Coronavirus: Asian experts say Oxford study showing higher hospital death rate among non-whites suggests socioeconomic, not genetic effects

Asian public health experts say socioeconomic factors rather than genetics are likely to be behind findings of a British study that showed Asian and black people are more likely to die of Covid-19 in hospital than those of white ethnicity.

Data on the pandemic's spread from countries in Asia and the Caribbean, and past research, suggest it is rare for an infectious disease to affect certain ethnicities more than others, the experts said.

The study, by researchers from the University of Oxford and London School of Hygiene & Tropical Medicine and released on May 7, looked at the records of more than 17 million British patients, including 5,638 who had died from Covid-19 up to April 16 " covering 40 per cent of the UK population.

It included patients' baseline characteristics such as diagnoses, medications and physiological parameters and found that higher levels of deprivation and existing medical conditions such as cardiovascular disease and diabetes only accounted for "a small part of the excess risk" of death.

The study concluded that members of Britain's ethnic minority groups were at higher risk because they tend to work frontline jobs, such as on the London Underground. Photo: AFP alt=The study concluded that members of Britain's ethnic minority groups were at higher risk because they tend to work frontline jobs, such as on the London Underground. Photo: AFP

Instead, it concluded that members of Britain's ethnic minority groups were at higher risk because they tend to work frontline jobs and live in more crowded households.

When other risk factors such as obesity, hypertension and smoking were taken into account, Asian and black patients were still found to be 1.62 and 1.71 times more likely to die, respectively, than their white counterparts.

Asked about the findings, health care experts in Asia said the unequal outcomes were likely caused by socioeconomic factors that affect how members of these communities live and work.

Paul Tambyah, president of the Asia Pacific Society of Clinical Microbiology and Infection and an infectious diseases doctor in Singapore, said he thought "socio-economic factors have played a much greater role than any ethnic indications".

"The data from South Asia as well as the Caribbean and Africa do not support any genetic differences in outcomes," he said.

African Americans like Sevonna Brown of mutual aid group Black Women's Blueprint and her son have been more adversely affected by the pandemic in New York than whites, health care experts say. Photo: AFP alt=African Americans like Sevonna Brown of mutual aid group Black Women's Blueprint and her son have been more adversely affected by the pandemic in New York than whites, health care experts say. Photo: AFP

Others, such as Abrar Chughtai " an epidemiologist at the University of New South Wales in Australia " pointed to social disparities. Making a comparison to the United States "where African Americans are infected more in New York", he said members of ethnic minority communities "generally have less access to the health and community services".

It is also "very rare" for an infectious disease to be more virulent among certain broad ethnic groups, according to Hsu Li Yang, associate professor at the National University of Singapore's Saw Swee Hock School of Public Health, who said "most such claims in the past " and there have been many " have been refuted'.

One of the study's authors, professor of clinical epidemiology Liam Smeeth, told This Week in Asia that he would "seriously doubt that there are any genetic explanations", as the differences between ethnic groups "are generally smaller than the differences within ethnic groups".

He said that in Britain, and especially in its big cities, "many people from black and Asian backgrounds work in jobs with a lot of human contact " public transport, care industries, taxi drivers, small shops", putting them at greater risk of being infected.

Migrant workers comprise the bulk of Singapore's coronavirus cases. Photo: EPA alt=Migrant workers comprise the bulk of Singapore's coronavirus cases. Photo: EPA

Members of ethnic minority groups have been disproportionately affected by the Covid-19 outbreak outside Britain, too. In Singapore, low-wage migrant workers make up about one-sixth of the city state's 5.7 million people, but account for over 90 per cent of the more than 25,000 infections. The workers live in cramped conditions and are not incentivised to report sickness to their employers because their already low pay would be docked.

Similarly, Qatar has about 25,000 cases and The Guardian reported that the vast majority are also migrant workers. The Gulf state of 2.8 million people is home to 2 million migrant workers, many building football stadiums ahead of the 2022 World Cup and living in cramped, unhygienic camps. In Norway, the Financial Times reported that people born in Somalia " who are poorer, live in tight family units, and often work as taxi drivers " are 10 times more likely to get Covid-19.

In Hong Kong, where one in four members of ethnic minority groups live in poverty, some have found it hard to obtain masks, hygiene products, and access to information related to the outbreak. But apart from a few infections in domestic helpers, Ben Cowling, professor of epidemiology at the University of Hong Kong School of Public Health, said the city had "done well to avoid a community epidemic".

Parvaiz A Koul, an infectious diseases expert at the Sher-i-Kashmir Institute of Medical Sciences in Srinagar, said that in India there appeared to be more confirmed cases among people of relatively high socioeconomic status, including those who had travelled abroad, but further study was needed into the impact of the virus on different groups.

"I am also conscious of the fact that in many lower income countries the disease may only be peaking now and the immediate future might give us answers to these questions," he said.

Countries have taken steps to safeguard these marginalised groups. Singapore authorities quickly swooped in to set up medical teams at migrant workers' dormitories and on Tuesday said they would test all migrant workers for the disease. They have promised to improve living conditions and look into any missteps in how the outbreak was controlled.

Last month, South Korean Prime Minister Chung Sye-kyun announced that migrants who were tested or treated for the virus would not be asked about their immigration status, amid concerns deportation fears could spur unchecked infections among the country's estimated 400,000 undocumented workers.

"Normally public service workers are responsible for reporting illegal immigrants, but currently they are exempted from such duty with regard to any service related to Covid-19," said Cho Sung-il, a professor of epidemiology at Seoul National University. "This policy has been emphasised previously with other infectious diseases, since any motivation to hide from disease surveillance should be avoided for the protection of the whole community."

In Australia, steps have been taken to protect indigenous populations in remote locations. Photo: AFP alt=In Australia, steps have been taken to protect indigenous populations in remote locations. Photo: AFP

In Australia, steps have been taken to protect indigenous populations in remote and rural locations, after authorities took cues from the 2009 H1N1 influenza epidemic, which killed four-times more indigenous than non-indigenous people.

There are now strict limitations on travel in or out of indigenous communities, and since some do not have facilities for isolation and quarantine, protocols have been developed to transfer infected people or suspected cases into regional centres. So far, there have been 52 cases of Covid-19 among indigenous Australians " all of whom were living in urban areas.

Teo Yik Ying, dean of the NUS Saw Swee Hock School of Public Health in Singapore, said the pandemic would "amplify the disparities" in society and governments should tailor their policies to mitigate the disproportionate impact on certain groups.

"Policymakers need to strengthen both health and economic safety nets for the lower socioeconomic status [groups], in part to encourage better health-seeking behaviour so these people are willing to come forward to seek treatment " that is fully subsidised " when feeling unwell, and in part to provide for these people to ward off destitution and any ensuing risky behaviour to protect livelihoods," he said.

This article originally appeared on the South China Morning Post (SCMP).

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