Migrant status, ethnicity and COVID-19: more accurate European data are greatly needed

In the past months, systematically higher levels of severe COVID-19 illness and death among individuals belonging to migrant or ethnic minority groups have been reported in several countries, including USA, UK, Sweden, Brazil, Spain South Africa. particular, racialized populations tend less access testing, rates disease, mortality worse sequalae when they survive infection [1Holmes Jr., L. Enwere M. Williams J. Ogundele B. Chavan P. Piccoli T. et al.Black-White risk differentials (SARS-COV2) transmission, case fatality United States: translational epidemiologic perspective challenges.Int J Environ Res Public Health. 2020; 17 (PMID: 32560363; PMCID: PMC7345143): 4322https://doi.org/10.3390/ijerph17124322Crossref Scopus (120) Google Scholar, 2Hansson E. Albin Rasmussen Jakobsson K. Stora skillnader i överdödlighet våren 2020 utifrån födelseland [Large differences excess March-May by country birth Sweden].Lakartidningen. 117Google 3Baqui Bica I. Marra V. Ercole A. van der Schaar Ethnic regional variations hospital from Brazil: a cross-sectional observational study.Lancet Glob 8: e1018-e1026Abstract Full Text PDF PubMed (310) 4Jaqueti Aroca Molina Esteban L.M. García-Arata García-Martínez en pacientes españoles e inmigrantes un área sanitaria de Madrid.Rev Esp Quimioter. 33 ([COVID-19 Spanish immigrant patients sanitary district Madrid]): 289-291Crossref (11) 5Klugman K.P. Zewdu S. Mahon B.E. Dowell S.F. Srikantiah Laserson K.F. al.Younger ages at Covid-19 communities color.Gates Open Res. 4: 69Crossref (6) Scholar]. The interacting social, behavioural biological pathways underlying these disparities are doubtlessly complex, but hierarchy social advantage societies drives health status, exposure, housing, employment healthcare, undoubtedly plays dominant role [[6]Karlsen Nazroo Measuring analyzing "race", racism, racial discrimination.in: Oakes J.M. Kaufman J.S. Methods epidemiology. 2nd en. John Wiley Sons, San Francisco, CA2017: 43-68Google Yet, with notable exception European countries do not report statistics according status ethnicity (i.e. individuals' origin, nationality membership an group), faced complexity collecting using such information for public purposes [[7]Simon failure importation ethno-racial Europe: debates controversies.Ethn Racial Stud. 2017; 40: 2326-2332Crossref (32) To exemplify issues stake suggest way forward, we wish take France, which has substantial population is date hardest hit epidemic. immigrants make up 10% descendants 12% (https://www.insee.fr/fr/statistiques/4238373?sommaire=4238781#:~:text=En%202018%2C%207%2C5%20millions,le%20m%C3%AAme%20pays%20d?origine.), recent most frequently originating African (47%). Data show that, compared native population, persons who foreign-born had on average double all-cause between March April 2020, some were due COVID-19; however, that exact proportion known [[8]Papon Robert-Bobée Une hausse des décès deux fois plus importante pour les personnes nées à l'étranger que celles France mars-avril 2020. INSEE Focus, 2020https://www.insee.fr/fr/statistiques/4627049Google Specifically, while increased 22% native-born, it rose 54% born North Africa, 91% those Asia 114% sub-Saharan This trend also reflected geographic inequalities mortality, 118% increase preceding year Seine-Saint-Denis, Paris poorest where 30% immigrant, 96% itself [[9]Observatoire Régional Santé Ile FranceLa surmortalité durant l'épidémie dans départements franciliens.2020https://www.ors-idf.org/nos-travaux/publications/la-surmortalite-durant-lepidemie-de-covid-19-dans-les-departements-franciliens.htmlGoogle However, full extent migrants members rest can only be assessed if population-wide data morbidity healthcare collected status. stark reality available statistics, conjunction climate condemnation structural racism following George Floyd associated worldwide mobilizations, given rise renewed discussion about risks benefits “ethnic statistics”. Similar this area taking place other (http://www.oecd.org/officialdocuments/publicdisplaydocumentpdf/?cote=SDD/DOC(2018)9&docLanguage=En). regulations regarding protection as General Protection Regulation (GDPR) restrict collection research administrative making possible identify “racial origins” same level political opinions, labour union membership, sexual orientation genetic background, unless specific law adequate safeguards (https://ec.europa.eu/info/law/law-topic/data-protection/reform/rights-citizens/how-my-personal-data-protected/how-data-my-religious-beliefs-sexual-orientation-health-political-views-protected_en). Likewise, instance, individual's regularly national surveys, ascertain regard well domains, particularly regards BAME (Black, Asian, Minority Ethnic) (https://dataingovernment.blog.gov.uk/2019/06/27/how-were-helping-people-understand-ethnicity-data/). hand, deliberate choice made implement strict sense, regulatory authorities being directly called upon each time decision inclusion any migrant/ethnic background made. Indeed, survey employing sensitive (ethnicity birth, religion, orientation), special authorizations exceptionally delivered. These rules legacy interpretation Article 1 French Constitution, states prohibition distinction citizens bases race, origin meant protect misuse discrimination. there flaws above argument. First, obvious discrimination exist even absence reliable measure them. researchers Ombudsman's office repeatedly documented domains education, housing (https://www.defenseurdesdroits.fr/fr/etudes-et-recherches/2020/06/inegalites-dacces-aux-droits-et-discriminations-en-france). received little attention. Second, seems reasonable limit geographical, religious purposes, surveys makes impossible quantify disparities, barring possibility reducing sources lost opportunities [[10]Krieger N. Gonsalves G. Bassett M.T. Hanage W. Krumholz H.M. fierce urgency now: closing glaring gaps US surveillance COVID-19.Health Affairs Blog. 14, For demonstration HIV Africa was used inform design prevention strategies adapt screening treatment procedures, involving improve their effectiveness. type benefit led international institutions WHO ECDC provide recommendations ways problems (https://www.who.int/migrants/en/; https://www.ecdc.europa.eu/en/methods/specific-populations/migrant-and-ethnic-groups). Third, balanced pros cons assessing groups, taboo relative measurement geographical origins projects specifically designed address obtaining authorization collect participants' region prove impossible. elevated problems—particularly infectious diseases—among does carry risks, greatest likely stigmatization. Such stigmatization course deliberate, leads actual discrimination, consistent Union's Charter Fundamental Rights, prohibited law. Lack contextualization lead characterization behaviour instead visualizing detecting economic society systems fundamental drivers disparities. However misinterpreted, observed mistakenly attributed makeup There therefore need observe monitor accompany analysis thoughtful interpretation. One moving direction without doing wrong get involved pertains health. should components late capture upstream exposure mechanisms contributing vulnerability, include determinants disease. production immigration during epidemic first step towards broader necessity migrants—first, second, third generation—and majority population. More generally, Europe, further progress will necessarily require consideration clarification terms indicators (migrant ethnicity) help physicians professionals understand how interpret based action falling into ‘genetic trap’. may opportunity relevance analysing move forward politically socially acceptable surveillance.