The impact of COVID-19 related regulations and restrictions on mobility and potential for sustained climate mitigation across the Netherlands, Sweden and the UK: a data-based commentary.

Human behaviour change is necessary to meet targets set by the Paris Agreement to mitigate climate change. Restrictions and regulations put in place globally to mitigate the spread of COVID-19 during 2020 have had a substantial impact on everyday life, including many carbon-intensive behaviours such as transportation. Changes to transportation behaviour may reduce carbon emissions. Behaviour change theory can offer perspective on the drivers and influences of behaviour and shape recommendations for how policy-makers can capitalise on any observed behaviour changes that may mitigate climate change. For this commentary, we aimed to describe changes in data relating to transportation behaviours concerning working from home during the COVID-19 pandemic across the Netherlands, Sweden and the UK. We display these identified changes in a concept map, suggesting links between the changes in behaviour and levels of carbon emissions. We consider these changes in relation to a comprehensive and easy to understand model of behaviour, the Opportunity, Motivation Behaviour (COM-B) model, to understand the capabilities, opportunities and behaviours related to the observed behaviour changes and potential policy to mitigate climate change. There is now an opportunity for policy-makers to increase the likelihood of maintaining pro-environmental behaviour changes by providing opportunities, improving capabilities and maintaining motivation for these behaviours.

The impact and effectiveness of the general public wearing masks to reduce the spread of pandemics in the UK: a multidisciplinary comparison of single-use masks versus reusable face masks.

During the coronavirus (COVID-19) pandemic, the UK government mandated the use of face masks in various public settings and recommended the use of reusable masks to combat shortages of medically graded single-use masks in healthcare. To assist decision-making on the choice of masks for future pandemics, where shortages may not be a contributing factor, the University College London (UCL) Plastic Waste Innovation Hub has carried out a multidisciplinary comparison between single-use and reusable masks based on their anatomy, standalone effectiveness, behavioural considerations, environmental impact and costs. Although current single-use masks have a higher standalone effectiveness against bacteria and viruses, studies show that reusable masks have adequate performance in slowing infection rates of respiratory viruses. Material flow analysis (MFA), life cycle assessment (LCA) and cost comparison show that reusable masks have a lower environmental and economic impact than single-use masks. If every person in the UK uses one single-use mask each day for a year, it will create a total of 124,000 tonnes of waste, 66,000 tonnes of which would be unrecyclable contaminated plastic waste (the masks), with the rest being the recyclable packaging typically used for transportation and distribution of masks. Using reusable masks creates >85% less waste, generates 3.5 times lower impact on climate change and incurs 3.7 times lower costs. Further behavioural research is necessary to understand the extent and current practices of mask use; and how these practices affect mask effectiveness in reducing infection rates. Wearing single-use masks may be preferred over reusable masks due to perceptions of increased hygiene and convenience. Understanding behaviour towards the regular machine-washing of reusable masks for their effective reuse is key to maximise their public health benefits and minimise environmental and economic costs.

Interventions to increase personal protective behaviours to limit the spread of respiratory viruses: A rapid evidence review and meta-analysis

PURPOSE: Increasing personal protective behaviours is critical for stopping the spread of respiratory viruses, including SARS-CoV-2: we need evidence to inform how to achieve this. We aimed to synthesise evidence on interventions to increase six personal protective behaviours (e.g. hand hygiene, face mask use) to limit the spread of respiratory viruses. METHODS: We used best practice for rapid evidence reviews. We searched Ovid MEDLINE and Scopus. Studies conducted in adults or children with active or passive comparators were included. We extracted data from published intervention descriptions on study design, intervention content, delivery mode, population, setting, mechanism(s) of action, acceptability, practicability, effectiveness, affordability, spill-over effects and equity impact. Study quality was assessed with Cochrane's risk of bias tool. A narrative synthesis and random-effects meta-analyses were conducted. RESULTS: We identified 39 studies conducted across 15 countries. Interventions targeted hand hygiene (n=30) and/or face mask use (n=12) and used two- or three-arm study designs with passive comparators. Interventions were typically delivered face-to-face and included a median of three behaviour change techniques. The quality of included studies was low. Interventions to increase hand hygiene (k=6) had a medium, positive effect (_d_=0.62, 95% CI=0.43-0.80, _p_<.001, I2=81.2%). Interventions targeting face mask use (k=4) had mixed results, with an imprecise pooled estimate (OR=4.14, 95% CI=1.24-13.79, _p_<.001, I2=89.67%). Between-study heterogeneity was high. CONCLUSIONS: We found low-quality evidence for positive effects of hand hygiene interventions, with unclear results for face mask use interventions. There was a lack of evidence for interventions targeting most behaviours of interest within this review.

Face masks to prevent community transmission of viral respiratory infections: A rapid evidence review using Bayesian analysis

Background: Face masks have been proposed as an important way of reducing transmission of viral respiratory infections, including SARS-CoV-2. Objective: To assess the likelihood that wearing face masks in community settings reduces transmission of viral respiratory infections. Methods: We conducted a rapid evidence review and used a Bayesian statistical approach to analysing experimental and observational studies conducted in community-dwelling children and adults that assessed the effectiveness of face mask wearing (vs. no face masks) on self-reported, laboratory-confirmed, or clinically diagnosed viral respiratory infections. Results: Eleven RCTs and 10 observational studies met the inclusion criteria. The calculation of Bayes factors and cumulative posterior odds from the RCTs showed a moderate likelihood of a small effect of wearing surgical face masks in community settings in reducing self-reported influenza-like illness (ILI) (cumulative posterior odds = 3.61). However, the risk of reporting bias was high and evidence of reduction of clinically- or laboratory-confirmed infection was equivocal (cumulative posterior odds = 1.07 and 1.22, respectively). Observational studies yielded evidence of a negative association between face mask wearing and ILI but with high risk of confounding and reporting bias. Conclusions: Available evidence from RCTs is equivocal as to whether or not wearing face masks in community settings results in a reduction in clinically- or laboratory-confirmed viral respiratory infections. No relevant studies concerned SARS-CoV-2 or were undertaken in community settings in the UK.

Enabling countries to apply behavioural science in using global survey data to inform their Covid-19 policies

The COVID-19 pandemic highlighted the vital importance and impact of human behaviour on viral transmission. During 2020, large amounts of global survey data were collected and made freely available to help the response. Many teams responding to the pandemic lack capacity to interpret and apply behavioural data. A collaboration of the World Health Organization's Behavioural Insights team and UCL's Centre for Behaviour Change designed and piloted two templates to enable survey data use during the first months of the pandemic. The first template documents key behaviours, thoughts and emotions related to the pandemic, with social interactions and population adherence to behavioural guidelines. The second template enables countries to formulate questions or issues that they would like behavioural data to address. This collaborative process applying behavioural science theory produced structured templates to enable the organisation, interpretation, sharing and application of survey data to inform policy and practice in different country contexts.

Public health and social measures during health emergencies such as the COVID‐19 pandemic: An initial framework to conceptualize and classify measures

Background Public health and social measures (PHSM) intend to reduce the transmission of infectious diseases and to reduce the burden on health systems, economies and societies. During the COVID‐19 pandemic, PHSM have been selected, combined and implemented in a variable manner and inconsistently categorized in policy trackers. This paper presents an initial conceptual framework depicting how PHSM operate in a complex system, enabling a wide‐reaching description of these measures and their intended and unintended outcomes. Methods In a multi‐stage development process, we combined (i) a complexity perspective and systems thinking;(ii) literature on existing COVID‐19 PHSM frameworks, taxonomies and policy trackers;(iii) expert input and (iv) application to school and international travel measures. Results The initial framework reflects our current understanding of how PHSM are intended to achieve transmission‐related outcomes in a complex system, offering visualizations, definitions and worked examples. First, PHSM operate through two basic mechanisms, that is, reducing contacts and/or making contacts safer. Second, PHSM are defined not only by the measures themselves but by their stringency and application to specific populations and settings. Third, PHSM are critically influenced by contextual factors. The framework provides a tool for structured thinking and further development, rather than a ready‐to‐use tool for practice. Conclusions This conceptual framework seeks to facilitate coordinated, interdisciplinary research on PHSM effectiveness, impact and implementation;enable consistent, coherent PHSM monitoring and evaluation;and contribute to evidence‐informed decision‐making on PHSM implementation, adaptation and de‐implementation. We expect this framework to be modified and refined over time.

Public health and social measures during health emergencies such as the COVID-19 pandemic: An initial framework to conceptualize and classify measures.

Background: Public health and social measures (PHSM) intend to reduce the transmission of infectious diseases and to reduce the burden on health systems, economies and societies. During the COVID-19 pandemic, PHSM have been selected, combined and implemented in a variable manner and inconsistently categorized in policy trackers. This paper presents an initial conceptual framework depicting how PHSM operate in a complex system, enabling a wide-reaching description of these measures and their intended and unintended outcomes. Methods: In a multi-stage development process, we combined (i) a complexity perspective and systems thinking; (ii) literature on existing COVID-19 PHSM frameworks, taxonomies and policy trackers; (iii) expert input and (iv) application to school and international travel measures. Results: The initial framework reflects our current understanding of how PHSM are intended to achieve transmission-related outcomes in a complex system, offering visualizations, definitions and worked examples. First, PHSM operate through two basic mechanisms, that is, reducing contacts and/or making contacts safer. Second, PHSM are defined not only by the measures themselves but by their stringency and application to specific populations and settings. Third, PHSM are critically influenced by contextual factors. The framework provides a tool for structured thinking and further development, rather than a ready-to-use tool for practice. Conclusions: This conceptual framework seeks to facilitate coordinated, interdisciplinary research on PHSM effectiveness, impact and implementation; enable consistent, coherent PHSM monitoring and evaluation; and contribute to evidence-informed decision-making on PHSM implementation, adaptation and de-implementation. We expect this framework to be modified and refined over time.

Knowledge of Self-Isolation Rules in the UK for Those Who Have Symptoms of COVID-19: A Repeated Cross-Sectional Survey Study.

OBJECTIVES: To investigate knowledge of self-isolation rules and factors associated with knowledge. METHODS: Repeated cross-sectional online surveys (n ≈ 2000 UK adults) between 9 November 2020 and 16 February 2022 (78,573 responses from 51,881 participants). We computed a composite measure of knowledge of self-isolation rules and investigated associations between knowledge and survey wave, socio-demographic characteristics (age, gender, UK nation, index of multiple deprivation), trust in government, and participants' belief that they had received enough information about self-isolation. RESULTS: In total, 87.9% (95% CI 87.7% to 88.1%, n = 67,288/76,562) of participants knew that if they had symptoms of COVID-19 they should 'self-isolate'. However, only 62.8% (n = 48,058/76,562, 95% CI 62.4% to 63.1%) knew the main rules regarding what that meant. Younger people had less knowledge than older people, and men had less knowledge than women. Knowledge was lower in people living in England versus in Scotland, Wales, and Northern Ireland. The pattern of association between knowledge and trust in government was unclear. Knowledge was lower in people living in a more deprived area and those who did not believe they had enough information about self-isolation. Knowledge was lower in December 2020 to January 2021, compared with before and after this period. CONCLUSIONS: Approximately 63% of UK adults between November 2020 and February 2022 appeared to know the main rules regarding self-isolation if symptomatic with COVID-19. Knowledge was lower in younger than older people, men than women, those living in England compared with Scotland, Wales or Northern Ireland, and those living in more deprived areas.

Human mobility variations in response to restriction policies during the COVID-19 pandemic: An analysis from the Virus Watch community cohort in England, UK

Objective Since the outbreak of COVID-19, public health and social measures to contain its transmission (e.g., social distancing and lockdowns) have dramatically changed people's lives in rural and urban areas globally. To facilitate future management of the pandemic, it is important to understand how different socio-demographic groups adhere to such demands. This study aims to evaluate the influences of restriction policies on human mobility variations associated with socio-demographic groups in England, UK. Methods Using mobile phone global positioning system (GPS) trajectory data, we measured variations in human mobility across socio-demographic groups during different restriction periods from Oct 14, 2020 to Sep 15, 2021. The six restriction periods which varied in degree of mobility restriction policies, denoted as “Three-tier Restriction,” “Second National Lockdown,” “Four-tier Restriction,” “Third National Lockdown,” “Steps out of Lockdown,” and “Post-restriction,” respectively. Individual human mobility was measured with respect to the time period people stayed at home, visited places outside the home, and traveled long distances. We compared these indicators across the six restriction periods and across socio-demographic groups. Results All human mobility indicators significantly differed across the six restriction periods, and the influences of restriction policies on individual mobility behaviors are correlated with socio-demographic groups. In particular, influences relating to mobility behaviors are stronger in younger and low-income groups in the second and third national lockdowns. Conclusions This study enhances our understanding of the influences of COVID-19 pandemic restriction policies on human mobility behaviors within different social groups in England. The findings can be usefully extended to support policy-making by investigating human mobility and differences in policy effects across not only age and income groups, but also across geographical regions.

A framework for considering the utility of models when facing tough decisions in public health: a guideline for policy-makers.

The COVID-19 pandemic has brought the combined disciplines of public health, infectious disease and policy modelling squarely into the spotlight. Never before have decisions regarding public health measures and their impacts been such a topic of international deliberation, from the level of individuals and communities through to global leaders. Nor have models-developed at rapid pace and often in the absence of complete information-ever been so central to the decision-making process. However, after nearly 3 years of experience with modelling, policy-makers need to be more confident about which models will be most helpful to support them when taking public health decisions, and modellers need to better understand the factors that will lead to successful model adoption and utilization. We present a three-stage framework for achieving these ends.

Covid-19 in the UK: policy on children and schools

Deepti Gurdasani and colleagues argue UK covid policy did not give children sufficient priority and question the evidence behind government decisions

How has the emergence of the Omicron SARS-CoV-2 variant of concern influenced worry, perceived risk and behaviour in the UK? A series of cross-sectional surveys.

OBJECTIVES: To investigate changes in beliefs and behaviours following news of the Omicron variant and changes to guidance understanding of Omicron-related guidance, and factors associated with engaging with protective behaviours. DESIGN: Series of cross-sectional surveys (1 November to 16 December 2021, five waves of data collection). SETTING: Online. PARTICIPANTS: People living in England, aged 16 years or over (n=1622-1902 per wave). PRIMARY AND SECONDARY OUTCOME MEASURES: Levels of worry and perceived risk, and engagement with key behaviours (out-of-home activities, risky social mixing, wearing a face covering and testing uptake). RESULTS: Degree of worry and perceived risk of COVID-19 (to oneself and people in the UK) fluctuated over time, increasing slightly around the time of the announcement about Omicron (p<0.001). Understanding of rules in England was varied, ranging between 10.3% and 91.9%, with people overestimating the stringency of the new rules. Rates of wearing a face covering and testing increased over time (p<0.001). Meeting up with people from another household decreased around the time of the announcement of Omicron (29 November to 1 December), but then returned to previous levels (p=0.002). Associations with protective behaviours were investigated using regression analyses. There was no evidence for significant associations between out-of-home activity and worry or perceived risk (COVID-19 generally or Omicron-specific, p≥0.004; Bonferroni adjustment p<0.002 applied). Engaging in highest risk social mixing and always wearing a face covering were associated with worry and perceived risk about COVID-19 (p≤0.001). Always wearing a face covering in shops was associated with having heard more about Omicron (p<0.001). CONCLUSIONS: Almost 2 years into the COVID-19 outbreak, the emergence of a novel variant of concern only slightly influenced worry and perceived risk. The main protective behaviour (wearing a face covering) promoted by new guidance showed significant re-uptake, but other protective behaviours showed little or no change.