Month: August 2021

Impact of social restrictions during the COVID-19 pandemic on the physical activity levels of older adults

Physical inactivity adversely affects older adults, with more than 60% of those aged over 75 years not sufficiently physically active for good health as defined by meeting the WHO and UK guidelines. From March until June 2020 in the UK, a national ‘lockdown’ was implemented to reduce exposure to, and transmission of, COVID-19. Although applied to the whole population, adults aged over 70 years and those with underlying health conditions at higher risk of severe COVID-19 disease were asked to follow more stringent social distancing measures. These included remaining at home where possible; avoiding social mixing in the community; avoiding physically interacting with friends and family; and avoiding public transport.

In a paper published in the journal BMJ Open, we examined self-reported physical activity before and after the introduction of lockdown, as measured by metabolic equivalent of task (MET) minutes. Associations of physical activity with demographic, lifestyle and social factors, mood and frailty were also examined. The study population comprised adults enrolled in the Cognitive Health in Ageing Register for Investigational and Observational Trials cohort from general practitioner practices in North West London from April to July 2020. 6219 cognitively healthy adults aged 50–92 years completed the survey.

Mean physical activity was significantly lower following the introduction of lockdown from 3519 to 3185 MET min/week (p<0.001). After adjustment for confounders and pre-lockdown physical activity, lower levels of physical activity after the introduction of lockdown were found in those who were over 85 years old (640 (95% CI 246 to 1034) MET min/week less); were divorced or single (240 (95% CI 120 to 360) MET min/week less); living alone (277 (95% CI 152 to 402) MET min/week less); reported feeling lonely often (306 (95% CI 60 to 552) MET min/week less); and showed symptoms of depression (1007 (95% CI 612 to 1401) MET min/week less) compared with those aged 50–64 years, married, cohabiting and not reporting loneliness or depression, respectively.

We concluded that markers of social isolation, loneliness and depression were associated with lower physical activity  following the introduction of lockdown in the UK. Targeted interventions to increase physical activity in these groups are needed to limit adverse health outcomes from lower levels of exercise.


Vaccinating healthcare workers against Covid-19

In an article published in the British Medical Journal, we discuss the topic of vaccinating healthcare workers against Covid-19. Our conclusion is that compulsion is unnecessary and inappropriate.

Parliament’s decision to make vaccination against covid-19 a condition of employment for care home workers has fuelled the debate around compulsory vaccination for healthcare workers, which may follow. Compulsory vaccination is not a panacea and may harm the safety of patients and healthcare workers, as well as affecting workload and wellbeing. It is a dilemma familiar to occupational health services in many NHS trusts.

Is there a vaccine hesitancy problem in UK healthcare for which mandatory vaccination is an appropriate solution? Data suggesting pockets of poor uptake of covid-19 vaccination among care home staff led the government to make vaccination compulsory, abandoning a targeted but voluntary approach. The government’s Scientific Advisory Group for Emergencies (SAGE) has not published a recommended minimum acceptable level of staff vaccination for healthcare settings, but over 80% of frontline healthcare workers in NHS trusts have now received two vaccine doses,4 reaching over 90% in some trusts. The level of risk posed by the remaining minority is unlikely to justify policy change at a national level.

Vaccination is already compulsory for staff working in healthcare settings in France and Italy. However, both countries have a history of compulsory vaccinations in response to substantial vaccine hesitancy and outbreaks of vaccine preventable infections such as measles. In Italy, legislation introducing compulsory childhood vaccinations was followed by a decrease in the incidence of measles and rubella. Nevertheless, this policy is under review and may be made more flexible depending on regional vaccine coverage.

The full text of the article is available in the BMJ.


How long does immunity from Covid-19 vaccination last?

In a letter published in the British Medical Journal, I discuss the topic of how we assess the long-term safety and efficacy of Covid-19 vaccination. Vaccines for COVID-19 were eagerly awaited; and their rapid development, testing, approval and implementation are a tremendous achievement by all: scientists, pharmaceutical companies, drugs regulators, politicians and healthcare professionals; and by the patients who have received them.[1] Early real-world data from vaccine recipients in England, Scotland and Israel show that vaccination provides a high level of protection from symptomatic COVID-19 infection and serious illness, along with a large reduction in the risk of hospital admissions and death.

However, because these vaccines are new, we do not yet have information on how long the immunity generated by COVID-19 vaccines will last; or on how well they will protect against new variants of SARS-CoV-2. Longitudinal data on ‘vaccine failures’, or re-infections can help guide national policies on how frequently booster doses of vaccines are needed to maintain a good level of immunity in the population, and on whether vaccines need modification to provide protection against new variants of SARS-CoV-2.[2]

The UK is well-placed to collect these data and to secure its timely evaluation and integration with information provided by its strong life sciences research industry, to guide public health decision making. We also have a National Health Service that has developed computerised medical records for use in general practices on a population of around 67 million people. These electronic medical records provide longitudinal data on people’s health and medical experiences and can be used to estimate the longer-term efficacy of Covid-19 vaccines.[3] This will provide a valuable resource, not just for guiding public health policy in the UK, but also for global health.


1. Majeed, A, Molokhia, M. Vaccinating the UK against COVID-19. BMJ 2020; 371: m4654–m4654.

2. Majeed A, Papaluca M, Molokhia M. Assessing the long-term safety and efficacy of COVID-19 vaccines. Journal of the Royal Society of Medicine. May 2021. doi:10.1177/01410768211013437

3. Hodes S, Majeed A. Building a sustainable infrastructure for covid-19 vaccinations long term BMJ 2021; 373 :n1578 doi:10.1136/bmj.n1578