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Gilham EL, Raja AI, van Veldhoven K, Nicholls G, Sandys V, Atkinson B, Spencer A, Nicholls I, Cooke J, Bennett A, Morgan D, Keen C, Fletcher T, Pearce N, Manley P, Brickley EB, Chen Y. A SARS-CoV-2 outbreak in a public order and safety training facility in England, June 2021. Ann Work Expo Health 2024; 68:770-776. [PMID: 38785326 DOI: 10.1093/annweh/wxae038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 04/24/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND The public order and safety (POS) sector remains susceptible to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreaks, as workplace attendance is typically compulsory and close physical contact is often needed. Here, we report on a SARS-CoV-2 outbreak with an attack rate of 39% (9/23), which occurred between 19 and 29 June 2021 among a cohort of new POS recruits participating in a mandatory 18-week training programme in England. METHODS The COVID-OUT (COVID-19 Outbreak investigation to Understand Transmission) study team undertook a multidisciplinary outbreak investigation, including viral surface sampling, workplace environmental assessment, participant viral and antibody testing, and questionnaires, at the two associated training facilities between 5 July and 24 August 2021. RESULTS Environmental factors, such as ventilation, were deemed inadequate in some areas of the workplace, with carbon dioxide (CO2) levels exceeding 1,500 ppm on multiple occasions within naturally ventilated classrooms. Activities during safety training required close contact, with some necessitating physical contact, physical exertion, and shouting. Furthermore, most participants reported having physical contact with colleagues (67%) and more than one close work contact daily (97%). CONCLUSIONS Our investigation suggests that site- and activity-specific factors likely contributed to the transmission risks within the POS trainee cohort. Potential interventions for mitigating SARS-CoV-2 transmission in this POS training context could include implementing regular rapid lateral flow testing, optimizing natural ventilation, using portable air cleaning devices in classrooms, and expanding use of well-fitted FFP2/FFP3 respirators during activities where prolonged close physical contact is required.
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Affiliation(s)
- Ellie L Gilham
- Rapid Investigation Team, Field Services, UK Health Security Agency, Wellington House, Waterloo Road, London, United Kingdom
| | - Amber I Raja
- Health Equity Action Lab, Department of Infectious Disease Epidemiology & International Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, United Kingdom
| | - Karin van Veldhoven
- Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London, United Kingdom
| | - Gillian Nicholls
- Science Division, Health and Safety Executive, Harpur Hill, Buxton, United Kingdom
| | - Vince Sandys
- Science Division, Health and Safety Executive, Harpur Hill, Buxton, United Kingdom
| | - Barry Atkinson
- Research and Evaluation, UK Health Security Agency, Porton Down, Salisbury, United Kingdom
| | - Antony Spencer
- Research and Evaluation, UK Health Security Agency, Porton Down, Salisbury, United Kingdom
| | - Ian Nicholls
- Research and Evaluation, UK Health Security Agency, Porton Down, Salisbury, United Kingdom
| | - Joan Cooke
- Science Division, Health and Safety Executive, Harpur Hill, Buxton, United Kingdom
| | - Allan Bennett
- Research and Evaluation, UK Health Security Agency, Porton Down, Salisbury, United Kingdom
| | - Derek Morgan
- Science Division, Health and Safety Executive, Harpur Hill, Buxton, United Kingdom
| | - Chris Keen
- Science Division, Health and Safety Executive, Harpur Hill, Buxton, United Kingdom
| | - Tony Fletcher
- Chemical and Environmental Effects Department, UK Health Security Agency, Harwell Campus, Chilton, United Kingdom
| | - Neil Pearce
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, Keppel Street, London, United Kingdom
| | - Petra Manley
- Rapid Investigation Team, Field Services, UK Health Security Agency, Wellington House, Waterloo Road, London, United Kingdom
| | - Elizabeth B Brickley
- Health Equity Action Lab, Department of Infectious Disease Epidemiology & International Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, United Kingdom
| | - Yiqun Chen
- Science Division, Health and Safety Executive, Harpur Hill, Buxton, United Kingdom
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Rutter CE, van Tongeren M, Fletcher T, Rhodes S, Chen Y, Hall I, Warren N, Pearce N. Risk factors for SARS-CoV-2 infection at a UK electricity-generating company: a test-negative design case-control study. Occup Environ Med 2024; 81:184-190. [PMID: 38508710 PMCID: PMC11103344 DOI: 10.1136/oemed-2023-109184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 02/11/2024] [Indexed: 03/22/2024]
Abstract
OBJECTIVES Identify workplace risk factors for SARS-CoV-2 infection, using data collected by a UK electricity-generating company. METHODS Using a test-negative design case-control study, we estimated the OR of infection by job category, site, test reason, sex, vaccination status, vulnerability, site outage and site COVID-19 weekly risk rating, adjusting for age, test date and test type. RESULTS From an original 80 077 COVID-19 tests, there were 70 646 included in the final analysis. Most exclusions were due to being visitor tests (5030) or tests after an individual first tested positive (2968).Women were less likely to test positive than men (OR=0.71; 95% CI 0.58 to 0.86). Test reason was strongly associated with positivity and although not a cause of infection itself, due to differing test regimes by area, it was a strong confounder for other variables. Compared with routine tests, tests due to symptoms were highest risk (94.99; 78.29 to 115.24), followed by close contact (16.73; 13.80 to 20.29) and broader-defined work contact 2.66 (1.99 to 3.56). After adjustment, we found little difference in risk by job category, but some differences by site with three sites showing substantially lower risks, and one site showing higher risks in the final model. CONCLUSIONS In general, infection risk was not associated with job category. Vulnerable individuals were at slightly lower risk, tests during outages were higher risk, vaccination showed no evidence of an effect on testing positive, and site COVID-19 risk rating did not show an ordered trend in positivity rates.
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Affiliation(s)
- Charlotte E Rutter
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Martie van Tongeren
- Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, The University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Tony Fletcher
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Sarah Rhodes
- Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, The University of Manchester, Manchester, UK
| | - Yiqun Chen
- Science Division, Health and Safety Executive, Buxton, UK
| | - Ian Hall
- Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, The University of Manchester, Manchester, UK
- Public Health, Advice, Guidance and Expertise, UK Health Security Agency, London, UK
| | | | - Neil Pearce
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
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3
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Raja AI, Nicholls G, Coldwell M, van Veldhoven K, Sandys V, Atkinson B, Nicholls I, Spencer A, Graham A, Higgins H, Atchison C, Keen C, Fletcher T, Pearce N, Brickley EB, Chen Y. A SARS-CoV-2 outbreak investigation at a storage and distribution centre in England: an assessment of worker- and workplace-related risk factors. Sci Rep 2024; 14:9561. [PMID: 38671031 PMCID: PMC11053053 DOI: 10.1038/s41598-024-60194-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 04/19/2024] [Indexed: 04/28/2024] Open
Abstract
An outbreak of SARS-CoV-2 (1 March to 10 May 2021) with an attack rate of 26.5% among approximately 1150 workers at a storage and distribution centre in England prompted a multidisciplinary outbreak investigation (5 May to 6 August 2021), with the aim of better understanding worker- and workplace-related risk factors for viral transmission in the warehousing sector. Overall, environmental factors (e.g., ventilation, humidity and temperature) were assessed to be appropriate at the facility. Nevertheless, 39 (51.3%) surface samples from across the site tested positive for low/ very low levels of SARS-CoV-2 RNA (Ct value ≥ 32.0 for all). Among the study participants, of whom 35.6% were confirmed or suspected cases, 95.5% reported having received COVID-19 prevention training, 100.0% reported handwashing, and 80.0% reported use of face coverings at work. Notably, 43.9% and 19.0% reported working with a symptomatic and a positive contact respectively. Furthermore, 80.5% and 46.3% had concerns regarding reduction in their income and future unemployment, respectively, due to self-isolation. The findings of this study suggest that, in addition to targeted workplace infection control measures and tailored work area specific risk assessments, an enhanced and equitable sick leave policy may help limit presenteeism and viral transmission in large workplaces.
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Affiliation(s)
- Amber I Raja
- Health Equity Action Lab, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | - Karin van Veldhoven
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Vince Sandys
- Science Division, Health and Safety Executive, Buxton, UK
| | - Barry Atkinson
- Research and Evaluation, UK Health Security Agency, Porton Down, Salisbury, UK
| | - Ian Nicholls
- Research and Evaluation, UK Health Security Agency, Porton Down, Salisbury, UK
| | - Antony Spencer
- Research and Evaluation, UK Health Security Agency, Porton Down, Salisbury, UK
| | - Alice Graham
- Rapid Investigation Team, Field Services, UK Health Security Agency, Wellington House, London, UK
| | - Hannah Higgins
- Rapid Investigation Team, Field Services, UK Health Security Agency, Wellington House, London, UK
| | - Christina Atchison
- Rapid Investigation Team, Field Services, UK Health Security Agency, Wellington House, London, UK
| | - Chris Keen
- Science Division, Health and Safety Executive, Buxton, UK
| | - Tony Fletcher
- Chemical and Environmental Effects Department, UK Health Security Agency, Chilton, UK
| | - Neil Pearce
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - Elizabeth B Brickley
- Health Equity Action Lab, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Yiqun Chen
- Science Division, Health and Safety Executive, Buxton, UK.
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Nicholls I, Spencer A, Chen Y, Bennett A, Atkinson B. Surface sampling for SARS-CoV-2 RNA in workplace outbreak settings in the UK, 2021-22. J Appl Microbiol 2023; 134:lxad216. [PMID: 37742225 DOI: 10.1093/jambio/lxad216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 08/14/2023] [Accepted: 09/19/2023] [Indexed: 09/26/2023]
Abstract
AIMS To utilize environmental surface sampling to evaluate areas of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) contamination within workplaces to identify trends and improve local coronavirus disease 2019 (COVID-19) control measures. METHODS AND RESULTS Surface sampling was undertaken at 12 workplaces that experienced a cluster of COVID-19 cases in the workforce between March 2021 and March 2022. A total of 7.4% (61/829) samples collected were positive for SARS-CoV-2 RNA by the quantitative PCR (qPCR) with only 1.8% (15/829) of samples identified with crossing threshold (Ct) values <35.0. No sample returned whole-genome sequence inferring RNA detected was degraded. CONCLUSIONS Few workplace surface samples were positive for SARS-CoV-2 RNA and positive samples typically contained low levels of nucleic acid. Although these data may infer a low probability of fomite transmission within the workplace, Ct values may have been lower at the time of contamination. Workplace environmental sampling identified lapses in COVID-19 control measures within individual sites and showed trends throughout the pandemic.
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Affiliation(s)
- Ian Nicholls
- Research and Evaluation, UK Health Security Agency, Porton Down, Salisbury, SP4 0JG, United Kingdom
| | - Antony Spencer
- Research and Evaluation, UK Health Security Agency, Porton Down, Salisbury, SP4 0JG, United Kingdom
| | - Yiqun Chen
- Science Division, Health and Safety Executive, Buxton, SK17 9JN, United Kingdom
| | - Allan Bennett
- Research and Evaluation, UK Health Security Agency, Porton Down, Salisbury, SP4 0JG, United Kingdom
| | - Barry Atkinson
- Research and Evaluation, UK Health Security Agency, Porton Down, Salisbury, SP4 0JG, United Kingdom
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Chen Y, Beattie H, Simpson A, Nicholls G, Sandys V, Keen C, Curran AD. A COVID-19 Outbreak in a Large Meat-Processing Plant in England: Transmission Risk Factors and Controls. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6806. [PMID: 37835076 PMCID: PMC10572747 DOI: 10.3390/ijerph20196806] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 08/11/2023] [Accepted: 09/19/2023] [Indexed: 10/15/2023]
Abstract
The meat-processing industry had frequent COVID-19 outbreaks reported worldwide. In May 2021, a large meat-processing plant in the UK had an outbreak affecting 4.1% (63/1541) of workers. A rapid on-site investigation was conducted to understand the virus transmission risk factors and control measures. This included observational assessments of work activities, control measures, real-time environmental measurements and surface microbial sampling. The production night-shift attack rate (11.6%, 44/380) was nearly five times higher than the production day-shift (2.4%, 9/380). Shared work transport was provided to 150 staff per dayshift and 104 per nightshift. Production areas were noisy (≥80 dB(A)) and physical distancing was difficult to maintain. Face visors were mandatory, additional face coverings were required for some activities but not always worn. The refrigeration system continuously recirculated chilled air. In some areas, the mean temperature was as low as 4.5 °C and mean relative humidity (RH) was as high as 96%. The adequacy of ventilation in the production areas could not be assessed reliably using CO2, due to the use of CO2 in the packaging process. While there were challenges in the production areas, the observed COVID-19 control measures were generally implemented well in the non-production areas. Sixty surface samples from all areas were tested for SARS-CoV-2 RNA and 11.7% were positive. Multi-layered measures, informed by a workplace specific risk assessment, are required to prevent and control workplace outbreaks of COVID-19 or other similar respiratory infectious diseases.
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Affiliation(s)
- Yiqun Chen
- Science Division, Health and Safety Executive, Buxton SK17 9JN, UK
| | - Helen Beattie
- Science Division, Health and Safety Executive, Buxton SK17 9JN, UK
| | - Andrew Simpson
- Science Division, Health and Safety Executive, Buxton SK17 9JN, UK
| | - Gillian Nicholls
- Science Division, Health and Safety Executive, Buxton SK17 9JN, UK
| | - Vince Sandys
- Science Division, Health and Safety Executive, Buxton SK17 9JN, UK
| | - Chris Keen
- Science Division, Health and Safety Executive, Buxton SK17 9JN, UK
| | - Andrew D Curran
- Science Division, Health and Safety Executive, Buxton SK17 9JN, UK
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Investigation of a SARS-CoV-2 Outbreak at an Automotive Manufacturing Site in England. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116400. [PMID: 35681985 PMCID: PMC9180680 DOI: 10.3390/ijerph19116400] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/18/2022] [Accepted: 05/19/2022] [Indexed: 02/06/2023]
Abstract
Workplace-related outbreaks of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continue to occur globally. The manufacturing sector presents a particular concern for outbreaks, and a better understanding of transmission risks are needed. Between 9 March and 24 April 2021, the COVID-19 (coronavirus disease 2019) Outbreak Investigation to Understand Transmission (COVID-OUT) study undertook a comprehensive investigation of a SARS-CoV-2 outbreak at an automotive manufacturing site in England. The site had a total of 266 workers, and 51 SARS-CoV-2 infections. Overall, ventilation, humidity, and temperature at the site were assessed to be appropriate for the number of workers and the work being conducted. The company had implemented a number of infection control procedures, including provision of face coverings, spacing in the work, and welfare areas to allow for social distancing. However, observations of worker practices identified lapses in social distancing, although all were wearing face coverings. A total of 38 workers, including four confirmed cases, participated in the COVID-OUT study. The majority of participants received COVID-19 prevention training, though 42.9% also reported that their work required close physical contact with co-workers. Additionally, 73.7% and 34.2% had concerns regarding reductions in future income and future unemployment, respectively, due to self-isolation. This investigation adds to the growing body of evidence of SARS-CoV-2 outbreaks from the manufacturing sector. Despite a layered COVID-19 control strategy at this site, cases clustered in areas of high occupancy and close worker proximity.
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7
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Raja AI, van Veldhoven K, Ewuzie A, Frost G, Sandys V, Atkinson B, Nicholls I, Graham A, Higgins H, Coldwell M, Simpson A, Cooke J, Bennett A, Barber C, Morgan D, Atchison C, Keen C, Fletcher T, Pearce N, Brickley EB, Chen Y. Investigation of a SARS-CoV-2 Outbreak at an Automotive Manufacturing Site in England. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116400. [PMID: 35681985 DOI: 10.1101/2022.01.31.22269194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/18/2022] [Accepted: 05/19/2022] [Indexed: 05/25/2023]
Abstract
Workplace-related outbreaks of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continue to occur globally. The manufacturing sector presents a particular concern for outbreaks, and a better understanding of transmission risks are needed. Between 9 March and 24 April 2021, the COVID-19 (coronavirus disease 2019) Outbreak Investigation to Understand Transmission (COVID-OUT) study undertook a comprehensive investigation of a SARS-CoV-2 outbreak at an automotive manufacturing site in England. The site had a total of 266 workers, and 51 SARS-CoV-2 infections. Overall, ventilation, humidity, and temperature at the site were assessed to be appropriate for the number of workers and the work being conducted. The company had implemented a number of infection control procedures, including provision of face coverings, spacing in the work, and welfare areas to allow for social distancing. However, observations of worker practices identified lapses in social distancing, although all were wearing face coverings. A total of 38 workers, including four confirmed cases, participated in the COVID-OUT study. The majority of participants received COVID-19 prevention training, though 42.9% also reported that their work required close physical contact with co-workers. Additionally, 73.7% and 34.2% had concerns regarding reductions in future income and future unemployment, respectively, due to self-isolation. This investigation adds to the growing body of evidence of SARS-CoV-2 outbreaks from the manufacturing sector. Despite a layered COVID-19 control strategy at this site, cases clustered in areas of high occupancy and close worker proximity.
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Affiliation(s)
- Amber I Raja
- Health Equity Action Lab, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Karin van Veldhoven
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Adanna Ewuzie
- Health Equity Action Lab, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Gillian Frost
- Science Division, Health and Safety Executive, Buxton SK17 9JN, UK
| | - Vince Sandys
- Science Division, Health and Safety Executive, Buxton SK17 9JN, UK
| | - Barry Atkinson
- Research and Evaluation, UK Health Security Agency, Porton Down, Salisbury SP4 0JG, UK
| | - Ian Nicholls
- Research and Evaluation, UK Health Security Agency, Porton Down, Salisbury SP4 0JG, UK
| | - Alice Graham
- Rapid Investigation Team, Field Services, UK Health Security Agency, Wellington House, London SE1 8UG, UK
| | - Hannah Higgins
- Rapid Investigation Team, Field Services, UK Health Security Agency, Wellington House, London SE1 8UG, UK
| | - Matthew Coldwell
- Science Division, Health and Safety Executive, Buxton SK17 9JN, UK
| | - Andrew Simpson
- Science Division, Health and Safety Executive, Buxton SK17 9JN, UK
| | - Joan Cooke
- Science Division, Health and Safety Executive, Buxton SK17 9JN, UK
| | - Allan Bennett
- Research and Evaluation, UK Health Security Agency, Porton Down, Salisbury SP4 0JG, UK
| | - Chris Barber
- Science Division, Health and Safety Executive, Buxton SK17 9JN, UK
| | - Derek Morgan
- Science Division, Health and Safety Executive, Buxton SK17 9JN, UK
| | - Christina Atchison
- Rapid Investigation Team, Field Services, UK Health Security Agency, Wellington House, London SE1 8UG, UK
| | - Chris Keen
- Science Division, Health and Safety Executive, Buxton SK17 9JN, UK
| | - Tony Fletcher
- Chemical and Environmental Effects Department, UK Health Security Agency, Chilton OX11 0RQ, UK
| | - Neil Pearce
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
| | - Elizabeth B Brickley
- Health Equity Action Lab, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Yiqun Chen
- Science Division, Health and Safety Executive, Buxton SK17 9JN, UK
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