University of Bristol) 

On the last weekend of May 2020, much of the world watched with horror scenes of US urban disturbances in response to the death of George Floyd – another Black person killed in police custody. On the other side of the pond, many in the UK also awaited the release of an official report into the higher rates of infection and death of Black and other ethnic minority people from COVID-19.

Photo by Thomas de LUZE on Unsplash

Delays and disappointment

This Public Health England (PHE) report was heralded as an opportunity to finally provide answers to questions we’d had since evidence of these inequalities first emerged. The inquiry’s lead, Professor Kevin Fenton, described the pressing need for open discussion, to listen to the views of people from Black communities and those who worked with them to find out what was producing these inequalities.

Unfortunately, the report which was finally released is very far from fulfilling these ambitions. It does not provide a detailed investigation of the drivers of these ethnic inequalities and includes very little new information from which to make sense of these patterns.

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PolicyBristol and Covid-19

Written by Lindsey Pike

These are uncertain times. Both research and policymaking has been thrown into unknown territory, and anxiety is running high. The coronavirus situation is dynamic and is likely to change how we live and work for the foreseeable future. At PolicyBristol we are looking at how we can reprioritise how we work and what we do, to ensure we’re making the most of the resources we have within the team.  

The team are working from home, but are available to discuss policy engagement and related issues – related to COVID, or any other topic – over the phone or videoconferencing.  

We understand that both researchers and policy colleagues that we work with are under pressure to adapt to working from home, often while coordinating and managing childcare and other responsibilitiesHowever, we’ll continue to signpost you to relevant opportunities and information to make sure that, especially in times such as these, policy decisions are informed by a robust evidence base.  

We’re also aware that other policy priorities, while currently overshadowed, have not gone away. We’d like to reiterate that regardless of your area of research or policy, we’re here to support you. 

Many colleagues in our research community are already forging links with public health, clinical, social and third sector services to offer the resources we have. If you are a researcher whose work is relevant to Covid-19, we have listed some relevant engagement opportunities below: please get in touch with one of the team (emails below) if we can support you in any way; for example with support to edit or structure scientific summaries into policy/ lay friendly ones, horizon scanning, or any other task related to getting findings out there and used.  

Contact your faculty’s PolicyBristol Associate 

Meet the team and contact us here. 

We hope you stay safe and well during this time. 

Resources from the University of Bristol 

Guidance for researchers during the COVID-19 outbreak (internal). 

The University is keen to hear about the circumstances our partners and communities are facing, how they are responding and how we might work together to meet these unparalleled new challenges. Please contact us if you have suggestions for how the University, our staff and students can support your organisational or community activities in response to COVID-19. 

The University of Bristol’s researchers, staff and students are working together and with partners from across society to understand coronavirus (COVID-19) and its far-reaching impact on our lives. Find out more here. 

National consultations and inquiries related to COVID19 

Online harms (Home Affairs Committee) The inquiry seeks evidence on Online Harms arising from the Covid-19 lockdown period and the adequacy of the Government’s proposals to counter them. Deadline 21 May 2020

Covid-19 and the food supply (Environment, Food and Rural Affairs Committee)
This inquiry examines issues related to the food supply chain and access to healthy foods. Deadline: 22 May 2020

Economic impact of coronavirus (Treasury Committee) In this stage, the Committee will examine the operational effectiveness, cost and sustainability of the Government’s and Bank of England’s support packages. The Committee will also examine the impact on the economy and different sectors, the implications for public finances, and how the Government can work towards a sustained recovery. Deadline 27 May 2020

The impact of coronavirus on business and workers (Business, Energy and Industrial Strategy Committee)
The BEIS Select Committee has launched an inquiry into the impact of coronavirus on businesses and workers. Deadline: 29 May 2020

The impact of Covid-19 on education and children’s services (Education Committee) The inquiry will examine both short term impacts, such as the effects of school closures and exam cancellations, as well as longer-term implications particularly for the most vulnerable children.
Deadline: 31 May 2020 

Left behind white pupils from disadvantaged backgrounds (Education Committee) This inquiry will investigate the issues faced by disadvantaged groups, with an initial inquiry into the educational underachievement of white pupils from disadvantaged backgrounds including white working class pupils. This inquiry will examine the extent of the achievement gap between this group and their peers and how it is measured, alongside a consideration of the effects of the COVID-19 outbreak. It will also look at what the priorities should be for tackling this issue. Deadline 5 June 2020

Defence contribution to the UK’s pandemic response (Defence Committee) This inquiry will focus on the Ministry of Defence’s and the Armed Forces’ contribution to the United Kingdom’s response to the Covid-19 pandemic. The scope will include: assessing the MoD’s planning and preparedness for a pandemic; understanding how the Armed Forces have supported the civilian authorities during the pandemic; evaluating the effectiveness of the specific actions and activities undertaken by military and civilian personnel, and; exploring how the MoD has ensured that potential adversaries have not taken advantage of the need to focus on the pandemic response. Deadline: 15 June 2020

Impact of COVID-19 on DCMS sectors: (Digital Culture Media and Sport Committee) The DCMS Committee has launched an inquiry into the ‘Impact of Covid-19 on DCMS sectors’. It will consider both the immediate and long-term impact that Covid-19 and the related social and financial measures are having on the wide range of industries and organisations under the Committee’s remit. The Committee expects to hold a number of evidence sessions from late April onwards to hear directly from stakeholders, arms-length bodies and Government about what is being done and what further support is needed. Deadline 19 June 2020

Coronavirus and Scotland (Scottish Affairs Committee). Deadline 23 June 2020

Coronavirus: implications for transport: (Transport committee)The Transport Committee is asking transport workers, stakeholders and members of the public to write to them about the transport issues they face during the coronavirus outbreak. MPs will explore the impact felt by the industry, its workers and passengers in a rolling programme of work to monitor the impact of coronavirus on UK transport, sector by sector. Deadline: 29 June 2020

The science of COVID-19: (Science and Technology Committee (Lords) This inquiry will investigate the scientific and technological aspects of the COVID-19 pandemic, including the nature of the SARS-CoV-2 virus, its transmission and spread, the development of vaccines and treatments, and how digital technologies can be used for tracking and modelling. The inquiry aims to help Government and society learn from the pandemic and better prepare for future epidemics.Deadline: 30 June 2020

The Government’s response to Covid-19: human rights implications
(Human Rights Joint Committee)
The Committee is seeking evidence on how the Government is ensuring measures are human-rights compliant, the impact of these measures on human rights in the UK, and the groups who will be disproportionately affected. Deadline: 22 July 2020

UK Science, Research and Technology Capability and Influence in Global Disease Outbreaks (Science and Technology Committee)
Once the COVID-19 pandemic has passed its peak, the Committee will inquire formally into the place of UK research, science and technology in the national and global response, and what lessons should be learned for the future. Deadline: 31 July 2020 

Past COVID inquiries

Impact of Covid-19 on the charity sector
(Digital, Culture, Media and Sport Committee)
Deadline: 16th April 2020 

  • This is a short inquiry into the impact on the charity sector. Find out more here. 

Home Office preparedness for Covid-19
(Home Affairs Committee)
Deadline: 21 April 2020 

  • The Home Affairs Committee is undertaking a short inquiry into the Home Office’s preparations for and response to Covid-19 (Coronavirus). Find out more here. 

The Covid-19 pandemic and international trade
(International Trade Committee)
Deadline: 24th April 2020 

  • This wide-ranging inquiry seeks views on impact on UK businesses, supply chains, and access to essential goods. Find out more here 

Unequal impact: Covid-19 & people with protected characteristics
(Women and Equalities Committee)
Deadline: 30th April 2020 

  • The committee wants to hear about the different and disproportionate impact that the Coronavirus – and measures to tackle it – is having on people with protected characteristics under the Equality Act. Find out more here.  

Humanitarian crises monitoring: impact of coronavirus
(International Development Committee)
Deadline: 17 April/ 8th May 2020 

  • This inquiry is seeking evidence in two waves; current situation and immediate risks (17 April) and longer-term issues and implications (8 May). Find out more here.

Life of Breath – The perspective of the humanities on COVID-19

This post was written by Professor  Havi Carel (University of Bristol) and Professor Jane Macnaughton (Durham University)

Editor Note: COVID-19, with its wide ranging impacts, has opened up an opportunity to demonstrate the value of scholarly analysis from a wide range of perspectives.  The use of an Arts and Humanities lens helps reveal unexamined areas of interest and importance that would otherwise remain blindspots in our understanding of the health, disease and societal impacts. This piece not only highlights beneficial arts and science collaborations (Singing for Lung Health) but also shows the power of reframing concepts in new ways, which can affect how we approach them.

For the last five years (2015-2020) we have been leading a Wellcome-funded project, the Life of Breath  https://lifeofbreath.org/.  Our aim has been to explore the experience of breathing and breathlessness from an interdisciplinary medical humanities perspective, including insights and knowledge from the humanities, social science and the arts.  It is astonishing that just as we submitted our end of project report, the whole world has been taken over by the COVID-19 pandemic and, with it, the fear of breathlessness. This is all the more strange because a major theme of our project was the invisibility of breath: how as healthy individuals we take breathing for granted; how hidden are those who live with the daily fear of death that accompanies severe breathlessness; and how trustingly we rely on the air around us.

Although breathlessness is central to the diagnosis of COVID-19, and also a sign of disease progression, it is still not highly visible in the media, despite being a pervasive symptom of severe disease.  Many of our pressing current concerns are more tangential: we are concerned about the curbs on personal freedom, about accessing food, and most of all about the health and wellbeing of our loved ones. Why are we not trying to understand the experience of breathlessness better?

Our research sheds light on this strange avoidance.  Breath is essential to life and any threat to it is too frightening to be able to comprehend, let alone express.  Our deepest and most atavistic fears relate to suffocation, drowning, or being unable to breathe.  Breathlessness itself, we have found, is a complex experience that is difficult to articulate, and clinical language can obstruct understanding and prevent the update of suitable management. https://lifeofbreath.org/2019/07/the-meaning-of-the-name-pulmonary-rehabilitation-oxley-et-al-2019/

Much of our work explored how arts and humanities approaches can be used to support and alleviate the suffering associated with chronic breathlessness.  Our research showed that encouraging expression of what breathlessness feels like can be aided by involvement with the arts, for example, through the ‘letter to my breath’ workshops our project designed and ran (https://lifeofbreath.org/2019/01/dear-breath-using-story-structure-to-understand-the-value-of-letter-writing-for-those-living-with-breathlessness-penny-malpass-2019/)

Outreach work from our Catch your Breath exhibition showed that poetry unleashes ideas and metaphors that enable the experience of breathlessness to be not only expressed to others but also understood by the breathless person themselves.  Our ‘Singing for Lung Health’ groups provided important evidence that learning basic diaphragm control and simple singing exercises can increase confidence and sense of control.

Philosophy has also been used in our work to develop a framework for understanding breathlessness more broadly, as a lived experience, rather than as a medical symptom.

See: https://lifeofbreath.org/2016/10/phenomenology-of-illness-by-havi-carel/

We have also published policy recommendations on how breathlessness could be better managed, especially in end of life care:

http://www.bristol.ac.uk/policybristol/policy-briefings/life-of-breath/

Approaches to management can be enhanced if we take a step away from clinical contexts and instead step onto the dance floor to improve exercise capacity.

http://www.bristol.ac.uk/policybristol/policy-briefings/life-of-breath/

The Life of Breath website provides resources based on our research to support people with breathlessness or who are feeling anxious during this difficult time.  We hope you find them useful.

https://lifeofbreath.org/2020/03/breathing-in-isolation-support-with-anxiety-breathlessness-during-lockdown/

https://lifeofbreath.org/2020/03/dance-easy-breathe-better-and-feel-good/

This post was originally published by the International Science Council. You can read the original article here.

Covid-19 in South Africa: The Long Walk to Freedom Continues

Angelique Retief (PhD student, School of Policy Studies, University of Bristol)

The large number of deaths of BAME people due to the coronavirus has quickly disproved the claim that the pandemic is a ‘great equaliser’ and has instead brought to the fore the many social ills in society. As most determinants of health are socially created, it logically follows then that the fact that socioeconomic deprivation disproportionately affects BAME people will be a precursor to the impact of the virus on those communities. With living space, gardens, and local areas (or the lack thereof) dictating our wellbeing, the gap between the rich and the poor has never been more obvious. The coronavirus will therefore not be felt equally and – compounded by the already profound challenges to wellbeing in non-OECD countries – will only serve to further entrench existing racial and economic disparities.

Racial disparities have a history. The product of centuries of colonialism, apartheid and racial exclusion, South Africa’s welfare system has struggled to provide the freedoms promised in 1994. It has been 26 years since South Africa’s first democratic election, and it is still one of the world’s most unequal societies. With unemployment levels at a decade high of 30% (reaching 40% in some areas), poor levels of basic service provision (StatsSA, 2018), over 2 million AIDS orphans, and the highest level of people with HIV of any country (UNAIDS, 2018), the impacts of Covid-19 will be acutely felt in this part of the world.

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