Are some ethnic groups more vulnerable to COVID-19 than others? #covid19rftlks

Institute for Fiscal Studies | May 2020 | Are some ethnic groups more vulnerable to COVID-19 than others?

According to analysis undertaken by the Institute for Fiscal Studies  (IFS) In the short term, ethnic inequalities are likely to manifest from the COVID-19 crisis in two main ways:

  • through exposure to infection and health risks, including mortality;
  • through exposure to loss of income.

Some of the report’s key findings:

  • The impacts of the COVID-19 crisis are not uniform across ethnic groups, and aggregating all minorities together misses important differences.
  • Per-capita COVID-19 hospital deaths are highest among the black Caribbean population and three times those of the white British majority.
  • Once you take account of age and geography, most minority groups ‘should’ have fewer deaths per capita than the white British majority.
  • Occupational exposure may partially explain disproportionate deaths for some groups.
  • Men from minority groups are more likely to be affected by the shutdown.
  • Self-employment – where incomes may currently be especially uncertain – is especially prevalent amongst Pakistanis and Bangladeshis.

The IFS’ report outlines how analysis that aggregates groups together masks much of the story with regards to ethnic inequalities, and limits the scope for understanding why they have come about. Moreover, simply comparing mortalities with overall populations fails to take account of key characteristics of different groups that we would expect to lead to different outcomes in the aggregate, such as demographics and place of residence.

 

The report collates evidence on the unequal health and economic impacts of COVID-19 on the UK’s minority ethnic groups, presenting information on risk factors for each of the largest minority groups in England and Wales: white other, Indian, Pakistani, Bangladeshi, black African and black Caribbean. For the most part, the IFS focus on these six groups (and the white British majority) for which there is reliable information across different data sources.

Click to access Are-some-ethnic-groups-more-vulnerable-to-COVID-19-than-others-IFS-Briefing-Note.pdf

Download the report from the IFS

In the news:

The Guardian British BAME Covid-19 death rate ‘more than twice that of whites’

Accounting for the variation in the confirmed Covid-19 caseload across England: the role of multi-generation households #covid19rftlks

New Policy Institute | April 2020| Accounting for the variation in the confirmed Covid-19 caseload across England: an analysis of the role of multi-generation households
This paper develops a model to measure the size of the impact of various socio-economic variables on the confirmed Covid-19 caseload. Alongside the proportion of over-70s who share a home with people of working-age, these variables include overcrowding and local area deprivation. It also draws out the policy questions raised by the model. Some of them relate to the policy response to the virus over the coming months.

Summary of key findings

  • The proportion of over-70s in a local authority area who share a household with people of working-age is confirmed to be a significant factor in accounting for the variation in the number of Covid-19 cases across England – even when levels of local deprivation, the time since the area first recorded five cases and an additional, non-specific, “London effect” are taken into account.
  • In the short term, this finding poses question about the provision for people of working-age who, if they find themselves with mild symptoms, may not wish to self-isolate at home because they cannot maintain the necessary distance from other household members.
  • In the medium term and beyond, the finding challenges both the norms which have come to define what constitute an adequate standard of housing, as well as local authorities’ and others’ strategic plans for the provision of homes (for example, the London Plan) which reflect those standards.
  • Read the full publication below, or alternatively download following the link to the NPI

Click to access 20-04-11_Accounting_for_the_variation_in_Covid_cases_across_England.pdf

Fast-track advice for researchers developing novel diagnostics or therapeutics #covid19rftlks

NICE | April 2020| NICE joins international collaboratives to respond to the COVID-19 pandemic


NICE is providing free fast-track advice for researchers developing novel diagnostics or therapeutics for COVID-19.

NICE has produced a PDF guide to clinical evidence generation for developers of medicinal products for COVID-19.

Further details from NICE

See also: NICE joins international collaboratives to respond to the COVID-19 pandemic #covid19rftlks

Home testing programme for coronavirus will track levels of infection in the community #covid19rftlks

100,000 people will be sent self-testing kits to determine if they are currently infected | Department of Health & Social Care

A major new programme of home testing for coronavirus will track the progress of the infection across England, the government have announced.

The programme, commissioned by the Department of Health and Social Care, is being led by a world-class team of scientists, clinicians and researchers at Imperial College London, alongside colleagues at Imperial College Healthcare NHS Trust and Ipsos MORI.

It will help improve understanding of how many people are currently infected with the virus, and potentially how many have been infected and recovered since the outbreak began.

Accurate testing for the virus on a wide scale will provide authorities with a clearer picture of the current spread of the disease and the number of people who have previously caught it. It will help identify individuals who may have some immunity to the virus, and to plan services for those who do not.

Full story: Major home testing programme for coronavirus will track levels of infection in the community

Second phase of NHS response to COVID-19 #covid19rftlks

Second phase of NHS response to COVID-19: Letter from Sir Simon Stevens and Amanda Pritchard | NHS England

In this letter Sir Simon Stevens, NHS chief executive and Amanda Pritchard, NHS chief operating Officer ask all NHS local systems and organisations working with regional colleagues to step up non-Covid19 urgent services as soon as possible over the next six weeks. They stress that this needs to be a safe restart with full attention to infection prevention and control as the guiding principle.

Full document: Second phase of NHS response to COVID-19

Are more black, Asian and minority ethnic people dying with Covid-19 than might be expected? #covid19rftlks

Amid worrying recent media reports that a disproportionate number of BAME people are dying from Covid-19, Theo Georghiou and John Appleby of the Nuffield Trust take a look at how the demographics of the areas worst hit by the coronavirus can affect attempts to assess the extent of the problem.

Full detail at Nuffield Trust

See also:

 

 

Coronavirus disease 2019 (COVID-19): Cancer care during the pandemic #covid19rftlks

Uzzo, R. G., Kutikov, A., & Geynisman, D.M. (2020). Coronavirus disease 2019 (COVID-19): Cancer care during the pandemic. UpToDate. Retrieved from: https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19-cancer-care-during-the-pandemic

UpToDate has made their information available during COVID-19, this topic looks at cancer care during the pandemic, to discuss issues related to balancing the risk from treatment delay versus harm from COVID-19, ways to minimize the compromise of social distancing during care delivery, how limited healthcare resources can be appropriately and fairly allocated, and reviews the recommendations for cancer care during the COVID-19 epidemic from expert groups.

UpToDate Coronavirus disease 2019 (COVID-19): Cancer care during the pandemic

NIHR: National, collaborative platform launched to fast-track potential COVID-19 treatments for most vulnerable patients #covid19rftlks

A new clinical trial platform to accelerate the development of life-saving treatments for the most vulnerable, this initiative will involve NIHR and its partners in industry and the government.

This new collaborative platform, known as ACCORD (Accelerating, COVID-19 Research & Development), aims to get an early indication of potential drug treatments’ effectiveness in treating coronavirus. If positive results are seen, these drugs will advance rapidly into the large-scale trials in progress across the country such as the RECOVERY trial, currently the world’s largest randomised controlled clinical trial for COVID-19 treatment

COVID-19 treatments could be fast-tracked through a new national clinical trial initiative involving the NIHR and its partners in industry and the government.

This platform will accelerate the development of new drugs for patients hospitalised with COVID-19, reducing the time taken to set up clinical studies for new therapies from months to just weeks and helping to ease pressure on the NHS and ultimately save lives (Source: NIHR).

National, collaborative platform launched to fast-track potential COVID-19 treatments

 

JAMA: Treatment of 5 critically ill patients with COVID-19 with convalescent plasma, preliminary findings raise the possibility that convalescent plasma transfusion may be helpful in the treatment of critically ill patients with COVID-19 and ARDS, but requires evaluation in RCTs #covid19rftlks

Shen C, Wang Z, Zhao F, et al. (2020)Treatment of 5 Critically Ill Patients With COVID-19 With Convalescent Plasma. JAMA.323(16):1582–1589. doi:10.1001/jama.2020.4783

Key Points

Question  Could administration of convalescent plasma transfusion be beneficial in the treatment of critically ill patients with coronavirus disease 2019 (COVID-19)?

Findings  In this uncontrolled case series of 5 critically ill patients with COVID-19 and acute respiratory distress syndrome (ARDS), administration of convalescent plasma containing neutralizing antibody was followed by an improvement in clinical status.

Meaning  These preliminary findings raise the possibility that convalescent plasma transfusion may be helpful in the treatment of critically ill patients with COVID-19 and ARDS, but this approach requires evaluation in randomized clinical trials.

Abstract

Importance  Coronavirus disease 2019 (COVID-19) is a pandemic with no specific therapeutic agents and substantial mortality. It is critical to find new treatments.

Objective  To determine whether convalescent plasma transfusion may be beneficial in the treatment of critically ill patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.

Design, Setting, and Participants  Case series of 5 critically ill patients with laboratory-confirmed COVID-19 and acute respiratory distress syndrome (ARDS) who met the following criteria: severe pneumonia with rapid progression and continuously high viral load despite antiviral treatment; Pao2/Fio2 <300; and mechanical ventilation. All 5 were treated with convalescent plasma transfusion. The study was conducted at the infectious disease department, Shenzhen Third People’s Hospital in Shenzhen, China, from January 20, 2020, to March 25, 2020; final date of follow-up was March 25, 2020. Clinical outcomes were compared before and after convalescent plasma transfusion.

Exposures  Patients received transfusion with convalescent plasma with a SARS-CoV-2–specific antibody (IgG) binding titer greater than 1:1000 (end point dilution titer, by enzyme-linked immunosorbent assay [ELISA]) and a neutralization titer greater than 40 (end point dilution titer) that had been obtained from 5 patients who recovered from COVID-19. Convalescent plasma was administered between 10 and 22 days after admission.

Main Outcomes and Measures  Changes of body temperature, Sequential Organ Failure Assessment (SOFA) score (range 0-24, with higher scores indicating more severe illness), Pao2/Fio2, viral load, serum antibody titer, routine blood biochemical index, ARDS, and ventilatory and extracorporeal membrane oxygenation (ECMO) supports before and after convalescent plasma transfusion.

Results  All 5 patients (age range, 36-65 years; 2 women) were receiving mechanical ventilation at the time of treatment and all had received antiviral agents and methylprednisolone. Following plasma transfusion, body temperature normalized within 3 days in 4 of 5 patients, the SOFA score decreased, and Pao2/Fio2 increased within 12 days (range, 172-276 before and 284-366 after). Viral loads also decreased and became negative within 12 days after the transfusion, and SARS-CoV-2–specific ELISA and neutralizing antibody titers increased following the transfusion (range, 40-60 before and 80-320 on day 7). ARDS resolved in 4 patients at 12 days after transfusion, and 3 patients were weaned from mechanical ventilation within 2 weeks of treatment. Of the 5 patients, 3 have been discharged from the hospital (length of stay: 53, 51, and 55 days), and 2 are in stable condition at 37 days after transfusion.

Conclusions and Relevance  In this preliminary uncontrolled case series of 5 critically ill patients with COVID-19 and ARDS, administration of convalescent plasma containing neutralizing antibody was followed by improvement in their clinical status. The limited sample size and study design preclude a definitive statement about the potential effectiveness of this treatment, and these observations require evaluation in clinical trials.

Full article available from JAMA 

JAMA case series reports critically ill patients admitted to ICUs in Lombardy, Italy, with laboratory-confirmed COVID-19, a high proportion required mechanical ventilation and ICU mortality was 26% as of March 25, 2020. #covid19rftlks

Grasselli G, Zangrillo A, Zanella A, et al. (2020). Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of the Lombardy Region, Italy. JAMA. 2020;323(16):1574–1581. doi:10.1001/jama.2020.5394

Key Points

Question  What are the baseline characteristics and outcomes of patients with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection admitted to intensive care units (ICUs) in Lombardy, Italy?

Findings  In this retrospective case series that involved 1591 critically ill patients admitted from February 20 to March 18, 2020, 99% (1287 of 1300 patients) required respiratory support, including endotracheal intubation in 88% and noninvasive ventilation in 11%; ICU mortality was 26%.

Meaning  In this case series of critically ill patients admitted to ICUs in Lombardy, Italy, with laboratory-confirmed coronavirus disease 2019 (COVID-19), a high proportion required mechanical ventilation and ICU mortality was 26% as of March 25, 2020.

Abstract

Importance  In December 2019, a novel coronavirus (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) emerged in China and has spread globally, creating a pandemic. Information about the clinical characteristics of infected patients who require intensive care is limited.

Objective  To characterize patients with coronavirus disease 2019 (COVID-19) requiring treatment in an intensive care unit (ICU) in the Lombardy region of Italy.

Design, Setting, and Participants  Retrospective case series of 1591 consecutive patients with laboratory-confirmed COVID-19 referred for ICU admission to the coordinator center (Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy) of the COVID-19 Lombardy ICU Network and treated at one of the ICUs of the 72 hospitals in this network between February 20 and March 18, 2020. Date of final follow-up was March 25, 2020.

Exposures  SARS-CoV-2 infection confirmed by real-time reverse transcriptase–polymerase chain reaction (RT-PCR) assay of nasal and pharyngeal swabs.

Main Outcomes and Measures  Demographic and clinical data were collected, including data on clinical management, respiratory failure, and patient mortality. Data were recorded by the coordinator center on an electronic worksheet during telephone calls by the staff of the COVID-19 Lombardy ICU Network.

Results  Of the 1591 patients included in the study, the median (IQR) age was 63 (56-70) years and 1304 (82%) were male. Of the 1043 patients with available data, 709 (68%) had at least 1 comorbidity and 509 (49%) had hypertension. Among 1300 patients with available respiratory support data, 1287 (99% [95% CI, 98%-99%]) needed respiratory support, including 1150 (88% [95% CI, 87%-90%]) who received mechanical ventilation and 137 (11% [95% CI, 9%-12%]) who received noninvasive ventilation. The median positive end-expiratory pressure (PEEP) was 14 (IQR, 12-16) cm H2O, and Fio2 was greater than 50% in 89% of patients. The median Pao2/Fio2 was 160 (IQR, 114-220). The median PEEP level was not different between younger patients (n equal to 503 aged less than or equal to63 years) and older patients (n equal to 514 aged more than or equal to64 years) (14 [IQR, 12-15] vs 14 [IQR, 12-16] cm H2O, respectively; median difference, 0 [95% CI, 0-0]; P equal to .94). Median Fio2 was lower in younger patients: 60% (IQR, 50%-80%) vs 70% (IQR, 50%-80%) (median difference, −10% [95% CI, −14% to 6%]; P = .006), and median Pao2/Fio2 was higher in younger patients: 163.5 (IQR, 120-230) vs 156 (IQR, 110-205) (median difference, 7 [95% CI, −8 to 22]; P equal to .02). Patients with hypertension (n equal to 509) were older than those without hypertension (n equal to 526) (median [IQR] age, 66 years [60-72] vs 62 years [54-68]; P less than .001) and had lower Pao2/Fio2 (median [IQR], 146 [105-214] vs 173 [120-222]; median difference, −27 [95% CI, −42 to −12]; P equal to .005). Among the 1581 patients with ICU disposition data available as of March 25, 2020, 920 patients (58% [95% CI, 56%-61%]) were still in the ICU, 256 (16% [95% CI, 14%-18%]) were discharged from the ICU, and 405 (26% [95% CI, 23%-28%]) had died in the ICU. Older patients (n equal to 786; age more than or equal to64 years) had higher mortality than younger patients (n equal to 795; age less than or equal to 63 years) (36% vs 15%; difference, 21% [95% CI, 17%-26%]; P  less than .001).

Conclusions and Relevance  In this case series of critically ill patients with laboratory-confirmed COVID-19 admitted to ICUs in Lombardy, Italy, the majority were older men, a large proportion required mechanical ventilation and high levels of PEEP, and ICU mortality was 26%.

Access the full article here