Vanessa Chalmers, Daily Mail, November 12, 2020
Black people are twice as likely to get infected with Covid-19 compared to those of white ethnicity, a study has revealed.
But they are no more likely to die of the illness, according to the researchers at the universities of Leicester and Nottingham.
People from Asian backgrounds are, however, more likely to both catch coronavirus, become severely ill and die from it.
The findings come from the first ‘robust’ analysis of evidence on ethnicity and Covid-19 so far, with a stream of studies over the pandemic having shown a relationship between the two.
It involved data from more than 18million people who had taken part in 50 studies in the UK and US.
But it still failed to answer exactly why those of BAME backgrounds are at higher risk of Covid-19, with the scientists claiming there are likely to be a number of factors contributing.
Experts have so far suggested BAME people are more at risk of Covid because they are key workers and are more likely to have underlying health conditions or live in crowded houses.
But the researchers claimed there is ‘no evidence’ so far that genetics are to blame —even though scientists are still investigating that.
The scientists said their findings should be of ‘importance to policymakers going forward’, and could lead to changes in the vaccine priority list.
The study, published in the EClinical Medicine journal by The Lancet, honed in on 50 studies, most of which were based in the US.
When looking at the risk of infection, the team found people of Asian ethnicity were 50 per cent more likely to be struck down than white people. And Black people had double the risk.
Asian people were twice as likely to suffer severe Covid-19 and be admitted to ICU. But there was no increased risk for black people.
Data also showed that Asian people faced around a 20 per cent higher risk of dying than white people. But there was no difference for black people.
Researchers found people from Asian backgrounds made up twice as many stroke patients among a group infected with coronavirus than in a group without it.
While only seven per cent of stroke victims in the non-Covid group of patients were of Asian ethnicity, this surged to 19 per cent among people who had tested positive for coronavirus. This was a bigger increase than in any other ethnic group.
Although the scientists admitted this may partly be because Asian people were more likely to catch the virus in the first place, they said it was ‘unlikely that this is the sole explanation’.
They compared the result to that of Afro-Caribbean black people, who face the highest risk of catching Covid-19 in England but did not suffer the same increase in strokes.
The experts said interpreting the findings is ‘difficult’
Experts suggest the coronavirus thickens the blood, making it easier to clot and triggering a stroke. The body’s inflammatory response may also play a role.
Strokes from Covid-19 are around twice as deadly as usual strokes, this study and others before have shown.
The risk of death was only of borderline statistical significance, the team said, because it was based on weaker studies.
The team said that their study provides clear evidence that those of BAME background have been more impacted by Covid-19.
This mainly comes down to them being more likely to pick up the coronavirus in the first instance, the researchers believe.
A recent review of evidence commissioned by London Mayor Sadiq Khan found that black people are almost twice as likely to die from Covid-19 as white people.
And the ONS last month found the risk of dying for black and South East Asian men was two-and-a-half times greater than white men, even when comorbidities and age had been factored in. Among women the risk was double.
But scientists today said disproportionate deaths in BAME groups could be reduced, if infections could be prevented in the first place.
Dr Manish Pareek, senior author of this study and an infectious diseases expert at the University of Leicester, said: ‘The key intervention here really has to be reducing the risk of individuals getting infected.
‘If you don’t get infected, you won’t need to be going to intensive care or sadly dying.’
Lead author of the paper Dr Daniel Pan, of the University Hospitals of Leicester NHS Trust, said: ‘Future papers must try to adjust for the risk of infection when looking at the risk of ITU admission and death in order for us to accurately assess the impact of ethnicity on an individual’s risk of death once they are infected.’
Dr Pareek said many explanations exist as to why there Covid-19 infection rips through ethnic minority communities.
Experts have so far suggested that people of BAME background are more at risk of Covid-19 because they are more likely to have underlying health problems, such as diabetes or heart disease, or live in deprivation.
BAME groups are more likely to live in large household sizes comprised of multiple generations, where young people mix more often with the elderly.
They are more often employed in key worker roles, where working from home is not an option and they are often exposed to the coronavirus.
The Covid-19 death rate for female care home residents from an Asian background was two times as high compared to white residents, the Office for National Statistics (ONS) said in October.
The death rate for male Asian residents was 1.6 times greater than the rate for white residents.
Black residents were 1.6 and 1.7 times more likely to die with Covid-19 than white men and women respectively.
The ONS estimated mortality rates involving Covid-19 of ethnic groups based on deaths between March 2 and July 28 which could be linked to the 2011 Census.
And analysts used NHS hospital episode statistics to see whether attending hospital in the past three years for a relevant health condition affects the risk of death with the virus.
While they identified an increased risk for certain ethnicities in care homes, the ONS said it is lower than the increased risk between ethnicities living in private homes.
When adjusting for care homes’ geography and population density, the risk was reduced for all ethnic groups when compared to the white population.
The increased risk for black males reduced to 1.3, and for black women to 1.4, while for Asian men and women it decreased to 1.4 and 1.7 respectively.
Further adjusting for underlying health status reduced the risk by a small amount for both ethnicities, with the resulting increased risk for black men no longer significant.
The ONS said: ‘Overall, the mortality rates among ethnic groups do not show the same extent of increased risk observed among ethnic minorities in the general population.
‘After controlling for geography and health, we observe only a small significant increased risk for Asian males and black and Asian females; the risk to Asian females after adjustment is 1.7 times the risk to white females.’
This analysis attempted to account for some of these key factors, as well as age and gender, as much as possible to understand whether, even after adjusting for those things, there is still a link between Covid-19 and BAME people.
But it was not possible to completely rule them out, muddying the true reasons why BAME people are at higher risk.
On why Asian people appear to be more at risk of serious disease or death, study co-author Dr Jatinder Minhas said: ‘I don’t think there is a specific one word answer or explanation.’
The study, supported by the National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, did not look at whether genetics play a role.
But Dr Pareek said: ‘I don’t think this is a genetic issue… I’ve not seen any evidence so far, that I’m aware of, that genetics is associated with outcomes.’
Numerous reports, including government-funded research, have made the same conclusions, raising questions over whether ethnicity should be seen as an independent risk factor.
Dr Pareek said it may lead to the Joint Committee on Vaccination and Immunisation (JCVI) reconsidering their priority list for vaccination, which so far does not consider ethnicity in its categorisation.
He told a Science Media Centre briefing yesterday: ‘The government and JCVI will need to make important and difficult discussion, and decisions about how to allocate what will undoubtedly be limited vaccines at the outset.
‘I don’t think we are necessarily suggesting individuals of ethnic minority are a priority group, but that there are several priority groups that the government needs to make difficult decisions on.
‘I’ve not seen anything come out of the JCVI to examine this. But I’m sure with this work, I suspect they will come back and look at it again. We would be happy to present [our data].’
Other researchers have dismissed the idea of ethnicity being a independent risk factor its own, saying socioeconomic factors, for example, are the real reasons behind poorer health outcomes, not skin colour.
Number 10’s Race Disparity Unit said in a report last month that ‘job exposure, population density, pre-existing health conditions and household composition’ all contributed to an increased risk among ethnic minorities.
One of its authors said: ‘Being an ethnic minority is not a risk factor for Covid in and of itself.’
But the report admitted – as the recent study has said – that part of the excess risk remains unexplained for some groups.
It ruled out structural racism as a driving factor behind BAME people’s poorer health outcomes after catching Covid, saying there was ‘no evidence’ to support the theory.
The report called for Number 10 to work more closely with local authorities to target Covid-19 messaging to minorities who may not speak English as a first language.