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Coronavirus statistical update: Bame population more likely to become seriously ill

As the coronavirus works its way towards peak effect, HOT is providing a regular update of the statistics for our region and the country provided by the public health authorities and other official sources. Members of the Bame population are more susceptible to becoming seriously ill with the virus and dying. Text and graphics by Russell Hall.

Research suggests people from black, Asian and minority ethnic (Bame) backgrounds are at greater risk of becoming seriously ill with Covid-19.

The Intensive Care National Audit & Research Centre (Icnarc) has found that 34.5% of hospital patients critically ill with Covid-19 identified as Bame. However, Bame communities make up only 24.3% of the population.

Downing Street has commissioned an investigation into the issue.

Communities secretary Robert Jenrick said: “There does appear to be a disproportionate impact of the virus on Bame communities in the UK.”

Speaking at the daily Downing Street press conference on 18 April, he added: “It is for that reason that the Chief Medical Officer commissioned work from Public Health England to better understand this issue. It is right we do thorough research swiftly, so we can better understand it and then take any action that is required.”

Professor Kamlesh Khunti, from the University of Leicester and the Centre for Black and Minority Ethnic Health, said: “A lot of people have been concerned about this issue based on anecdotal reports and now this [Icnarc] data is showing a signal regarding a higher number of black and minority ethnic populations being admitted to intensive care units.”

More research needed

But this data is just a first step in understanding the issue, he warns, with more research and analysis needed. Public Health England is to start recording coronavirus cases and deaths by ethnicity.

Asked if she could explain why some people, for instance older people – men in particular – are more vulnerable to Covid-19 than others, Professor Sarah Gilbert, vaccinologist at Oxford University, said: “That seems to be largely to do with the level of expression of the receptor that the virus uses to get into cells, so it’s the ACE2 [angiotensin I converting enzyme 2] protein that’s found on the surface of the cells in the respiratory tract, and the virus catches onto that and then uses that to pull itself inside the cell.

“We know in children who have mild infections, they are getting infected but these infections are generally very mild in children, they have quite low levels of ACE2 receptor expression in the respiratory tract, but it increases with age and it’s higher in men than in women and that seems to be the main difference in why men are having infections worse than women, and more fatalities.

“The other thing is the immune system. As the immune system ages it’s less able to fight off viruses, so as we get older we don’t always have the capability to deal with viruses, particularly if there’s a very high viral load at the time of infection, so if we get a high exposure to the virus it can overwhelm the immune system and mean that we can’t fight it off. So there are lots and lots of variables to be taken onto account, I’m sure genetics will come into play as well.

“It seems as though we are seeing some differences in the outcomes in different races and that could be down to genetics, which is affecting susceptibility to infection in a different way, or possibly affecting the immune response in a different way and all of that is still to be worked out.”

However, the high representation of Bame communities critically ill with Covid-19 in hospital is not repeated to the same degree in the ethnic make- up of people dying from the disease in England, although the Bame proportion, at 18.7%, is higher than the 14.6% in the population.

NHS England started publishing Covid-19 deaths by ethnicity on 19 April, with 13,918 Covid-19 deaths recorded so far in England. Ethnicity is captured through matching records from the Covid-19 deaths data collection with emergency department, inpatient or outpatient datasets and using the ethnicity recorded in those datasets for their most recent visit or spell.

For 1.8%% of records no match was found in existing datasets to identify ethnicity information and 7.7% of patients did not state their ethnicity; these are excluded from the chart below comparing the percentage of Covid-19 deaths in the Bame population with the ethnic group composition of the population in England.

Peak past?

Sir Jeremy Farrar, Director of the Wellcome Trust, said on 19 April that the number of new infections stabilised maybe a week or two ago, the number of hospitalisations maybe a week or so ago, and the number of people dying is now either stabilising or starting to come down. The UK is probably just past the peak in many parts of the country, but “further waves” are expected in future.

Meanwhile the number of confirmed Covid-19 cases in East Sussex rises at a slowing rate. Yesterday it reached 449, up four on the previous day and 62 in the last six days.

There were no deaths in East Sussex due to the coronavirus yesterday – the last one occurred on 18 April. The total stands at 48.

The number of hospital patients with the virus remains steady at 1,933, up one on the day.

In the UK 4,676 new cases were recorded yesterday, down 1,174 on the previous day. Deaths were down by 147 to 449. As of 5pm on 19 April, of those hospitalised in the UK who tested positive for coronavirus, 16,509 have died.

As of 9am 20 April, 501,379 tests have concluded, with 19,316 tests carried out on 19 April. However, as some people are tested more than once, the number of people  tested was 14,106, down by 1,838 on the previous day. In total 386,044 people have been tested, of whom 124,743 (32.3%) have tested positive.

Caveats

A number of caveats need to be borne in mind regarding the PHE statistics:

  1. Cumulative case numbers include people who have recovered.
  2. With respect to testing, cases are reported when lab tests are completed, which may be a few days after initial testing.
  3. Testing capacity is increasing, resulting in a greater number of observed cases.
  4. Testing capacity constraints mean there are likely many more cases than currently recorded here.
  5. Deaths recorded by Public Health England include only those in hospital and exclude those in the community and care homes.
  6. There is a delay in many deaths being recorded from a few days to up to two weeks.
  7. Deaths tend to be recorded around three weeks after first symptoms in fatal cases.

Posted 20:41 Monday, Apr 20, 2020 In: Covid-19

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