[Open Access] Black, Asian and Minority Ethnic groups in England are at increased risk of death from COVID-19: indirect standardisation of NHS mortality data

Black, Asian and Minority Ethnic groups in England are at increased risk of death from COVID-19: indirect standardisation of NHS mortality data

Aldridge RW, Lewer D, Katikireddi SV et al. Black, Asian and Minority Ethnic groups in England are at increased risk of death from COVID-19: indirect standardisation of NHS mortality data [version 1; peer review: 3 approved with reservations]. Wellcome Open Res 2020, 5:88 (https://doi.org/10.12688/wellcomeopenres.15922.1)

ABSTRACT

Background: International and UK data suggest that Black, Asian and Minority Ethnic (BAME) groups are at increased risk of infection and death from COVID-19. We aimed to explore the risk of death in minority ethnic groups in England using data reported by NHS England.
Methods: We used NHS data on patients with a positive COVID-19 test who died in hospitals in England published on 28th April, with deaths by ethnicity available from 1st March 2020 up to 5pm on 21 April 2020. We undertook indirect standardisation of these data (using the whole population of England as the reference) to produce ethnic specific standardised mortality ratios (SMRs) adjusted for age and geographical region.
Results: The largest total number of deaths in minority ethnic groups were Indian (492 deaths) and Black Caribbean (460 deaths) groups. Adjusting for region we found a lower risk of death for White Irish (SMR 0.52; 95%CIs 0.45-0.60) and White British ethnic groups (0.88; 95%CIs 0.86-0.0.89), but increased risk of death for Black African (3.24; 95%CIs 2.90-3.62), Black Caribbean (2.21; 95%CIs 2.02-2.41), Pakistani (3.29; 95%CIs 2.96-3.64), Bangladeshi (2.41; 95%CIs 1.98-2.91) and Indian (1.70; 95%CIs 1.56-1.85) minority ethnic groups.
Conclusion: Our analysis adds to the evidence that BAME people are at increased risk of death from COVID-19 even after adjusting for geographical region. We believe there is an urgent need to take action to reduce the risk of death for BAME groups and better understand why some ethnic groups experience greater risk. Actions that are likely to reduce these inequities include ensuring adequate income protection (so that low paid and zero-hours contract workers can afford to follow social distancing recommendations), reducing occupational risks (such as ensuring adequate personal protective equipment), reducing barriers in accessing healthcare and providing culturally and linguistically appropriate public health communications.

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Abstract

[Open Access] Global call to action for inclusion of migrants and refugees in the COVID-19 response

CORRESPONDENCE | THE LANCET | VOLUME 395, ISSUE 10235, P1482-1483, MAY 09, 2020

Global call to action for inclusion of migrants and refugees in the COVID-19 response

“Lancet Migration1 calls for migrants and refugees to be urgently included in responses to the coronavirus disease 2019 (COVID-19) pandemic.2 Many of these populations live, travel, and work in conditions where physical distancing and recommended hygiene measures are impossible because of poor living conditions3 and great economic precarity. This global public health emergency highlights the exclusion and multiple barriers to health care4 that are faced by migrants and refugees, among whom COVID-19 threatens to have rapid and devastating effects.5 From an enlightened self-interest perspective, measures to control the outbreak of COVID-19 will only be successful if all populations are included in the national and international responses. Moreover, excluding migrants and refugees contradicts the commitment to leave no one behind and the ethics of justice that underpin public health. Principles of solidarity, human rights, and equity must be central to the COVID-19 response; otherwise the world risks leaving behind those who are most marginalised. Join our global call to action for the inclusion of migrants and refugees in the COVID-19 response (panel).”

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[Open Access] Racism and discrimination in COVID-19 responses

Racism and discrimination in COVID-19 responses

CORRESPONDENCE | THE LANCET | VOLUME 395, ISSUE 10231, P1194, APRIL 11, 2020

“The strength of a health system is inseparable from broader social systems that surround it. Epidemics place increased demands on scarce resources and enormous stress on social and economic systems. Health protection relies not only on a well functioning health system with universal coverage, but also on social inclusion, justice, and solidarity. In the absence of these factors, inequalities are magnified and scapegoating persists, with discrimination remaining long after. Division and fear of others will lead to worse outcomes for all.”

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[Open Access] Travel health risk perceptions of Chinese international students in Australia – Implications for COVID-19

Travel health risk perceptions of Chinese international students in Australia – Implications for COVID-19

Tara Maa, Anita HeywoodaC., Raina MacIntyreb
aSchool of Public Health and Community Medicine, UNSW Australia, Kensington, NSW, 2052 Australia
bBiosecurity Program, The Kirby Institute, UNSW Australia, Kensington, NSW, 2052 Australia

Abstract

Background

International students frequently return to their country of origin to visit friends and relatives (VFR), and are at increased risk of travel-associated infections. Little is known of their travel health seeking behaviours. China is the biggest source of international students studying in Australia and the unprecedented epidemic of COVID-19 in China makes this an important area of research.

Methods

Focus groups of Chinese international students were conducted to explore travel health-related knowledge, attitudes and practices. Eligible participants were studying in Sydney, and had travelled to China and Hong Kong to visit friends and relatives in the preceding 18 months. A variety of topics were explored, using a focus group guide. Thematic analysis was undertaken on the transcripts using nVivo software. The list of codes and themes were not pre-determined but developed through content analysis.

Results

Two focus groups were held with a total of 28 participants. Risk perception about VFR travel was generally low among Chinese international students. Pre-travel healthcare was not sought. Students strongly relied on the Internet, social media, parents and friends in China for travel health advice.

Conclusion

This research provides insights into Chinese international students as VFR travellers. It confirms students could be a risk population for importations of infections such as COVID-19 because of low risk perception and lack of seeking travel health advice. This can inform health promotion strategies for students.

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[Open Access] COVID-19 Vaccine Development: Time to Consider SARS-CoV-2 Challenge Studies?

COVID-19 Vaccine Development: Time to Consider SARS-CoV-2 Challenge Studies?

Schaefer, G.O and Tam, Clarence C. and Savulescu, Julian and Voo, Teck Chuan, COVID-19 Vaccine Development: Time to Consider SARS-CoV-2 Challenge Studies? (March 20, 2020). Available at SSRN: https://ssrn.com/abstract=3568981 or http://dx.doi.org/10.2139/ssrn.3568981

Abstract

While a human challenge study holds the prospect of accelerating the development of a vaccine for the coronavirus SARS-CoV-2, it may be opposed due to risks of harm to participants and researchers. Given the increasing number of human deaths and severe disruption to lives worldwide, we argue that a SARS-CoV-2 challenge study is ethically justifiable as its social value substantially outweighs the risks. Such a study should therefore be seriously considered as part of the global research response towards the COVID-19 pandemic. This paper contributes to the debate by addressing the misperception that a challenge study would lower scientific and ethical standards for vaccine research as well as other ethical concerns. Information that need to be disclosed to prospective participants to obtain their consent are set out.

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[Open Access] Mapping population mental health concerns related to COVID-19 and the consequences of physical distancing: a Google trends analysis

Mapping population mental health concerns related to COVID-19 and the consequences of physical distancing: a Google trends analysis

Knipe D, Evans H, Marchant A et al. Mapping population mental health concerns related to COVID-19 and the consequences of physical distancing: a Google trends analysis [version 1; peer review: 2 approved with reservations]. Wellcome Open Res 2020, 5:82 (https://doi.org/10.12688/wellcomeopenres.15870.1)

ABSTRACT

Background: The 2020 Coronavirus pandemic is a major international public health challenge.  Governments have taken public health protection measures to reduce the spread of the virus through non-pharmalogical measures. The impact of the pandemic and the public health response on individual and population mental health is unknown. 
Methods: We used Google Trends data (1 Jan 2020 – 1 Apr 2020) to investigate the impact of the pandemic and government measures to curb it on people’s concerns, as indexed by changes in search frequency for topics indicating mental distress, social and economic stressors and mental health treatment-seeking. We explored the changes of key topics in Google trends in Italy, Spain, USA, UK, and Worldwide in relation to sentinel events during the pandemic.
Results: Globally there appears to be significant concerns over the financial and work-related consequences of the pandemic, with some evidence that levels of fear are rising. Conversely searching for topics related to depression and suicide fell after the pandemic was announced, with some evidence that searches for the latter have risen recently. Concerns over education and access to medication appear to be particular social stressors. Whilst searches for face-to-face treatments have declined, those for self-care have risen.
Conclusions: Monitoring Google trends shows promise as a means of tracking changing public concerns. In weeks to come it may enable policy makers to assess the impact of their interventions including those aiming to limit negative consequences, such as government funded financial safety nets.

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[open access] Covid-19: how a virus is turning the world upside down

Covid-19: how a virus is turning the world upside down

BMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m1336 (Published 03 April 2020)
Cite this as: BMJ 2020;369:m1336

Ilona Kickbusch, director1,  

Gabriel M Leung, dean of medicine2,  

Zulfiqar A Bhutta, co-director3,  

Malebona Precious Matsoso, director of health regulatory science platform4,  

Chikwe Ihekweazu, director general5,  

Kamran Abbasi, executive editor6

1Global Health Programme, Graduate Institute of International and Development Studies, Geneva, Switzerland

2Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China

3Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada

4Wits Health Consortium, University of Witwatersrand, Johannesburg, South Africa

5Nigeria Centre for Disease Control, Abuja, Nigeria

6The BMJ, London, UK

Correspondence to: I Kickbusch kickbusch@bluewin.ch

“Covid-19 has taught us that health is the basis of wealth, that global health is no longer defined by Western nations and must also be guided by Africa and Asia, and that international solidarity is an essential response and a superior approach to isolationism. We may emerge from this with a healthier respect for the environment and our common humanity. All citizens, governments, businesses, and organisations must heed these lessons. Covid-19 is the virus that is turning the world upside down. It will destroy the world as we know it; in the process we may learn to hold it together.”

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[Open Access] COVID-19 control in low-income settings and displaced populations: what can realistically be done?

COVID-19 control in low-income settings and displaced populations: what can realistically be done?

Maysoon Dahab1, Kevin van Zandvoort2, Stefan Flasche2, Abdihamid Warsame2, Paul B. Spiegel3, Ronald J Waldman4 5, Francesco Checchi2 *

1  Conflict & Health Research Group, King’s College London, London, UK

2 Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK

3 Centre for Humanitarian Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA

4 Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA

5 Doctors of the World USA, New York, NY, USA

* Corresponding author: Francesco.checchi@lshtm.ac.uk

Background

“While modelling predictions1 suggest that uncontrolled or even partially mitigated COVID-19 epidemics in high-income countries could lead to substantial excess mortality, the virus’ impact on people living in low-income settings or affected by humanitarian crises could potentially be even more severe. Three mechanisms could determine this: (i) higher transmissibility due to larger household sizes2, intense social mixing3 between the young and elderly4, overcrowding in urban slums and displaced people’s camps, inadequate water and sanitation, and specific cultural and faith practices such as mass prayer gatherings, large weddings and funerals during which super-spreading events might propagate transmission disproportionately5; (ii) higher infection-to-case ratios and progression to severe disease due to the virus’ interaction with highly prevalent co-morbidities, including non-communicable diseases (NCDs; prevalence of hypertension and diabetes is often higher in low- than high-income settings, with a far lower treatment coverage6), undernutrition, tuberculosis7 and HIV; and (iii) higher case-fatality due to a dire lack of intensive care capacity, especially outside large cities. Moreover, extreme pressure on curative health services could result in indirect impacts resulting from disrupted care for health problems other than COVID-19.8 While these risk factors could be counterbalanced by younger age distributions and hot temperatures, on balance we believe that, given current evidence and plausible reasoning, drastic action is required immediately to protect the world’s most fragile populations from this unfolding threat.”

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[Open Access] Targeting COVID-19 interventions towards migrants in humanitarian settings

COMMENT | Lancet Infectious Diseases | VOLUME 20, ISSUE 6, P645-646, JUNE 01, 202

Targeting COVID-19 interventions towards migrants in humanitarian settings

Published:April 21, 2020DOI: https://doi.org/10.1016/S1473-3099(20)30292-9

“Millions of refugees and migrants reside in countries devastated by protracted conflicts with weakened health systems, and in countries where they are forced to live in substandard conditions in camps and compounds, and high-density slum settings.1 Although many such settings have yet to feel the full impact of coronavirus disease 2019 (COVID-19), the pandemic is now having an unprecedented impact on mobility, in terms of border and migration management, as well as on the health, social, and economic situation of migrant populations globally. An urgent coordinated effort is now needed to align these populations with national and global COVID-19 responses.”

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Risk behind bars: Coronavirus and immigration detention

Risk behind bars: Coronavirus and immigration detention

BY RANIT MISHORI

“….an outbreak in a facility threatens the outside community as well. An outbreak in a detention facility endangers all who come in contact with migrants, from immigration enforcement staff to workers at detention facilities, asylum officers, lawyers, and judges. All those people come in contact with the detainees and go home to their families at night.”

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