The Government’s long-awaited Covid-19 risk algorithm has identified a black, Asian and minority ethnic (BAME) background as one of the top risk factors, alongside being male and aged over 70.
In June, a new risk prediction model was commissioned by the chief medical officer so GPs could assess risk of serious illness or death from Covid-19 based on factors such as age, sex, ethnicity, deprivation, smoking status, body mass index, pre-existing medical conditions and current medications.
Today, a paper published in the BMJ said the risk algorithm ‘performed well’ in development. However, it remains unclear when a risk calculator will be embedded in GP systems as promised and what action GPs will have to take as a result.
The Department of Health and Social Care (DHSC) previously said the tool would inform GPs’ work to update the shielding list, with a view for it to be finalised by September.
However, despite the publication of the paper, a DHSC spokesperson told Pulse that the algorithm is not yet a risk tool but is just research at this stage.
The study findings are based on data from more than 8 million patients aged between 19 and 100 years at 1,205 GP practices in England, linked to Covid-19 test results and hospital and death registry data.
Those in the top 5% for ‘predicted risk of death’ accounted for 76% of Covid deaths within the 97-day study period, while those in the top 20% for predicted risk of death accounted for 94% of Covid deaths, the paper said.
The algorithm also backed up previous research that those who are male, from a BAME background, over 70 and with certain health conditions such as diabetes were most at risk of death from coronavirus.
The paper said: ‘Of those who died, 2517 (57.4%) were male, 732 (16.7%) were BAME, 3616 (82.5%) were aged 70 and over, 1417 (32.3%) had type 2 diabetes, 1311 (29.9%) had dementia, and 1033 (23.6%) were identified as living in a care home.’
The algorithm is designed for use by clinicians with patients across the UK’s adult population to inform ‘shared decision-making’, the paper said, adding that it ‘may have relevance for shielding or other policies that seek to mitigate risk of viral exposure’.
Other applications could include ‘supporting targeted recruitment for clinical trials, prioritisation for vaccination and discussions between patients and clinicians on workplace or health risk mitigation’, it added.
The researchers said the ‘absolute risks’ should be ‘interpreted with caution’ as they will change over time and the impact of shielding measures taken during the study period could lead to the ‘underestimation’ of some risk factors.
However, they added that the model has the potential to be ‘dynamically updated as the pandemic evolves’.
They concluded: ‘This study presents robust risk prediction models that could be used to stratify risk in populations for public health purposes in the event of a “second wave” of the pandemic and support shared management of risk.’
Commenting on the algorithm, deputy chief medical officer for England Dr Jenny Harries said the Government is ‘working at pace’ and will engage with the NHS, patients and the voluntary sector on ‘how we use this knowledge to ensure we continue protecting and supporting the most clinically vulnerable’.
She added: ‘Continuing to improve our understanding of the virus and how it affects different members of the population is vital as prevalence continues to rise.
‘This is why we commissioned and funded this research, and I’m pleased it is providing useful evidence to help us move towards a more nuanced understanding of Covid-19 risk.’
Earlier this week, experts criticised the delay to the risk algorithm amid ‘unclear’ guidance from the Government.
The Government last week issued updated guidance for clinically extremely vulnerable patients advising them to take precautions depending on what ‘tier’ their local area is in. But to date no local area has advised patients to resume shielding, including in the ‘very high risk’ tier 3 lockdown areas.
Experts previously warned that patients with diabetes, hypertension and cardiovascular disease should be added to the list of patients who may be asked to shield during a second Covid-19 spike.
The current list of clinically extremely vulnerable patients is the same as during lockdown and includes patients with severe respiratory disease and those receiving treatment for cancer.
READERS' COMMENTS [5]
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I wonder if anyone has done a study, or developed an algorithm, to look at risk factors from flu. None of the identified factors included come as any surprise to me. The two questions that remain unanswered are (1) is the BAME risk related to the anomaly on Chromosome 3 that has already been identified in cytokine storm syndromes from other precipitants and (2) has the role of leptin been assessed to explain the excess risk of obesity and diabetes (leptin being a pro-inflammatory hormone produced by fat cells, and therefore in excess in the obese.
That aside, I have been suggesting special shielding for BAME staff in hospital since May based on the observation in point 1.
It is egregious and staggering how discriminatory Covid 19 has turned out to be . The aged ones and minority ethnic groups( at least in this country) are disproportionately jeopardised. My philosophical question behind this ‘nature call’ is , ‘what is the meaning to humanity after all ?’
(1)As I wrote before , cruelty lies where all the phenomena were somehow converging to a natural selection for survival . The lockdowns have shielded away the vulnerable ones but at the same time, increased human reproduction.
My female partner just confirmed this morning my suspicion that both wanted and unwanted pregnancies (and hence , termination of pregnancies ) were substantially increased in the last seven months . I am more than interested to see some solid figures .
So , are we seeing a phenomenon of virtual metabolism of dilapidated entities replaced by fledgling ones ?
To me , Covid 19 is simply an insult challenging our modern civilisation and values (liberty , equally but also legislation and social contract) . Bottom line is , we should try our best to protect people physically , emotionally, economically and socially . Yes , easy said than done but the objectives should never be doubted .
(2)It was painful to watch how the Greater Manchester mayor had a go against Westminster yesterday . While he undoubtedly had politicised the issue of tier 3 local restrictions, I cannot find myself totally disagreeing to what he said . Perhaps , he should have this press conference a week earlier when at least , the number of hospitalised Covid patients (hence , ITU as well ) was less.
As a LFC fan , I am always thankful for what he(an Evertonian) did for the Hillsborough inquiry and could be biased judging him this time round.
(3)Reality is , when we came out of the first wave , the government did not seem to have a clear vision about this current second one . The prime minister (needless to mention the health secretary and Mr Stevens) was constantly conflicting against SAGE as far as policies to prevent another big upsurge of Covid cases( as we are seeing now) are concerned . I think nobody expected we would have zero case in any day but the current circumstances are rendering another total lockdown almost inevitable, especially if this three tier system fails to come to fruition . Then Andy Burnham’s argument of virtually grinding down those financially and socially disadvantaged will become logical and realistic …….
I’m not an epidemiologist but looking how huge Sickle Cell Disease is a factor, one wonders urgently if Thalassaemia and sickle cell traits could be a possible explanation- and therefore possible treatable problem, in BAME patients. The data won’t be there and would need to be found.
Interesting report in BBC News this morning looking into possible reasons behind higher incidence and mortality in BAME , attributed to a more socioeconomic model ;
https://www.bbc.co.uk/news/health-54634721
Four main points on the characteristics of these BAME patients :
(1)Where people live – with a higher risk in urban areas with greater population density
(2)Occupational exposure – for example data shows Black people are more likely to work in healthcare than other groups
(3)Household composition, with larger households at greater risk
(4)Pre-existing health conditions – such as obesity, which can make it harder to recover from the virus.
(Quoted from the article)
BAME get a tricky deal in healthcare. It’s a multifactorial fact. But, I think this ‘BAME’ polarisation is akin to what Trump did. The Government do not want to worry and panic the majority. So they focussed on the minority and scared them excessively. Has anyone considered what it might feel like to be BAME and the anxiety of all these media headlines, of basically “you’re going to get it and no one else will”. That lead to the youngsters partying, a clear indifference to masks early on by the unperturbed and blockage of true stories of how diverse mortality is.