Investigating incidence, severity and risk factors for COVID-19 in BAME and Migrant groups to inform public health action.

The severity of illness from COVID-19 and risk of death appears to be increased in minority ethnic and migrant groups. Most of our information about COVID-19 is from people who are ill enough to have to go to hospital. This means we have an incomplete understanding of the infection and how we can tackle it in the community.

Our first study will solve this problem by including more minority ethnic and migrant communities in our existing study, Virus Watch, which is studying COVID-19 in the community. Each week we will ask 12,000 people to report any symptoms. We will test a subset any time they have symptoms, and we will perform antibody blood tests (to find evidence of ever having the infection) at the start and end of the study. We will be able to explore why COVID-19 affects BAME and migrant communities differently.

Our second study will use health records for nearly all non-EU migrants and refugees that arrived in the UK since 2015. We will use these data to examine how often these groups get diagnosed, hospitalised and die from COVID-19 and investigate whether their existing health conditions and socioeconomic circumstances affect their risk of COVID-19.

QUESTION: How can we understand and reduce the differential impact of COVID-19 on Black, Asian and Minority Ethnic (BAME) and migrant groups?

WP1: BAME INCLUSION BOOST TO VIRUS WATCH
Methods: 12,600 additional Black African, Black Caribbean, Indian, Bangladeshi, Pakistani and Polish across England and Wales- July 2020-June 2021. Baseline serology (n=3000) and survey, weekly symptom follow-up, PCR swabbing on day 2 of illness, monthly follow-up surveys, serology at end of study.

Outcomes: Seroprevalence, incidence, household transmission, symptom severity, mortality, mental health and economic impacts of pandemic and control measures.

Explanatory Factors: Ethnicity, migration, immunity, occupation, housing, socioeconomic, behaviour, healthcare usage (and barriers in access), contact patterns (including intergenerational contact), co-morbidities.

WP2: MILLION MIGRANT AND MINORITY ETHNIC COHORTS.

Data sources: Unique datasets including the majority of non-EU migrants and resettled refugees since 2015, characterised by migration and ethnicity (n=1.7 million migrants, 20,000 refugees, 2.0 million BAME).

Linkage: Previously validated probabilistic/deterministic algorithms to link to national COVID-19 laboratory data, hospitalisation, mortality data.

Outcomes: Differential SARS-CoV-2 infection, COVID-19 hospitalisations and deaths over first wave and winter 2020/21.

Explanatory Factors: Ethnicity, year of migration and immigration category, country of origin and birth, age, gender, language proficiency, comorbidities.

KEY REPORTS.
Dashboard-based real-time reporting of differential disease occurrence and contact patterns.
Autumn 2020: Differential impacts of the first wave and effect of easing lockdown.
Spring 2021: Differential impact of winter COVID-19 and other respiratory infections.

DISSEMINATION AND PARTNERS: PHE, NHS, Race Equality Foundation and Doctors of The World.