Fourteenth-century commentators writing on the black plague told stories of the homes of the wealthy open to anyone to plunder because the servants and their masters had died of the plague.
Death, it is said, since Roman times, is the great leveler.
Coronavirus – the closest to the 21st century has come to a plague that is sweeping the world – has not been a leveler, according to official data that is now available.
It has hit those hardest on the margins and those in disadvantaged communities the hardest.
He refutes Michael Gove’s claims after Prime Minister Boris Johnson and Health Secretary Matt Hancock fell ill with the virus that he “does not discriminate”.
Sky News analysis found that COVID-19[female[feminine hit people in the UK in five main categories harder than the others:
- People from disadvantaged areas
- People in low-paid or low-skilled jobs
- People with underlying health conditions
- Those from black communities and ethnic minorities
1. The poor
People who live in disadvantaged areas tend to have a shorter lifespan and are always hit harder by epidemics or seasonal illnesses.
However, the difference between the most disadvantaged and the least disadvantaged areas was particularly marked because of COVID-19.
Between March 1 and April 17, analysis shows that there were 55.1 coronavirus-related deaths per 100,000 in the most disadvantaged areas, compared to 25.3 per 100,000 in the least disadvantaged, more double the rate.
Experts like David Finch of the Health Foundation say the link to deprivation is not surprising.
He told Sky News, “There are two main ways people can be affected by COVID-19.
“It’s first and foremost because of the exposure and then how people cope if they have the virus.
“If you look at people living in more disadvantaged areas, they are much more likely to have an existing health problem.
“We would see this as a consequence of the daily conditions in which they live: it could be long working hours, variable working hours and the stress that can be caused by living in precarious housing.
“All of this will have an impact on your underlying health. ”
The National Statistics Office (ONS) deprivation indices examine a range of inequalities, including wealth levels, life expectancy, health, crime, employment and other “areas” that ‘it uses to classify areas from the most disadvantaged to the least disadvantaged. .
In general, the most deprived areas in the country – based on the proportion of the lowest 10% of sub-areas in each local authority – are places like Middlesbrough, Liverpool, Knowsley and Hull.
Among the disadvantaged areas that have been severely affected are: Newham, Lewisham, Haringey, Birmingham, Wolverhampton, Sandwell, Liverpool and Middlesbrough – many of the most disadvantaged.
Naveed Sattar, a professor of metabolic medicine at the University of Glasgow, says it is partly the virus itself.
He said: “In the past, most viruses like pneumonia, and others that infected people, did not have this effect on multi-organ systems.
“There’s something about this virus that affects more than the lungs – for example, about a third of deep vein thromboses, and others, even if they don’t get deep vein thrombosis … the blood thickens , which then affects the blood supply to your lungs, kidneys, heart and also potentially to the brain.
“So if you already have accelerated aging due to obesity, smoking, poor lifestyle or the accelerated age of your metabolism or your heart, if your organs are not as efficient at initially you are much more likely to succumb. “
2. Lower paid and less qualified professions
The ONS found that people in lower-skilled, lower-paying jobs are more likely to die from COVID-19 than those in better-paying jobs.
They are twice as likely to die from the virus as the average worker and four times more likely to die than men in the profession.
Security guards, taxi drivers and drivers, chefs, caregivers and bus drivers are the male professions with the highest mortality rates involving coronavirus.
Women working in care, recreation and services are twice as likely to die than those in related professional and technical occupations.
Experts say the degree to which people have been exposed – and significantly if they have used personal protective equipment (PPE) or other barriers if exposed – has become evident.
Professor Keith Neal, emeritus professor of epidemiology of infectious diseases at the University of Nottingham, told Sky News: “Transport workers, particularly taxi drivers, appear to be seriously affected. And you can probably see why – if you have different people in your cabin all the time.
“If black taxi drivers have been so badly affected, no one knows. In the black booth, you often have an upward partition, which should allow you to reduce the risk.
“The big surprise about the professions was not so much those that were included, but those that weren’t. Healthcare workers did not seem to be as affected as you might expect.
“It probably means what we have known for years – that the proper use of PPE … is very effective. PPE is not easy to use. “
The bus driver
Nadir Nur, 48, of Hackney, was the father of five children. He drove 394 from Islington to Homerton Hospital in east London every day. In late March, he contracted a coronavirus and died later. Her son Joseph says:
When we first found out that he wasn’t feeling well, we didn’t really think about it, because you don’t really think these things will affect you.
When it started to get worse, he was having trouble breathing, doing anything.
He went to the hospital, then to intensive care. When this was confirmed, it was then that we really started to fear the worst because he was mildly asthmatic.
He was put into a coma and about three or four days later, he developed a blood clot in his lungs and went into cardiac arrest. He died around 1 a.m. on April 2.
Before he got sick, he worried, but he was not the type of person who would hide anything. He had a job to do and he would do it.
He went to Homerton Hospital. It goes through Hoxton and Hackney then stops there.
This is probably one of the reasons – you pass the bus driver every time you get on the bus.
The government’s response was – I think everyone agrees that it is pretty poor – the protection it provided, the procedures that were in place.
If it was on the front of [politicians’] concerns, I think much more would have been done. Two people had to die for them to look at it and realize it.
He was a father. He was there for everyone in the family – holding us all together, always fixing things, helping all the family members who needed it.
He looked after all of us very well. He raised us into people I am proud to say I am. He was just an amazing person.
It was just the biggest shock because I thought he was the strongest person I know. Even when he was in the hospital, I said to myself “you are going to go there”, because it was him.
3. The elderly
It was clear from the start of the epidemic that older people were more likely to die.
Data from China indicates that most of the deaths have occurred in elderly people – indeed, much of the criticism of government management of nursing homes was due to the fact that it was well known in the beginning that the elderly should be protected.
The results from China and later from Italy were also confirmed in England and Wales.
In England and Wales overall, one in 1406 died and subsequently had a coronavirus listed on the death certificate during the epidemic (weeks 12-21).
But this increased considerably for the older groups.
Among those over 90, 1 in 59 died with COVID-19 during the eight weeks analyzed, compared to 1 in 198 of 75 to 90 years and 1 in 937 of 65 to 74 years.
Professor Neal says it is deaths in nursing homes that are responsible.
He said: “The infection rate among older people should be lower because they are not going to work, so they are less likely to get it, but when they do get it, it is much worse.
“He was distorted by the deaths in nursing homes. Very elderly people seem to be more likely to get it because they are in an institution.
“It is almost impossible to keep it away because nursing home workers – you are contagious before you experience symptoms – go to work, asymptomatic, and introduce the infection. And it has been all over Europe, not just a British problem. ”
However, since only those who tested positive or suspected of having had the virus and who died had a coronavirus recorded in their death certificates, a more accurate measure of the impact of the virus is excess mortality.
These are additional deaths over a given period greater than would have been expected under normal conditions.
Many of these additional deaths (other than those that would have been expected) were caused by COVID-19, but there are other surplus deaths, as yet unexplained, that also occurred during this period. Many of these events are likely to have occurred as a result of the crisis and the foreclosure – for example, people not seeking treatment or unable to obtain treatment for a life-threatening condition.
Birnham Roberts of the city of West Midlands in Smethwick had diabetes and had suffered a number of minor strokes. In March, he caught a coronavirus and died in hospital, where his daughter Cherelle believes he had the virus. Before being confusedly admitted, he was fit and active. Cherelle says:
He seemed a little confused – confusing his words and not making much sense when he spoke.
He had a history, so we brought him to the hospital hoping to have him checked to see if he had another stroke.
The next day, they thought he had some kind of chest infection. He was in a bay with many other people.
After two or three days, they said he had COVID.
They tried various antibiotics. Nothing seemed to work. And then you just watched it disappear.
I got a call early in the morning. By the time I got there, he was dead. It was March 18. It took nine days.
Normally he was in good shape. He was still driving and active. He would go to the gym, he would do tai chi… swim almost every day. He was very active in the church – a church director.
He has grandchildren and was also very active with them.
[Before] I don’t think there were many things [about coronavirus] at the time. I remember I planned to go see Cheltenham and they were thinking of canceling it, but that’s all I remember.
What could have helped would have been to disseminate more accessible information, because with the elderly, they are not really tech savvy, they are not really going to be on the Internet and discover things that way. So you probably need people to approach them. They are not going out and asking for advice. Someone should bring it to them.
It is certainly something he would have picked up during his hospital stay. I really regret having taken it.
He was someone who was always full of energy, always very caring for the community, always helping people.
He was in the 80s, but he was still going around and making sure that friends and church members were okay. He was always very concerned about his community.
4. Underlying health conditions
As with age data, a Chinese study identified early on that people with certain underlying health conditions were more likely to die from COVID-19.
In the same way that the British working in certain professions have been disproportionately affected by the epidemic, those who suffer from certain chronic diseases and illnesses have also died to a greater extent than the rest of the population.
90.4% of people who died with COVID-19 in England and Wales in March and April had at least one pre-existing condition, according to data from the ONS.
This figure includes deaths in nursing homes and the most common pre-existing condition was dementia and Alzheimer’s disease, which may be due to the fact that the virus is more severe in older population groups.
Meanwhile, an analysis of NHS England data, which includes only hospital deaths, shows that 95% of people who died in an English hospital until May 26 had a pre-existing medical condition.
While the elderly are more likely to suffer from underlying health problems, among the young, the proportion of deceased people who had a health problem was also high.
82% of people under 39 who died in English hospitals had a preexisting disease.
Professor Sattar said part of the problem may be related to obesity, since fat cells can produce immune proteins that can contribute to a potentially fatal hyperimmune response. But, making the problem worse may be that the underlying conditions make it harder for people’s bodies to cope if there is one.
He said: “Men, the poorest people, tend to be overweight and obese and have more health problems.
“Men, compared to women, tend to suffer from cardiovascular disease and diabetes at a younger age, which makes them more susceptible.
“There are groups … who, through accelerated aging of their cardiovascular and respiratory systems or their age, have less capacity to cope with the considerable stress that the immune response can cause on several organs of your body.
“Once you get an answer, the ability to cope with that response is diminished, in the sense that their ability – from their lungs, heart, blood vessels, metabolism – is diminished . ”
All of this adds up to a conclusion that will not surprise many – that COVID-19 was by far the largest cause of death during the period.
The Asian cardiologist
Ajit Kumar Agarwal, 68, from a village near Bury St Edmunds, worked in hospitals in East Anglia and the United Arab Emirates. Two days after his retirement, he fell down with a fever. He died just under three weeks later. His daughter Nitika Agarwal says:
My father had a career of 45 years.
He retired from full-time work on Monday March 23 and fell ill on Wednesday March 25 with a fever.
He was taken to hospital on April 1 and died two weeks later on April 15.
He had type 2 diabetes, but he was very well controlled by medication and he also had hypertension, which was controlled.
We thought it was very likely that he was a coronavirus when he went to the hospital because he had really had a fever for a week.
At the time, people were talking about how coughing was really the thing to watch out for – there was none, only a fever.
I don’t know what would have changed the result, but he was encouraged to stay at home long enough.
The virus clearly did a lot of damage during the week he was at home. He deteriorated fairly quickly after arriving at the hospital.
We think it is very likely that he took it when he saw patients.
He was very careful. Just before he retired, he actually worked in the UAE. He told us how he sanitized his keyboard and mouse and washed his hands.
Most likely he would have mentioned something – so we assume that he was not wearing PPE at this point.
It only later emerged that diabetes was an important risk factor.
I find it hard to believe that it would not have been recovered thanks to the Italian or Chinese experience that preceded ours. If this information had been available, I imagine that some doctors who present these risk factors could have rightly abstained from seeing patients and become more protective.
Dissemination of information has been an issue.
He was completely and totally dedicated to medicine, absolutely passionate about his work and had plans to bring cardiology to the community through GP practices – focusing on prevention at the primary care level.
He liked a good costume party. Romantic at heart, he was a passionate poet. He wrote on scraps of envelopes and scraps of paper, and he kept them all in one package. He has over 500 short verses, and little poems and speeches he has delivered to friends.
He was a real family member – happiest when he was with us. He has two grandchildren who are obviously completely devastated.
Unlike health issues and age, nothing in early Chinese studies identified ethnicity as a risk factor.
However, it has become clear that people of black and minority background (BAME) are much more at risk of dying from COVID-19 than whites.
It is under investigation but is already controversial – some commentators link it to the poorer conditions in which the BAME people live, due to systemic racism in society.
The ONS indicates that geographic and socio-economic factors (such as deprivation, household composition, disability, age, among others) explain more than half of the difference in risk between men and women d black and white origin.
However, these factors “do not explain all the difference, which suggests that other causes have yet to be identified,” adds the ONS analysis.
Experts say the causes, although still under investigation and awaiting further research, are complex.
Another study from Public Health England also concludes that death rates for the BAME groups are higher than for the white groups.
He found that after taking into account gender, age, deprivation and region, “people of Bangladeshi origin were about twice as likely to die compared to people of white British origin” .
He added: “People of Chinese, Indian, Pakistani, Asian, Caribbean and black descent had between 10% and 50% risk of death compared to white Britons.”
The PHE study indicates that “BAME communities are likely to be at increased risk of contracting infection” because they are more likely to live in urban areas, in overcrowded households, in disadvantaged areas and have jobs most at risk.
And it also indicates that they are also more likely to suffer from comorbidities such as cardiovascular disease or diabetes “which increase the risk of poorer results for COVID-19”.
Seif Shaheen, professor of respiratory epidemiology at Queen Mary University in London, told Sky News that he had just started a new study to try to examine some of the reasons that might not be spotted by the ONS.
He said: “The link is undisputed in the United Kingdom and the United States. There is a long list of possible explanations for this.
“The first is that in this country, South Asians and Afro-Caribbean people have more comorbidities, such as diabetes, heart disease and hypertension.
“Also higher levels of deprivation. They can live in poorer housing.
“And more specifically … if you take South Asians, in particular, they live in extended families, multigenerational families and therefore live in very overcrowded houses.
“It is a highly contagious infectious virus. If you are in a very crowded house, you are more likely to get it, and also more likely to get a larger dose of the virus, which may mean that you get the disease more severely.
“And being in the BAME community … they are more likely to have jobs for patients – in health care or social services – in publicly available jobs, such as working on public transport. As a result, they are more exposed … to infection because they come into more contact with people. ”
His comments are confirmed by other data from the ONS
The ONS found that the highest rate of death from COVID-19 was among those aged 20 to 64 in low-skilled elementary occupations and in care, recreation and other services.
Other ONS data show that black workers are one and a half times more likely than white workers to be in “basic” jobs – jobs like laborers, cleaners and parcel deliverers, and twice as much likely to be in care, leisure and other services.
Pakistanis and Bangladeshis, according to the ONS, are more than twice as likely to be in sales and customer service positions as whites and almost three times more likely to be factory operators and machine. These two areas had a much higher mortality rate than the COVID-19 average.
But Professor Shaheen said there could be other, less obvious, reasons why the people at BAME are so badly affected.
He said a colleague called Adrian Martineau had discovered through randomized trials that vitamin D deficiency could make people more susceptible to respiratory infections, of which COVID-19 is a type.
He added: “People with dark skin are more likely, especially in the UK and in a temperate climate, to be deficient in vitamin D.”
In addition, he continued, “Smoking is probably important. Some subgroups of the BAME community, men in Bangladesh in particular, smoke heavily.
“Right now there are a lot of things we don’t know. ”
Another expert said that much of the medical evidence ignores other factors.
Dr. Manish Pareek, associate clinical professor of infectious disease in the Department of Respiratory Sciences at the University of Leicester, works in a COVID-19 service but has also worked in the community with tuberculosis.
He and a group of colleagues examined the impact of culture and lifestyles on the spread of the coronavirus. He also considers that the size and profession of the household are important.
But, he added, “The other thing we don’t really know is, if you think about how the public health message has been defined by the government. It was largely driven by the five o ‘clock press briefings that Boris or others do. What we don’t know is whether people from different ethnic groups really listen to these public health messages.
“I work in Leicester. About 40% of us are foreign born. Government messages on public health, which are advertisements, Twitter, maybe Facebook and bus shelters… I’m not sure that is how they receive this information. .
“They are more likely to receive their information from relatives or friends via WhatsApp messages from abroad, from different news channels. They don’t necessarily look at Sky…
“All of these things mean … I don’t know how well the messages got through. “
What can or should be done?
The experts Sky spoke to believed that more work was needed to understand what had caused the fracture identified by the NSO. But, too, more needs to be done to address some of the causes that are already apparent.
Professor Pareek said: “There will probably be a second wave or certainly peaks in the coming months. Who knows when? And so, it is important that we try to tease this information now, when things are a little quieter.
“So we can spread these public health messages and be quite clear that we know that if you are of black ethnicity or, say, of Bangladeshi origin, your risk of dying and being infected is quite high , you have to do X, Y and Z.
“It is not only the ethnic minorities, it will also be the poor and those with underlying health problems. But these groups are slightly different, because if you had an underlying health problem, you were safe. I have not seen everything related to all this for the ethnic minority population.
“If you are a bus driver, in your late sixties, retired year-round or the next two years, and we know you have diabetes, etc., that may not make sense to me to see hundreds of people.
“If you look at the dead doctors, some of them probably shouldn’t have been on the front line.
“If we know that these groups are more at risk, how are we going to target these high-risk populations with vaccination programs?” We already know that in certain ethnic minority groups, vaccination coverage is lower. We need to think about it proactively. ”
Professor Shaheen agreed, “If you sort of go through the risk factor checklist, obviously, many of them cannot be changed. You cannot change your ethnicity. Vous ne pouvez pas changer les maladies que vous avez. Donc cela se résume probablement à un nombre limité de facteurs de risque modifiables liés au mode de vie.
« L’autre chose serait qu’il est important que ceux qui occupent des postes de contact avec le patient et le public soient suffisamment bien protégés, ce qui revient à l’ensemble du débat sur les EPI. Beaucoup dans ce type d’emplois – autres que ceux de première ligne, l’USI et ainsi de suite – estiment souvent qu’ils n’ont peut-être pas bénéficié d’une protection adéquate. ”
La Fondation pour la santé, quant à elle, pense que ce qu’il faut, c’est une réflexion plus large sur la façon dont les personnes issues des communautés défavorisées sont traitées.
David Finch a ajouté: « Dans une perspective à plus long terme, il y a certainement un cas où vous pourriez voir davantage une approche préventive dans le système de santé – essayer de garder les personnes en bonne santé en bonne santé, afin qu’elles n’aient pas besoin de dépendre du système de soins de santé .
« Il y avait une sorte d’incitation du gouvernement à adopter une approche préventive. C’est quelque chose qu’il est important de prioriser à l’avenir afin que nous puissions garder les gens en bonne santé et ne pas compter sur le NHS pour intervenir lorsque les gens tombent malades. “