People from Black and Asian backgrounds are at substantially greater risk of contracting coronavirus than white people, according to a study that highlights the disproportionate impact of the disease on different groups in society.
Black people are twice as likely to become infected with coronavirus as white people, and people from Asian backgrounds are one and a half times as likely, researchers found after analysing 50 studies that reported on the medical records of nearly 19 million Covid patients.
The analysis, published in the journal EClinicalMedicine by the Lancet, is the first comprehensive, systematic review of published research and preliminary papers that delve into the burden of coronavirus on different ethnic groups. About half of the papers have appeared in peer-reviewed journals and the rest are preliminary findings.
Beyond the raised risk of infection, the review suggests people from Asian backgrounds are more likely to be admitted to intensive care and may have a greater risk of death with coronavirus than white people. But the researchers cautioned that none of the studies on intensive care admissions had been peer-reviewed and that the increased risk of death was only borderline statistically significant.
Manish Pareek, an associate clinical professor in infectious diseases at the University of Leicester, said the combined message from the studies was that the disproportionate impact of coronavirus on Black and Asian people was driven by the higher risk of infection in those communities.
The dramatically different rates of infection are believed to be driven by a range of factors, such as greater levels of deprivation, living in larger, multi-generational households, and having more public-facing jobs where working from home is not an option.
Pareek said the findings exposed an urgent need for more targeted public messaging to help people reduce their risk of infection and encourage them to get medical help early on before they become too poorly. “It’s about trying to make sure interventions are available early on, so people can seek advice and care at early time points,” he said.
The research team screened 1,500 published articles and preprints before focusing their analysis on 50 papers produced in the US and the UK. The studies appeared between 1 December 2019 and 31 August this year. The patients with Covid either had a positive swab for the virus or had clinical signs and symptoms of the infection.
Last month a report from the Office for National Statistics said men from black African backgrounds in England and Wales are nearly three times more likely to die from Covid than white men. Women from black Caribbean backgrounds were nearly twice as likely to die as white women. The ONS study concluded that living arrangements and jobs were the main drivers for the increased death rates, rather than pre-existing health conditions such as heart disease and diabetes.
The stark differences in Covid risk raise crucial questions for the government as the NHS prepares to launch a mammoth effort to roll out vaccines, the first of which could be approved by regulators within weeks. While older age is the most important risk factor for dying from coronavirus, there is an argument for prioritising Black and Asian people within each age band.
“These are really difficult decisions that the government and the Joint Committee on Vaccination and Immunisation (JCVI) will need to come together on and make until vaccine is more widely available,” Pareek said.
Speaking at a No 10 press briefing on Wednesday, Prof Wei Shen Lim, the chair of the JCVI’s Covid immunisation group, said multiple social and occupational factors lay behind the greater burden of Covid disease in people from Black, Asian and minority ethnic backgrounds. “One of the opportunities we should take with this vaccination programme is to mitigate health inequalities,” he said. “That may mean we have special implementation programmes delivered by community leaders who understand their communities.”
Nishi Chaturvedi, a professor of clinical epidemiology at University College London, who was not involved in the latest study, said the findings largely confirmed concerns raised throughout the pandemic that minority ethic groups have higher risks of infection. But she said it was important to investigate the risks in more closely defined populations, for example Indian Asians and Chinese, rather than lumping the groups together. “We know that exposure and susceptibility factors vary markedly between groups,” she said.
Chaturvedi added that ethnicity was an imprecise proxy for real risk factors. For example, people from ethnic minorities are more likely to work in high-risk occupations such as health and social care, and are more likely to have co-morbidities such as diabetes.
When it comes to prioritising people for vaccine, “it would seem sensible to prioritise on ‘true’ risk factors that increase risk rather than an imprecise proxy”, she said. “I further doubt whether we will have the ability and the strong scientific rationale to create such fine prioritisation groups. Within older people, should we prioritise men, who are at greater risk of infection, or women, who are more prone to long Covid? Should we prioritise people with diabetes over people with established cardiovascular disease? Should we prioritise people living in multi-generational households?”
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