Background In this study, we aimed to evaluate the effects of tocilizumab in adult patients admitted to hospital with COVID-19 with both hypoxia and systemic inflammation. Methods This randomised, controlled, open-label, platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), is assessing several possible treatments in patients hospitalised with COVID-19 in the UK. Those trial participants with hypoxia (oxygen saturation <92% on air or requiring oxygen therapy) and evidence of systemic inflammation (C-reactive protein ≥75 mg/L) were eligible for random assignment in a 1:1 ratio to usual standard of care alone versus usual standard of care plus tocilizumab at a dose of 400 mg–800 mg (depending on weight) given intravenously. A second dose could be given 12–24 h later if the patient's condition had not improved. The primary outcome was 28-day mortality, assessed in the intention-to-treat population. The trial is registered with ISRCTN (50189673) and ClinicalTrials.gov ( NCT04381936 ). Findings Between April 23, 2020, and Jan 24, 2021, 4116 adults of 21 550 patients enrolled into the RECOVERY trial were included in the assessment of tocilizumab, including 3385 (82%) patients receiving systemic corticosteroids. Overall, 621 (31%) of the 2022 patients allocated tocilizumab and 729 (35%) of the 2094 patients allocated to usual care died within 28 days (rate ratio 0·85; 95% CI 0·76–0·94; p=0·0028). Consistent results were seen in all prespecified subgroups of patients, including those receiving systemic corticosteroids. Patients allocated to tocilizumab were more likely to be discharged from hospital within 28 days (57% vs 50%; rate ratio 1·22; 1·12–1·33; p<0·0001). Among those not receiving invasive mechanical ventilation at baseline, patients allocated tocilizumab were less likely to reach the composite endpoint of invasive mechanical ventilation or death (35% vs 42%; risk ratio 0·84; 95% CI 0·77–0·92; p<0·0001). Interpretation In hospitalised COVID-19 patients with hypoxia and systemic inflammation, tocilizumab improved survival and other clinical outcomes. These benefits were seen regardless of the amount of respiratory support and were additional to the benefits of systemic corticosteroids. Funding UK Research and Innovation (Medical Research Council) and National Institute of Health Research.

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The purpose of this paper is to provide insights into the impact of COVID-19 in the Scottish Prison Estate. During the 2020 lockdown in prison in response to the COVID-19 pandemic, all face-to-face research was paused. In response to this methodological challenge, a participatory correspondence methodology was designed, enabling project participants to influence the direction of this project through suggesting research questions. The main project findings relate to the analysis of ways in which the COVID-19 enhanced the pains of imprisonment for participants, exploring the challenges that the participants faced in relation to communication, feelings of heightened isolation and detachment from family, friends and the normal rhythms of life in prison. Analysis of the letters received as part of this study provides unique insights into the ways in which the COVID-19 pandemic in custody has added an additional layer or enhancement to pre-pandemic pains of imprisonment, increasing the ‘tightness’ ‘depth’ and ‘weight’ of participants time in custody.

Purpose The purpose of this paper is to foreground and analyse the views of people in custody about the management of the COVID-19 pandemic within the Scottish Prison Estate. The project is unique in using a correspondence participatory action methodology to engage with a group of people in custody at one Scottish prison. Design/methodology/approach At the time of ethical approval (early April 2020), all face-to-face research projects facilitated by the Scottish Prison Service were paused. In response to these methodological challenges, a participatory correspondence methodology was designed to allow people in custody to influence the direction of this project by suggesting research questions and themes. Eight participants were selected due to previous participation in research projects at one Scottish prison. All participants were adult males and serving long-term sentences. After consent was given via post, eight letters were distributed to participants with questions about their COVID-19 experiences. Methodologically, this project illustrates the potential for correspondence methods to facilitate insights into life in custody during what emerges as a particularly challenging time. Findings Participant suggested questions were used across six subsequent letters to elicit unique insights into the COVID-19 pandemic, of lockdown and subsequent easing of lockdown conditions in custody. The main project findings relate to challenges that the participants faced in relation to communication, feelings of heightened isolation and detachment from family, friends and the normal rhythms of life in prison. Analysis of letters provides unique insights into the ways in which the COVID-19 pandemic in custody enhanced the pains of imprisonment, increasing the “tightness”, “depth” and “weight” of participants’ time in custody. Originality/value This paper is methodologically, epistemologically and theoretically original in foregrounding the views of people in custody about the management of COVID-19 in prison and using a correspondence participatory action research method. The conclusion considers the extent to which views from what might be considered the bottom of hierarchies of power within prison settings are able to influence the direction of prison policy around the management of COVID-19 and future pandemics.

Sykes (1958) famously outlined five deprivations constituting the ‘pains of imprisonment’, later developed in a range of research, including research considering the gendered pains of imprisonment. Despite an increase in the visibility of transgender people in society and within prison settings, the specific pains of imprisonment experienced by transgender people have been largely overlooked. Within this context, this article analyses interviews with 13 transgender people in custody, facilitating an analysis of life within prison for transgender people. The article makes a unique contribution to the study of transgender people in custody within the devolved Scottish penal context, being the first to use the analytical lens of the ‘pains of imprisonment’ to consider the particular deprivations or frustrations that transgender people experience within prison settings.

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