BMJ

IntroductionThe spring 2023 COVID-19 booster vaccination programme in England used both Pfizer BA.4-5 and Sanofi vaccines. All people aged 75 years or over and the clinically vulnerable were eligible to receive a booster dose. Direct comparisons of the effectiveness of these two vaccines in boosting protection against severe COVID-19 events have not been made in trials or observational data. MethodsWith the approval of NHS England, we used the OpenSAFELY-TPP database to compare effectiveness of...

ObjectiveTo compare the effectiveness of sotrovimab (a neutralising monoclonal antibody) vs. molnupiravir (an antiviral) in preventing severe COVID-19 outcomes in non-hospitalised high-risk COVID-19 adult patients. DesignWith the approval of NHS England, we conducted a real-world cohort study using the OpenSAFELY-TPP platform. SettingPatient-level electronic health record data were obtained from 24 million people registered with a general practice in England that uses TPP software. The primary...

We describe our analyses of data from over 49.7 million people in England, representing near-complete coverage of the relevant population, to assess the risk of myocarditis and pericarditis following BNT162b2 and ChAdOx1 COVID-19 vaccination. A self-controlled case series (SCCS) design has previously reported increased risk of myocarditis after first ChAdOx1, BNT162b2, and mRNA-1273 dose and after second doses of mRNA COVID-19 vaccines in England. Here, we use a cohort design to estimate hazard ...

ObjectivesTo determine whether COVID-19 efficacy varies with clinical risk category and to investigate risk factors for severe COVID-19 in those who have received two doses of vaccine. DesignMatched case-control study (REACT-SCOT). SettingPopulation of Scotland from 1 December 2020 to 8 September 2021. Main outcome measureSevere COVID-19, defined as cases with entry to critical care or fatal outcome. ResultsEfficacy against severe COVID-19 of two doses of vaccine was 94% (95 percent CI 93% t...

BackgroundThe Winter Coronavirus (COVID-19) Infection Study (WCIS) was a sample-based household study in England and Scotland aiming to inform COVID-19-related epidemiology and health pressures over the 2023-2024 winter period. We aim to estimate vaccine effectiveness (VE) against both SARS-CoV-2 infection in general and specifically symptomatic infection (COVID-19) within the WCIS cohort in England. MethodsData from self-reported lateral flow device (LFD) tests for SARS-CoV-2 were collected fr...

BackgroundSARS-CoV-2 vaccines are highly effective in preventing severe COVID-19 but require boosting to maintain protection. Changes to circulating variants and prevalent natural immunity may impact on real-world effectiveness of boosters in different time periods and in different populations. MethodsWith NHS England approval, we used linked routine clinical data from >24 million patients to evaluate the effectiveness of the 2022 combined COVID-19 autumn booster and influenza vaccine campaign ...

BackgroundDiagnostic (self-)testing for SARS-CoV-2 may lead to selection bias in test-negative case-control designs (TND) for COVID-19 vaccine effectiveness (CVE) at primary care level. We investigated whether after the acute phase of the pandemic, (self-)testing among those with an acute respiratory infection (ARI) was associated with healthcare seeking behaviour at primary care level in the general Dutch population. MethodsWe pooled questionnaire data from three study rounds (June 2022, Novem...

BackgroundNearly 30,000 patients with coronavirus disease-2019 (COVID-19) have been hospitalized in New York City as of April 14th, 2020. Data on the epidemiology, clinical course, and outcomes of critically ill patients with COVID-19 in this setting are needed. MethodsWe prospectively collected clinical, biomarker, and treatment data on critically ill adults with laboratory-confirmed-COVID-19 admitted to two hospitals in northern Manhattan between March 2nd and April 1st, 2020. The primary out...

BackgroundChinese studies reported predictors of severe disease and mortality associated with coronavirus disease 2019 (COVID-19). A generalizable and simple survival calculator based on data from US patients hospitalized with COVID-19 has not yet been introduced. ObjectiveDevelop and validate a clinical tool to predict 7-day survival in patients hospitalized with COVID-19. DesignRetrospective and prospective cohort study. SettingThirteen acute care hospitals in the New York City area. Parti...

BackgroundIn this study we phenotyped individuals hospitalised with coronavirus disease 2019 (COVID-19) in depth, summarising entire medical histories, including medications, as captured in routinely collected data drawn from databases across three continents. We then compared individuals hospitalised with COVID-19 to those previously hospitalised with influenza. MethodsWe report demographics, previously recorded conditions and medication use of patients hospitalised with COVID-19 in the US (Co...

IntroductionThe last COVID-19 vaccine offered to all adults in England became available from November 2021. The most recent booster programme commenced in September 2023. Bivalent BA.4-5 or monovalent XBB.1.5 boosters were given. During the study period, the JN.1 variant became dominant in England. MethodsVaccine effectiveness against hospitalisation was estimated throughout using the test-negative case-control study design where positive PCR tests from hospitalised individuals are cases and co...

Despite much research on the topic, little work has been done comparing the use of methods to control for confounding in the estimation of COVID-19 vaccine effectiveness in routinely collected medical record data. We conducted a trial emulation study to replicate the ChAdOx1 (Oxford/AstraZeneca) and BNT162b2 (BioNTech/Pfizer) COVID-19 phase 3 efficacy studies. We conducted a cohort study including individuals aged 75+ from UK CPRD AURUM (N = 916,128) in early 2021. Three different methods were a...

ImportanceThe overall effects of vaccination on the risk of cardiac, and venous and arterial thromboembolic complications following COVID-19 remain unclear. ObjectiveWe studied the association between COVID-19 vaccination and the risk of acute and subacute COVID-19 cardiac and thromboembolic complications. DesignMultinational staggered cohort study, based on national vaccination campaign rollouts. SettingNetwork study using electronic health records from primary care records from the UK, prim...

IntroductionThis study aims to explore the impact of COVID-19 vaccination on critical care by examining associations between vaccination and admission to critical care with COVID-19 during Englands Delta wave, by age group, dose, and over time. MethodsWe used linked routinely-collected data to conduct a population cohort study of patients admitted to adult critical care in England for management of COVID-19 between 1 May and 15 December 2021. Included participants were the whole population of E...

ObjectiveTo assess the early vaccine administration coverage and vaccine effectiveness and outcome data across an integrated care system of eight CCGs leveraging a unique population-level care dataset DesignRetrospective cohort study. SettingIndividuals eligible for COVID 19 vaccination in North West London based on linked primary and secondary care data. Participants2,183,939 individuals eligible for COVID 19 vaccination ResultsDuring the NWL vaccine programme study time period 5.88% of ind...

ObjectiveUse of prone positioning increased among mechanically ventilated patients during the COVID-19 pandemic, but it is unknown whether implementation of this life-saving intervention was sustained. Thus, we aimed to evaluate peri-pandemic trends in proning use. DesignWe conducted a retrospective cohort study of proning use among mechanically ventilated adults, with proning rates compared across pre-pandemic (1/2018-2/2020), pandemic (3/2020-2/2022), and post-pandemic (3/2022-12/2024) period...

BackgroundCoronavirus disease 2019 (COVID-19) had a significant impact on the National Health Service in the United Kingdom (UK), with over 33 000 cases reported in London by July 6, 2020. Detailed hospital-level information on patient characteristics, outcomes and capacity strain are currently scarce but would guide clinical decision-making and inform prioritisation and planning. MethodsWe aimed to determine factors associated with hospital mortality and describe hospital and ICU strain by con...

The high numbers of COVID-19 patients developing severe respiratory failure has placed exceptional demands on ICU capacity around the world. Understanding the determinants of ICU mortality is important for surge planning and shared decision making. We used early data from the COVID-19 Hospitalisation in England Surveillance System (from the start of data collection 8th February -22nd May 2020) to look for factors associated with ICU outcome in the hope that information from such timely analysis ...

BackgroundRisk stratification of COVID-19 patients upon hospital admission is key for their successful treatment and efficient utilization of hospital resources. ObjectiveTo evaluate the risk factors associated with ventilation need and mortality. Design, setting and participantsWe established a retrospective cohort of COVID-19 patients from Mass General Brigham hospitals. Demographic, clinical, and admission laboratory data were obtained from electronic medical records of patients admitted to...

Mortality among patients admitted to intensive care with coronavirus disease 2019 (COVID-19) remains substantial despite advances in management. The contribution of pre-admission medication profiles to long-term survival is poorly defined. We analysed 497 adults with confirmed COVID-19 admitted to six intensive care units in southern Sweden between May 2020 and May 2021. Clinical and laboratory data were combined with prescription information from the national drug registry; drugs dispensed at l...