PHE surveillance report shows that while the number of infections is increasing mainly in 20-29, 30-39 ages in England, SARS-CoV-2 is spreading most in highly deprived areas - where people are in poorly paid work and can't afford to isolate. (17/n) https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/919676/Weekly_COVID19_Surveillance_Report_week_38_FINAL_UPDATED.pdf

In Madrid, 37 neighbourhoods are seeing the highest incidence, 4 x the Spanish average. Common factors: these areas are poorer, denser and have a high proportion of immigrant population. (18/n)

( https://elpais.com/sociedad/2020-09-19/como-son-las-zonas-restringidas-en-madrid-mas-densas-con-mas-inmigrantes-y-sobre-todo-mas-pobres.html)

Previous research suggests that although social distancing during the 2009 H1N1 pandemic was effective in reducing infections, this was most pronounced in households w greater socioeconomic advantage. Similar findings are emerging for COVID-19. (19/n) ( https://www.pnas.org/content/117/33/19658//)

Covid-19 could now be endemic in some parts of England that combine severe deprivation, poor housing and large BAME communities, national lockdown in these parts of the north of England had little effect in reducing the level of infections (20/n) ( https://www.theguardian.com/world/2020/sep/05/covid-19-could-be-endemic-in-deprived-parts-of-england//)

A real overlap in the causes of mortality and deprivation can be seen here. The age-standardised rate of deaths involving COVID-19 in the most deprived quintile was more than double (2.3 times higher) than in the least deprived quintile in Scotland. (21/n) https://www.nrscotland.gov.uk/files/statistics/covid19/covid-deaths-report-week-19.pdf

In summary:
The disproportionate impact of COVID-19 on households living in poverty, and the racial and ethnic disparities observed in many countries, emphasize the need to urgently update our definition of "vulnerable" populations for COVID-19 & address these inequities. (22/n)

These include social and income protection and support to ensure low paid, non-salaried and zero-hours contract workers can afford to follow isolation and quarantine recommendations, provision of protective equipment for workplaces and community settings. (23/n)

Early viral load peak in the disease course indicates that preventing onward transmission requires immediate self-isolation with symptom onset (for a min of 5 days). Messages should prioritise isolation practices, and policies should include supported isolation. (24/n)

There are many things that could be done within families to decrease transmission. We need to provide clear instructions, and means of support to enable those with symptoms/positive test and their contacts to isolate. (25/n) https://www.abc.net.au/news/2020-09-15/coronavirus-swept-through-jos-house.-heres-how-he-dodged-it/12660218

Policymakers and health experts can help the public differentiate between lower-risk and higher-risk activities and environments and public health messages could convey a spectrum of risk to the public to support engagement in alternatives for safer interaction (26/n)

Avoid crowded indoor poorly ventilated environments. Spend more time outdoors. Maintain your distance (more is better but 2 metre is not a panacea). Improve ventilation: open windows/doors. Wear a mask indoors. Wash hands. (27/n) ( https://www.vox.com/science-and-health/2020/5/22/21265180/cdc-coronavirus-surfaces-social-distancing-guidelines-covid-19-risks)

Public health strategies will be needed to mitigate transmission in nursing homes, prisons and jails, shelters, meat-packing plants such as personal protective equipment and routine testing to identify infected individuals early in the disease course. (28/n)

This thread is based on our new paper with @JuliaLMarcus Caroline Buckee and @aetiology

Accepted in CID - preprint version can be accessed here: ( https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3692807)