Background Black, Asian and minority ethnic (BAME) populations are emerging as a vulnerable group in the severe acute respiratory syndrome coronavirus disease (SARS-CoV-2) pandemic. We investigated the relationship between ethnicity and health outcomes in SARS-CoV-2. Methods and findings We conducted a retrospective, observational analysis of SARS-CoV-2 patients across two London teaching hospitals during March 1 –April 30, 2020. Routinely collected clinical data were extracted and analysed for 645 patients who met the study inclusion criteria. Within this hospitalised cohort, the BAME population were younger relative to the white population (61.70 years, 95% CI 59.70–63.73 versus 69.3 years, 95% CI 67.17–71.43, p<0.001). When adjusted for age, sex and comorbidity, ethnicity was not a predictor for ICU admission. The mean age at death was lower in the BAME population compared to the white population (71.44 years, 95% CI 69.90–72.90 versus, 77.40 years, 95% CI 76.1–78.70 respectively, p<0.001). When adjusted for age, sex and comorbidities, Asian patients had higher odds of death (OR 1.99: 95% CI 1.22–3.25, p<0.006). Conclusions BAME patients were more likely to be admitted younger, and to die at a younger age with SARS-CoV-2. Within the BAME cohort, Asian patients were more likely to die but despite this, there was no difference in rates of admission to ICU. The reasons for these disparities are not fully understood and need to be addressed. Investigating ethnicity as a clinical risk factor remains a high public health priority. Studies that consider ethnicity as part of the wider socio-cultural determinant of health are urgently needed.
Editor - The article by Samuriwo et al1 explores an important issue in medical education: How do we reduce the influence of gender on the system through which medical students develop into clinicians? As fifth-year students, we were encouraged to see that this issue is being discussed. However, in our opinion, Samuriwo et al1 treat gender bias as a simple, inevitable problem and fail to suggest appropriate action. First, Samuriwo et al1 reduce the problem into binary categories, only briefly acknowledging the existence of transgender or gender-fluid individuals. The fight against gender bias is hindered by these outdated definitions and ideas. We also believe that exclusion of the gender-fluid definitions from academic conversations has a trickle-down effect on medical education, such that issues regarding transgender patients are often missing from our curricula, even in genitourinary medicine and sexual health where this is vitally important.2 The most alarming aspect of the conversation around gender-based discrimination in clinical education is that there is no mention of accountability. Samuriwo et al1 discuss the degree of confidence felt by students in regard to challenging or reporting discriminatory behaviour. However, there is no discussion regarding the specific process of reporting discrimination, nor any mention of the duty of the medical school in such a situation. It is well established that gender discrimination can pose a significant problem for medical students’ learning, career progression and emotional well-being.3 Though doctors, nurses and other health care professionals have a duty to maintain a discrimination-free work environment, this duty at the workplace-level is too often used to overshadow the higher-level duty of the medical school to monitor and support its students' well-being. Students are often told to report any experience of discrimination to their medical school, but rates of reporting are low, which is often attributed to perceptions of ineffectiveness.4 If we want to eliminate gender bias in medical education, we need medical schools to commit to greater action. We should promote a top-down approach, involving regular reviews of gender-specific issues within each medical school along with a robust, centralised system for reporting issues to the medical school. The medical schools in the United Kingdom need to use inclusive definitions of gender and when issues do arise, they must take greater accountability over student well-being. It is time to stop talking about this issue and start dealing with it.
Background: We investigated the prevalence of anosmia and ageusia in adult patients with a laboratory confirmed diagnosis of severe acute respiratory distress syndrome coronavirus-2 (SARS-CoV-2).Methods: A retrospective observational analysis was conducted amongst patients and their household contacts across a central London population diagnosed with SARS-CoV-2 and admitted to hospital or managed in the community during March 1 - April 1, 2020. Symptomatology and duration were extracted from routinely collected clinical data. Descriptive statistics were used.Findings: Of 386 patients with a laboratory diagnosis of SARS-CoV-2, 141 (92 community patients, 49 discharged inpatients) had evaluable data and were included for analysis. 77/141 (55%) reported anosmia and ageusia; nine reported only ageusia and three only anosmia. The mean duration of symptoms (as defined by the Public Health England case definition for SARS-CoV-2) was 13·1 days (0-33). The mean onset of anosmia in relation to onset of SARS-CoV-2 symptoms was 4·6 days (0-21). Duration of anosmia was 12·3 days (0-30). Duration of SARS-CoV-2 symptoms in community patients was 11·5 days (0-28) versus 16·7 days (0-33) in admitted patients. As of April 1, 45 patients had ongoing SARS-CoV-2 symptoms and/or anosmia. 107/141 (76%) patients had one or more household contacts during their isolation period. Of these, 185 non-tested household contacts, 79 (43%) had SARS-CoV-2 symptoms with 46/79 (58%) reporting anosmia. Six household contacts had anosmia only.Interpretation: More than half of SARS-CoV-2 positive patients reported anosmia and ageusia. These findings suggest anosmia and ageusia should be added to case definitions for SARS-CoV2 and guide self-isolation protocols. This adaptation may be integral to case finding in the absence of population level testing. Until a time where we have successful population level vaccination coverage, these steps remain essential both in this pandemic and subsequent waves.Funding No specific funding was obtained for this work.Funding Statement: This research did not receive any grant from funding agencies in the public or commercial sectors.Declaration of Interests: EC has received speaker fees from bioMerieux (2019). NM has received speaker fees from Beyer (2016) and Pfizer (2019) and received educational support from Eumedica (2016) and Baxter (2017). LSPM has consulted for bioMerieux (2013), DNAelectronics (2015-18), Dairy Crest (2017–2018), Umovis Lab (2020), received speaker fees from Profile Pharma (2018- 2019) and Pfizer (2018-2020), received research grants from the National Institute for Health Research (2013-2020), CW+ Charity (2018-2019), and Leo Pharma (2016), and received educational support from Eumedica (2016–2018). AP, DLA, AA none to declare.Ethics Approval Statement: Data was collected as part of routine care by the responsible clinical team. No patient identifiable data is reported in this analysis. The need for written informed consent was waived by the Research Governance Office of Chelsea & Westminster NHS Foundation Trust.
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