Could a health professional explain why BAME are more likely to contract Covid.

[Livinginthecity]

I know nothing about it so would like to be informed.

Not a medical background but a medical person explained to me that it’s to do with ACE receptors

But not too sure if it’s since been misproven

I'd just like to know why this is being repeated ad hominem in news reports but no reason given.

There was a documentary on a few months ago, think it was channel 4 and it was called is Covid racist?

They were investigating if BAME were more succeptable to it or actually if it’s down to racism within the healthcare sector causing worse treatment and racism in general meaning that they are more likely to be exposed to it in the first place

The reason is not a simple one but is largely due to systematic and structural racism.
There are plenty of articles from the BMJ, the ONS and the guardian online- have a look by googling BAME and covid.
Typically people have greater levels of poverty so need to be out working more as there is nothing to fall back on if they are unemployed from already precarious jobs.
Typically BAME people have been more exposed to Covid-19. That is why they are more likely to die from it.

Vitamin D deficiency may also be contributory.

This summarises understanding of the matter by the BHF from May last year, though things might have moved on:

www.bhf.org.uk/informationsupport/heart-matters-magazine/news/behind-the-headlines/coronavirus/coronavirus-and-ethnic-minorities

Typically people have greater levels of poverty so need to be out working more as there is nothing to fall back on if they are unemployed from already precarious jobs.

Outcomes among BAME doctors were worse than Caucasian doctors, so that doesn’t stack up in its entirety,

There were theories early on that BAME patients in the U.K. were more likely to have depleted vitamin D levels and that put them at higher risk of serious illness/death.

I don’t know.

They are more likely to be exposed (much more likely to be in front line roles, high levels of self employment, unable to work from home, more multigenerational households) and more likely to be ill if they do catch it due to more underlying diabetes / obesity / high BP and barriers getting as high a level of care as white people.
Lots of structural racism and links with poverty.

Typically people have greater levels of poverty so need to be out working more as there is nothing to fall back on if they are unemployed from already precarious jobs.
Typically BAME people have been more exposed to Covid-19. That is why they are more likely to die from it

The only 2 people I know who have died from Covid were BAME and were members of the same family. They were both far from property stricken and neither had to go out to work.
They were both working from their home offices
I think it is down to certain genetics. I hear on the news how some families are devastated with 2 or 3 or more deaths in the family from Covid. But others seem to all get through it with just minor symptoms.

I’m convinced the vitamin D issue is relevant.

Surely if it were biological (ie due to skin colour etc) then India and Africa would have had worse outcomes than "whiter" countries but that's not the case. So it must be systemic.

@Livinginthecity

I'd just like to know why this is being repeated ad hominem in news reports but no reason given.

I don't know what ad hominem is but the BAME effect has been recognised since the very early days and has been discussed at length since then but afaik there isn't a scientific concensus about whether if exists and if so why.

The news reports don't give a reason because no one knows for sure. I'd suggest you google it but by now there must be millions of articles about it so probably not easy to see the wood for the tress

In Sweden a high proportion of Somali women who are covered died from it in the first few months. They speculated that it was due to vitamin D deficiency, due to no sunshine on the skin. Google 'Somali Covid Sweden' for the reports.
Is diabetes disproportionately high in BAME people?

It's vitamin D deficiency

There could be biological reasons, not just the question of vitamin D, but rather the genetic differences in the expression of ACE 2, plus higher prevalence of cardiovascular risk factors.

www.bmj.com/content/bmj/369/bmj.m1548.full.pdf

Is diabetes disproportionately high in BAME people?

Yes.

Higher levels of obesity and diabetes

Also many BAME people think it's a hoax/not real/won't take a vaccine.

I say this as a BAME person myself, I don't agree but majority of BAME I know think this - and people I see on social media sites. Not all bame, just a vast amount.

Therefore I think there's still a lot of mixing due to not taking the virus seriously - partly because bame do not trust government because government have never 'helped' bame people historically and most believe have only hindered so they are now thinking, why should I trust you?

@RoosterTheRoost not quite sure about that? Or where you got those stats from

@garlictwist

Surely if it were biological (ie due to skin colour etc) then India and Africa would have had worse outcomes than "whiter" countries but that's not the case. So it must be systemic.

The fact that they have a younger population is thought to be a protective factor re African countries / India.

Surely if it were biological (ie due to skin colour etc) then India and Africa would have had worse outcomes than "whiter" countries but that's not the case. So it must be systemic

But the life expectancy in Africa and India is not the same as in Europe. The virus kills mostly older people, people over 80 are more at risk, and there is a much much larger percentage of the population over that age in Europe than in Africa and India.
So, who knows...so many factors! Very difficult to know for sure.

Vitamin D deficiency,diabetes and cardiac problems .Poverty and exposure doesn’t really add up in many cases. BAME people who have sadly died often have been professional people with a decent income.

[quote tootsytoo]@RoosterTheRoost not quite sure about that? Or where you got those stats from [/quote]
From Diabetes UK. It's well recognised.

@garlictwist

Surely if it were biological (ie due to skin colour etc) then India and Africa would have had worse outcomes than "whiter" countries but that's not the case. So it must be systemic.

No, it’s impossible to make a casual comparison like that and conclude anything one way or the other.

Even if you go about it in an organised way with full stats at your disposal, it’s impossible to control properly for the full range of factors like climate, infrastructure development, population size and density and make a valid direct comparison.

I'm not an HP but am an infectious disease epidemiologist.

Nobody knows for fact... it's bound to be multi-factorial. It needs to be teased out with lots of individual records; take ages to assess in an unbiased way.

For me the compelling data are ICNARC (they describe outcomes of people who had critical care, comparing with covid vs. other types of respiratory pneumonia). Age most important risk factor, followed by sex & multi-comorbidities and then BAMEness.

BAMEness is not as big a risk factor for getting or dying from other viral pneumonias -- why not? What is different about covid?

Below are ideas why BAMEness makes covid worse. They mostly should be just as important to dying from other viral pneumonias -- but seemingly not. Why not?

poverty
structural racism
(lung damage) personal history of living in air polluted places
vitamin D deficiency (multi-systemic if relevant, but no good quality study supports this hypothesis)
higher level of comorbidities
more likely to be keyworkers, so higher exposure rates
genetic predisposition for obesity or T2DM or other underlying conditions
other genetic predisposition to respiratory diseases

So that's flipping intriguing.

COVID can cause cytokine storm (not usual feature of influenza) that is cause of death for many covid patients. Could that hyper-inflammatory risk interact with any of above risk factors to help explain why BAME people get covid worse?