April 30, 2020

expert comments about BAME ethnicity and COVID-19

Journalists have asked for comments on any links between COVID-19 and BAME ethnicity.

Dr Dyan Sellayah, Lecturer in Cellular and Organismal Metabolism, University of Reading, said:

“Obesity and overweight – Americans of African ancestry are much more likely to be overweight, obese or indeed morbidly obese than Caucasians and what we know from the data so far is that obesity is a clear risk factor for severe disease.  This may be because as your infection progresses and the virus infects more and more cells, the demand for oxygen in the tissues is much higher for an obese individual than it is for a lean individual.  Eventually the obese body becomes overwhelmed by the lack of oxygen getting to the major organs.  But there may also be other factors – rather than simply a higher metabolic demand in obese individuals – that is responsible (discussed below).

“Obese people tend to have dysfunctional immune systems – their fat tissue for example becomes a reservoir for immune cells known as macrophages.  While these cells reside in our fat under normal circumstances, in obesity they are at higher frequency and become more troublesome (they start to secrete inflammatory cytokines) and negatively impact on immune and metabolic health.  It is likely that the immune response to the virus is therefore ineffective in obese individuals, which may explain why people from BAME backgrounds who have higher incidence of obesity are vulnerable to the virus.

“People from BAME backgrounds, particularly those of African and south Asian origin, are prone to diabetes and cardiovascular disease and we know the virus is particularly problematic in these individuals who have underlying conditions such as diabetes and heart disease.  Part of the increased risk of diabetes and heart disease in BAME individuals may partly be mediated by the obesity but there also appears to be a direct risk, irrespective of body weight status (some genetic mutations that predispose to heart disease have been shown to be more prevalent in African Americans than Caucasians).

“Socio-economic factors may have played a role – the demographic evidence is suggesting that ethnic minorities live in larger family units and potentially have professional and family lifestyles which make it harder to self-isolate or follow social distancing guidelines (e.g. dependent of public transport etc.).  But its still early days and nothing can be conclusively stated regarding the underlying basis.

“Why might people of African origin be more prone to obesity?  Evidence suggests that society-economic and genetic factors are responsible.  Africans and south Asians tend to have lower metabolic rates and are prone to obesity and there are several genes and mutations that may underly this observation.”

Prof Tim Cook, Honorary Professor in Anaesthesia, University of Bristol, said:

“The disproportionately high number of BAME health and social care workers dying from COVID-19 is striking, so I welcome news that NHS England has recommended these individuals to be identified as potentially at greater risk.  Our analysis¹ showed 63 per cent of healthcare workers who have died from coronavirus were BAME individuals.  More than half of those individuals were not born in the UK and more than four fifths were staff employed by the NHS.

“These figures highlight the need for much greater scrutiny and central collection, analysis and publication of data.  Work is underway but there is an urgent need to identify whether social or employment inequalities are affecting the rates of infection of these staff and causing avoidable deaths.”

¹ https://www.hsj.co.uk/exclusive-deaths-of-nhs-staff-from-covid-19-analysed/7027471.article

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