Study raises important questions about lockdown effects on BAME communities

New research by University of Leicester academics reveals lockdown measures imposed in late March, during the first wave of the COVID-19 pandemic, may not have been as effective in Black, Asian and Minority Ethnic (BAME) communities with data showing that cases in these groups continued to rise in the three weeks after the announcement was made.

Published in EClinicalMedicine by The Lancet, the research was conducted by a team led by Dr Manish Pareek, Associate Clinical Professor in Infectious Diseases at the University of Leicester, studying patients admitted to the University Hospitals of Leicester NHS Trust. The hospital provides secondary healthcare to a population of more than one million people in one of the most ethnically diverse regions of the UK.

Findings from the study revealed that the proportion of BAME individuals testing positive continued to rise for a period of three weeks from 23 March 2020 peaking at 50.9 per cent - by contrast, proportions of positive tests in people from white backgrounds remained consistent at between 24 to 26 per cent. The research also found that those living in larger households had an increased likelihood of infection.

Dr Manish Pareek said: “Our study has raised serious questions as to whether lockdown alone as an intervention is effective for a diverse population. As the pandemic has spread reports have emerged that COVID-19 results in disproportionately serious adverse outcomes, including intensive care admission and mortality, in individuals from BAME communities. This emerging data underpins an urgent need to confirm an association between ethnicity and acquiring COVID-19 infection, and to discuss the underlying mechanisms driving such an association – and how best to protect these communities.

“Understanding this is highly relevant to the design of effective health policies worldwide, as it would have a significant impact on the clinical assessment and management of suspected COVID-19 and allow for targeted public health interventions aimed at specific BAME groups in advance of future pandemic waves.”

Some of the factors attributed to the rise in cases within BAME groups after lockdown included an increased likelihood of working in public facing jobs that cannot be performed from home and being overrepresented in professions that require close contact with others, leading to higher occupational exposure to COVID-19. In addition, linguistic and cultural barriers may have played a role in preventing timely access to information.

The study also highlighted how lockdown measures may be less effective in controlling viral transmission amongst those living in larger households, because of the increased risk of residual cross-infection after these measures are employed. This raises the important question of whether lockdown alone as an intervention is effective for a heterogeneous population as seen in Leicester.

UK census data indicates that those of South Asian ethnicity are more likely to live in intergenerational households with a greater number of residents than those of white ethnicity. Previous studies have suggested increased population density aids transmission of viral respiratory tract infections, which may explain the association between estimated household size and testing positive for COVID-19 in the current study.