Was Alpha deadlier than wild-type COVID? Analysis in rural England.

BACKGROUND: It is useful to document whether each newly dominant SARS-CoV-2 variant of concern was more or less dangerous than preceding dominant variant(s). We assessed if the emergence of the Alpha (B.1.1.7) variant in autumn 2020 could be linked to higher case fatality rates, compared to original wild-type COVID-19, subgrouping by age band, sex, deprivation or month of diagnosis as potential risk factors. METHODS: Observational study and secondary analysis were conducted of SARS-CoV-2 cases diagnosed due to medical need or occupational exposure in an administrative area of Eastern England, UK (base population 1 million), who first tested positive in the period 1 March 2020 to 28 February 2021. Multivariate logistic regression was performed to examine relationships of age group, sex, deprivation group and month of diagnosis with case fatality rates within 28 days of diagnosis. Marginal probabilities for risk of dying were calculated separately for the first two main 'wave' periods of the English pandemic. RESULTS: Older age and male sex consistently raised the risk of mortality in both wave periods. Higher deprivation was linked to mortality risk in the first wave period, but not in the second wave. Mortality decreased over time during the first wave period, but slightly increased over time during the second wave. Cases were younger in the second wave, and median age of the deceased varied little between waves. INTERPRETATION: The Alpha variant of SARS-CoV-2 did not lead to higher mortality rates for any age, deprivation or sex group, compared to case fatality rates in the early part of the pandemic period.

"Taking from Peter to pay Paul": The experience of people in receipt of fuel and food vouchers from a UK foodbank.

For people on very low incomes, household fuel and food environments are increasingly uncertain. Many live in precarious situations with little control over their lives. In addition to food parcels, many foodbanks also supply emergency fuel payments. There has been a surge in demand due to the cost of living crisis in the United Kingdom. This qualitative study, using semi-structured interviews, explored the lived experience of people who received a fuel voucher via a foodbank to gain insights into food preparation, eating practices and heating and appliance use in their homes. All participants (n = 6) described a change in life circumstances leaving them at crisis point with overwhelming uncertainty. Using Thematic Analysis, we identified four themes: (1) Bewilderment in using foodbank services; (2) The need to make trade-offs between food and fuel; (3) Feeling shame at using the services and (4) Missing out on pleasurable eating practices. Three case studies give fuller insights and context. All interviewees had acute and complex needs and described being 'at rock bottom', with fuel vouchers viewed as a 'lifeline' to address essential cooking, heating and electrical appliance needs. We, therefore, suggest the need for extra support and follow-up for first-time users who are in a state of denial and shock when seeking help. Further research is needed on how to best help organisations develop strategies to address and ameliorate a sense of powerlessness and shame felt by their clients which likely limits them from seeking help, despite being in acute, complex and dire need.

Societal costs of chemotherapy in the UK: an incidence-based cost-of-illness model for early breast cancer.

AIM: To estimate annual societal costs associated with chemotherapy for early breast cancer in the UK. DESIGN: Mixed methods: (a) an incidence-based cost-of-illness model was developed of indirect costs in patients with breast cancer and carers, and estimated from diagnosis through active treatment until death; (b) interviews with stakeholders were also undertaken to understand actual experiences and impacts of these costs. DATA SOURCES: Model data were collated from relevant national data sources covering general population statistics, UK cancer registries, clinical guidelines and published literature, and patient survey data. Patient and staff views were collected through semistructured interviews. PARTICIPANTS: Model: patients with early breast cancer receiving systemic anticancer therapy in the UK. Interviews were undertaken with women who had chemotherapy and medical practitioners involved in breast cancer care. RESULTS: Total costs of chemotherapy in the UK economy are over £248 million. Societal productivity losses amount to £141.4 million, which includes £3.2 million associated with premature mortality, short-term and long-term work absence (£28.6 million and £105 million, respectively). £3.4 million is associated with mortality losses from secondary malignancies due to adjuvant chemotherapy. A further £1.1 million in lost productivity arises from informal care provision. Out-of-pocket costs per round of chemotherapy account for £4.2 million, or an annual average of almost £1100 per patient. Interview findings support the cost burden modelled and also highlight the impact on cognitive function of patients and how this could increase the cost burden to patients, their families and wider society. In addition, estimated costs for carer emotional well-being are £82 million in lost quality of life. CONCLUSION: Chemotherapy use carries significant indirect costs for society, as well as patients and their carers. These wider costs and societal perspective should be considered by commissioners to ensure chemotherapy is better targeted at those who most need it and to avoid placing unnecessary costs on patients, their caregivers and wider society.