Background: UK local authorities that experience sustained high levels of COVID-19 are described as areas of enduring prevalence (1). This research was carried out to investigate reasons for sustained high prevalence, along with mitigation strategies employed by Directors of Public Health, who lead public health teams.

Methods: Interviews were conducted with Directors of Public Health in 19 local authority areas across England, between July and November 2021. This included nine areas identified as areas of enduring prevalence and ten ‘comparison’ areas.

Results: The research suggests that health inequalities influence the wider picture of prevalence rates of COVID-19. Structural factors including deprivation, employment, and housing, due to the disproportionate impact on specific groups, converged with demographic factors including ethnicity and age, and vaccination rates, and were identified as key drivers of enduring prevalence. There are key differences in these drivers both within local authorities, and to a lesser extent, between areas of enduring prevalence and their comparison areas.

Conclusions: The research suggests that existing health inequalities influenced the wider picture of prevalence rates of COVID-19. Participants advised that more research is needed on the effectiveness of mitigation strategies, and to better understand the factors that drive prevalence. This would include an assessment of how these factors to combine to predict transmission, how this varies between different areas, and the relative importance of each

Original languageEnglish
PublisherResearch Square
Publication statusPublished - 3 Nov 2022

Publication series

NameResearch Square
PublisherResearch Square


  • Community engagement
  • COVID-19
  • Employment
  • Deprivation
  • health inequalities
  • partnership working


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