Are clinical outcomes from COVID-19 improving in ethnic minority groups?

Disproportionately worse COVID-19 clinical outcomes in people from ethnic minority groups have been a concern since early the pandemic.1Pareek M. Bangash M.N. Pareek N. et al.Ethnicity and COVID-19: an urgent public health research priority.Lancet. 2020; 395: 1421-1422Summary Full Text PDF PubMed Scopus (277) Google Scholar Now as time progresses, it may be useful to look back at evolving evidence base. We performed first systematic review on May 2020, where we found across several countries higher proportion of patients infected with SARS-CoV-2, admitted intensive care units dying hospitals due COVID-19. However, collected data was too poor quality allow meaningful synthesis.2Pan D. Sze S. Minhas J.S. al.The impact ethnicity review.eClinicalMedicine. 23100404Summary (336) Our findings were used for debate UK Parliament June resulting recommendation mandate comprehensive collection recording part routine hospital systems.3Covid-19 Black, Asian communities.https://commonslibrary.parliament.uk/research-briefings/cdp-2020-0074/Date accessed: April 21, 2023Google After some time, more studies started emerge. This allowed us conduct meta-analysis disentangle why suffering disproportionately pandemic. In our second review, published November that USA had increased risk SARS-CoV-2 infection compared those White ethnicity. differences hospitalization death rates this meta-analysis, when synthesised, less clear.4Sze Pan Nevill C.R. meta-analysis.eClinicalMedicine. 29100630PubMed Whilst many reported mortality rate among majority groups, generation estimates, most did not take into account number individuals community (see Fig. 1, Panel A). latest March 2023, now including over 200 million study participants globally, remained elevated nearly all studied, group each country.5Irizar P. Kapadia al.Ethnic inequalities infection, hospitalisation, admission, death: global participants.eClinicalMedicine. 2023; 57101977Summary (1) observed far smaller admission following although there these outcomes. Therefore, least initially, appeared main driver disproportionate B). work cited by World Health Organization's living guideline prevention control, emphasizing need healthcare workers equal access personal protective equipment.6World OrganizationInfection control context coronavirus disease (COVID-19): guideline, 7th 2022.https://apps.who.int/iris/handle/10665/352339Date Concrete identifying quantifying factors relating remains limited, developing severe once infected. immunologically naïve population, mathematical models proposed airborne pathogen is related frequency and/or duration exposure who emit high quantities virus poorly ventilated spaces.7Sze To G.N. Chao C.Y. Review comparison between Wells-Riley dose-response approaches assessment infectious respiratory diseases.Indoor Air. 2010; 20: 2-16Crossref (220) Infection therefore likely occur homes workplaces ventilation occupations involving public-facing roles such healthcare, even during mandated national lockdowns, which are common groups. The prevalence multi-generational occupancy within poorer ventilation, also predispose them infection. complicate matters, know past provides immune protection against 40 weeks regardless variants.8COVID-19 Forecasting TeamPast re-infection: meta-analysis.Lancet. 401: 833-842Summary While populations resulted history previous survived their existing immunity protects reduced susceptible C). could explain UK's Office National Statistics recent report, shows deaths comparable, cases lower than British majority.9Updating religious contrasts (COVID-19), England: 24 January 2020 23 2022.https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/articles/updatingethniccontrastsindeathsinvolvingthecoronaviruscovid19englandandwales/24january2020to23november2022Date Going forwards, must implement tangible interventions reduce likelihood still ongoing. will require policy-makers address longstanding led 2010, Marmot highlighted systemic racial set clear policy objectives this. Ten years later, peak pandemic, Inequalities housing affordability, declines education funding, increase zero-hour contracts report.10Health equity 10 on. Institute Equity, 2020https://www.health.org.uk/sites/default/files/upload/publications/2020/Health%20Equity%20in%20England_The%20Marmot%20Review%2010%20Years%20On_full%20report.pdfGoogle Over three years, one thing has become clear: inequality root cause pandemic unique opportunity rebuild, plan ahead communities Only reducing gap can preventable next DP, SS, PI MP conceived idea manuscript. DP wrote initial draft All authors reviewed manuscript approved final version prior submission. KK Chair Ethnicity Subgroup Government Scientific Advisory Group Emergencies (SAGE) member SAGE. SVK co-chair Scottish Expert Reference reports grants UKRI-MRC, NIHR, Sanofi Gilead outside current received consulting fees QIAGEN. supported NIHR doctoral fellowship (NIHR302338). SS Academic Clinical Lectureship. RFB advanced (NIHR302494). funded Development Skills Enhancement Award Leicester Biomedical Research Centre (BRC). LJG Care (NIHR) Applied Collaboration East Midlands (ARC EM) BRC. views expressed author(s) necessarily or Department Social Care. acknowledges funding Medical Council (MC_UU_00022/2) Chief Scientist (SPHSU17).