Interesting report on healthcare worker deaths

[MRex]

www.hsj.co.uk/exclusive-deaths-of-nhs-staff-from-covid-19-analysed/7027471.article

Hard to tell if this is good news that healthcare workers are safer than we expect, bad news that BAME people face disproportionately high death rates, or if the workers being non-UK ties in with not receiving BCG vaccine when they were young (it's pointless after age 35). Thoughts from anyone?

As might smallpox (but you'd definitely have to be over 55 to have had that on NHS)

I'm only 50 but definitely have a smallpox scar - it looks like a peach stone. My sister who is two years younger didn't have it.

The theory is that BCG somehow 'primes' your immune response so it responds quicker to threats than it would otherwise. Evidence that BCG reduces your risk of lots of respiratory infections.

Most people under mid-50s wouldn't have had smallpox as a matter of routine. But if there was a case nearby, then there would have been a local buffer zone where everyone who had not been vaccinated would be done. It was a jab that wasn't risk free, so when the disease became rare, it moved from mass vaccination to dealing the odd case.

Weirdly I have had smallpox but not BCG. I'm in my mid 40s

Smallpox vaccn was indeed due to a case locally

I'm one of the few people that had the pinprick test, and it came up so I was exempt from bcg jab! I presume that would mean that I don't have the antibodies that the jab would give you though? I can't quite work it out in my head!

I was at secondary school in that window, and know I didn't have BCG because the 6 needle stamp test showed "just enough" immune response.

If nhs workers are no more likely to die than the general population then you would expect a markedly lower percentage of them dying than the general population as the average age will be younger and the rate of serious co-morbidities will be lower as the most unwell people wouldn’t be working at all.

Also it’s doctors and nurses and healthcare support workers who are dying at a much higher rate than admin staff

A more interesting comparison would be how the death rate amongst staff who are providing direct patient care compares to those who don’t have any contact with patients.

Out of curiosity, I don't know if this is a silly question but is there any way to work out if you would have been given the BCG vaccine? I am 34 so was at secondary school between 1997 and 2004 so would I have had it if they stopped doing it in 2005? Or had they already started reducing the number of people getting it before then?

I am the same age as you and definitely got it- although that may not mean much, as possible it was regional. Only other option is to ask your GP- I'm on the online patient access thing via my GP surgery and all my vaccinations are listed on my patient record.

Do you have a scar on your upper left arm, with three needle holes clearly visible? That's your BCG.

I'm one of the few people that had the pinprick test, and it came up so I was exempt from bcg jab!

This is my understanding of it. I remember a girl in our class had TB, she was off school for a long time. We all had to have the pinprick test. Like a circle of pinpricks on the wrist. I think this was to see if we had been exposed to it and i also think some of us didn't get the BCG because of this

I presume that would mean that I don't have the antibodies that the jab would give you though? I can't quite work it out in my head!

I think the pinprick test was for antibodies. So if the test came back positive there wouldn't be any point having the BCG jab, because you'd already been exposed to TB and made your own antibodies

I could be completely wrong though as I'm going from memory.

Something else I remember was that me and my siblings used to hold our breath when we walked past the poor girl with TB's house. Which was ridiculous of us of course, but we were just children. I believe the girl made a full recovery or at least that's what we were told

@MajesticWhine

Is the age distribution of NHS staff and staff deaths the same as in the general population. It is important to understand this before concluding whether NHS staff are at a greater relative risk of death from covid.

More or Less ran the numbers on healthcare workers last week. Their conclusion was that the death rate of health care workers in the UK to date was almost exactly the same as that of the general working age population , but with a few huge caveats: some people in the “working age” population will be very sick and probably not working, and crucially, the people dying now will have contracted the disease some weeks ago, before lockdown, which you’d expect to change the relative risk of the two groups.

Thank you. That's interesting.

This is the episode: a bit back of the envelope.
www.bbc.co.uk/programmes/m000hfqq

@Flaxmeadow I remember the hcp being very confused about why my pinprick test came back as being raised!!! I felt pretty lucky at the time. But I think in all likelihood that I had had the vaccine when I was younger. I was born overseas and my folks lived all over the place. They couldn't remember what jabs I'd had.... but likely that I'd either been exposed or had been given a vaccine as a much younger child!

I had to have BCG to study nursing in 2012 I wasn't allowed to enter the course without having it done I was 20. I did not have this nor was I offered this at school.

I'm looking forward to more research being done regarding vit D it would be such an easy fix !

There will be a lot of early speculation, initial findings etc about things like this. And whilst interesting, it just takes time to really know so I’d be very cautious about grabbing on to stuff too early.

No useful input from me but I definitely had the BCG at school, it was bloody awful. Absolutely no scar though. I've asked consultants about it before (am in/out of hospital often) and generally they've said lack of scar is not necessarily indicative of a failed BCG at all. I certainly recall not having the use of my arm for days and being in tears over it!

I had what we called 6 needles and then the BCG. No scar.

The doctor said the lack of scar had nothing to do with how effective it was. Some people got a scar and some people didn't.

I do think there need to be some research into the NHS staff numbers. Again yesterday in the news they talked about the pregnant nurse who died in relation to a lack of ppe. Whilst that woman death is sad, she was on maternity leave and hadn't worked with covid patients before that. It appeared she caught it in the community, potentially of her own father.

Her photo is shown along sideal the other NHS staff members who 'died fighting this awful disease'.

Last night they were talking about a local case. A woman had died and they kept saying she 'had worked as a nurse'. And talking about her work in a past tense. They have the impression, she had worked as a nurse recently

But I think it needs looking into.

How many of the NHS staff that have died were actually working before they caught covid? What was their role? Is it likely they caught it at work or more likely they caught it outside work? Are NHS numbers hugely higher than the general population.

Also the same with BAME, as pp said, looking at national population its seems to be disproportiate. But have people look at a more local, breakdown of population. There maybe some answers there. But either way I think its an important thing to look at.

@AuntieStella they give BCG to newborns who have extended family members from developing countries. Though how they tell you they need it is very hit and miss. For example if they don't realise one of the parents is South African then they don't advise the parents to have it.

@Shitsgettingcrazy The Guardian has done some analysis on the limited data available. www.theguardian.com/world/2020/apr/22/racial-inequality-in-britain-found-a-risk-factor-for-covid-19

One issue is ethnicity is not recorded on death certificates. With how the police record ethnicity and the crap I've heard from some healthcare professionals, I can understand why.

There has been a lot of comments about the "BCG vaccine."

However, apparently protection is coming not so much from the BCG vaccine in general, but from a specific strain that is used in certain countries.

The "Soviet" strain-formerly considered rather old fashioned!is the one that's mooted as being possibly protective. It has been used in many east Asian countries including Japan, Russia and most of Eastern Europe.

The strain that has been given in countries like the UKthe Western European or "Denmark" strain-does not appear to be protective or at least not protective in the same way.

Some discussion and links here.
www.jsatonotes.com/2020/03/if-i-were-north-americaneuropeanaustral.html

@LittleLittleLittle thank you. I read it and I could make head nor tail of it. I am going to read it when I have had more sleep.

But thank you for linking it.

@Shitsgettingcrazy the analysis looked at number of Covid-19 deaths to 3 April by LA area. The highest number of deaths are in areas with high BAME populations. However in there list of top 10 there is a complete outlier South Lakeland in Cumbria and an outlier Hertsmere. Hertsmere borders Brent and Harrow who have high BAME populations and highest numbers of Covid-19 deaths. The article doesn't mention it but as I have lived in one LA without a hospital, and in another LA were my nearest hospital was in the neighbouring LA, plus have always done things like schooling, working and shopping in neighbouring LAs it's not hard to guess why Hertsmere is also badly affected.