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.

@orangenasturtium

We are essentially multiple sub species that have adapted to our environment but over a very short period of time in the great scheme of things we have totally mixed things up.

I'm sure you don't mean it this way but suggesting that there are different human sub species is often used by racists. There are no human sub species.

I think PP was trying to say we are basically tribal and have developed evolutionarily to suit our historic locales. I knew she would get grief for the way she had phrased it, but there is really no need. It’s obvious no harm was meant.

Yes, I don't think @Angrymum22 meant to be offensive @RickiTarr and was trying to say that different genes are prevalent in different populations because of natural selection but it is inaccurate and offensive to use the term human subspecies so it might be best to ask for the post to be edited.

@Onedropbeat

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

Young healthy BAME people are more likely to suffer from autoimmune disease the NHS doesn’t actively look for or treat until it’s really bad (pcos, thyroid disorders, some forms of arthritis) and exaggerated inflamatory responses to disease (so called strong immune systems) - that’s the reason a St Thomas and Guys respiratory consultant told us when my healthy 20 something neice was hospitalised.

However even amongst BAME people the incidences of healthy young people being hospitalised is rare. Covid is still predominately an illness affecting unhealthy / sick and older people & BAME people who are 60+ are often immigrants who come from cultures where ill health / healthy lifestyle just isn’t taken seriously until you need to go to hospital.

Oh and I have a clotting disorder that causes strokes and preclampsia when inflamation levels (can be raised by viruses) are high enough. It’s a rare clotting disorder in the UK and so it’s not treated but it’s very common in India and over there doctors will put on permanent low doses of aspirin. Could explain why India isn’t, so far at least, experiencing the same mortality rates in the under 60s as BAME people from other countries.

There have been twin studies (comparing outcomes in identical and none identical twins) which have shown that there is a genetic component to a persons susceptibility to COVID. But they don’t know what that genetic difference is yet. It may well be something that is more common in certain racial groups, like blood types.

Vitamin d. Even non bame arent getting enough so if bame need longer exposure to get enough

Some genes that make people more susceptible to severe COVID-19 symptoms have been identified @Mustreadabook

www.nature.com/articles/d41586-020-03589-3

This is just a link to a lay summary but you can click through to the paper. It's quite heavy going though...

@MedSchoolRat

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?

The first cluster of London children to be observed with the Kawasaki-ish inflammatory response were all from BAME families.

I think we’ll eventually find some kind of genetic reason for the disproportionate levels of serious illness in male and/or BAME people. Possibly something on the x-chromosome. A combo of an inherited gene mutation, higher average age and vit d deficiency (due to living in grey old Britain) would explain why minority families in the U.K. are affected in a way that the majority population in their country of origin isn’t (eg the smaller the community, the more likely two gene fault carriers are to have babies together).

Could take decades to identify the responsible gene mutations though (and could be multiple different ones).

Not a health professional, but I think that food choices have a greater effect on inflammation in the body than we give credit for. Sugar being the main culprit. When I lived in the Caribbean, I struggled to buy any food which didn't have added sugar. From yoghurt to bread to cooked chicken in a restaurant. Interesting that two studies in Hong Kong and South Korea recently linked Covid to gut biome.
Metabolic syndrome, type 2 diabetes, obesity and vitamin D are all interlinked.
Had the UK population not been deficient in vitamin D, and if people didn't consume so much sugar, I think our outcome from this pandemic would have been vastly different.
The results of the August/September Cordoba Vitamin D Trial gave us a valuable insight, but we didn't seize the opportunity to rectify vitamin D deficiency before the onset of winter.
PHE also aren't compiling or analysing data on vitamin D deficiency among those admitted to hospital (according to a recent FOI request).

I have an Indian friend who says all her family back home in India have had it. She says many of them are overweight.

Reading in the independent 80% of those in hospital with Covid are vit D deficient
It’s not a coincidence I don’t believe

@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.

Surely not, given that they are closer to the equator and have much more light?

Better ask a sociologist I'm told.

GrumpyHoonMain are you saying PCOS is a risk factor for Covid, for anyone?

There is no such thing, biologically speaking, as race. There is however, an enormous amount of racism.

Structural racism causes poverty, which shows itself as poorer health, overcrowding, living in locations with poorer air quality, and increased likelihood of not accessing good treatment in a timely way.

Vitamin D levels may have a tiny impact, but I’d guarantee that everything g above has a much higher one.

If you’re really interested, Superior by Angela Saini is a very very good read on the subject.

@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.

This

Italy and France have huge numbers of covid affecting every race.

One of the impacts of structural racism and poverty is people with BAME heritage working in jobs, such as in public transport where they have been exposed to higher viral loads.

I'm interested in the vit D studies and have personally been taking vits D & K.

I've also begun following Dr Tim Specter from the Zoe study on Twitter - it looks like there are some interesting studies emerging about metabolic disease and COVID which will be highly pertinent to ethnicities predisposed to diabetes.

I would say there is definitely an impact from institutional racism. If you look at other areas of healthcare, you can see it reflected. Eg, black women are 5 times more likely to die in childbirth than white women in the UK, even if UK born. This may be out of date now but by December, 10 pregnant women in the UK had died of covid; 9 were BAME. There are lots of complex reasons for this, some are physiological, some are social, some are environmental. But I would say that the biggest reason is racism.

Why are 80% of patients with Covid in hospital deficient in vit D?

It is a fact that Ethnic minorities based in northern hemisphere are deficient in vit D.

Vit D impacts a lot of physiological functions. Deficiency in it caused problems that seem unconnected.

Why is more not being done about it?

I agree that ethnic minority groups do suffer from impact of institutional racism. However with Covid I think that vit D us a big factor.

Also look at air pollution charts which show black over parts of n italy.
The pollution blocks out sunlight.
Pcos and thyroid do both have links to vit d.

Vit D deficiency also a factor in MS. MS isn’t common in sunny countries.

It also supports immune response.

The news said BAME people are more likely to have Vit D deficiencies and also have more ACE2 receptors in the lungs.