Covid-19 and ethnicity: we must seek to understand the drivers of higher transmission

• Published in: BMJ (Online) 2021-11, Vol.375, p.n2709-n2709
• Main Authors: Pan, Daniel, Sze, Shirley, Martin, Christopher A, Nazareth, Joshua, Woolf, Katherine, Baggaley, Rebecca F, Hollingsworth, T. Déirdre, Khunti, Kamlesh, Nellums, Laura B, Pareek, Manish
• Format: Article
• Language: English
• Subjects: Clinical outcomes; Clinical trials; Contact tracing; Coronaviruses; COVID-19; COVID-19 - ethnology; COVID-19 - transmission; COVID-19 vaccines; Cultural differences; Disease transmission; Disease Transmission, Infectious; Ethnicity; Humans; Infections; Intensive care; Medical personnel; Medical research; Minority & ethnic groups; Minority Groups; Opinion; Pandemics; Primary care; Public health; Risk factors; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2; Vaccination
• ISSN: 1756-1833; 1756-1833
• DOI: 10.1136/bmj.n2709

By November 2020, a meta-analysis of over 18 million patients found a higher likelihood of infection in ethnic minority groups compared to White groups.2 This was confirmed by analysis of UK primary care data on the OpenSAFELY platform, which also found that the risk of testing positive between ethnic groups during the first wave was similar to the risk of covid-19 related death.3 Similarly, the REACT-2 study found that no differences existed in the infection-to-mortality ratio in ethnic minority groups compared to White groups despite high levels of SARS-CoV-2 antibodies in the ethnic minority population.4 It is increasingly recognised that the majority of disproportionate clinical outcomes from covid-19 is driven by public health factors, such as socioeconomic differences, occupation, and systemic exposure gaps rather than any genetic predisposition to severe illness.5 However, despite the major interest in disentangling the relationship between ethnicity and covid-19, surprisingly little attention has been given to examining the risk factors for infection, which unlike most of the risk factors for severe covid-19, are malleable and potentially reversible. [...]interventions aiming to reduce SARS-CoV-2 transmission such as lockdown, mass testing, contact tracing and vaccination, have adopted a “one size fits all” approach, with limited consideration of the specific cultural, social, or language barriers that exist for ethnic minority groups, and an absence of auditing which interventions work, and which do not work, at local and regional levels. [...]we call for an increased effort to include ethnic minority groups in covid-19 clinical trials.