Contributing factors and mitigation strategies for areas of enduring COVID19 prevalence Report 1 – Drivers and regional variations

Catherine Lewis, Sheena Johnson, Angelique Hartwig, Anna Coleman, Nicola Gartland, Janet Ubido, Amit Gaokar, C J Armitage, David Fishwick, Arpana Verma, Martie Van Tongeren, Helen Kreissl

Research output: Book/ReportCommissioned reportpeer-review


Background. Variations in enduring prevalence of COVID-19 have been identified, and several local UK authority areas have experienced sustained high levels of the virus. This report (Report 1) examines key drivers of prevalence, and variations between local authority areas. A second report (Report 2) examines the mitigation strategies implemented by Directors of Public Health across England during the course of the pandemic.
Methods. An analysis of the differences between areas of enduring prevalence of COVID-19 and comparison areas on a range of indicators was conducted. Data on deprivation, ethnicity, overcrowded households, and factors related to employment were collected for the local authority areas included in the research, to reflect some of the themes that were emerging from interviews with the Directors of Public Health and from the literature review.
Semi-structured interviews were undertaken with 19 Directors of Public Health across England, between July and November 2021. Nine of the 19 interviews were in areas identified by Public Health England as spending the highest number of days in an epidemic phase (‘areas of enduring prevalence’), and ten were in ‘comparison’ areas that had fewer days of high community infection during the pandemic.
Results. The indicator data analysis revealed that the areas of enduring prevalence overall were more deprived, had significantly lower levels of employment and significantly higher proportions of people working in lower skilled occupations, had a higher proportion of people who lived in overcrowded housing, a higher proportion of people from ethnic minority backgrounds and lower vaccination rates than the comparison areas. Directors of Public Health also identified high deprivation levels, overcrowded housing, and low vaccination rates as risk factors for enduring prevalence. Deprivation and employment were often jointly discussed as creating major barriers for people to self-isolate or work remotely. Not receiving sick pay, working on zero hours contracts or in insecure employment
were identified as reasons for inability to self-isolate. There were strong similarities in the drivers of enduring prevalence described by the Directors of Public Health in areas of enduring prevalence and comparison areas. All participants asserted that there were differences in these factors between different wards or geographical areas within their local authority, and between different groups, including people from different age groups and ethnic backgrounds. Participants in comparison areas were more likely to identify travel in and out of the local authority area as a risk factor.
Conclusion. The research suggests that health existing health inequalities influence the wider picture of prevalence rates of COVID-19. Structural factors including deprivation, employment, and housing, converging with demographic factors including ethnicity and age, and vaccination rates, are key drivers of prevalence, and there are key differences in these drivers both within local authorities, and to a lesser extent, between AEP and CA. Further research is needed, ideally at ward/SOA level, on how these factors combine to predict
transmission and how this varies between different areas, and on the relative importance of each of these factors
Original languageEnglish
PublisherPROTECT National Core Study Report (HSE)
Number of pages40
Publication statusPublished - 22 Jul 2022


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