Ethnicity and clinical outcomes in COVID-19: A systematic review and meta-analysis [Scholarly Article - The Lancet, 12 November 2020]

Title:

Ethnicity and clinical outcomes in COVID-19: A systematic review and meta-analysis

Authors:

Shirley Sze, Daniel Pan, Clareece R. Nevill, Laura J. Gray, Christopher A. Martin, Joshua Nazareth, Jatinder S. Minhas, Pip Divall, Kamlesh Khunti, Keith R. Abrams, Laura B. Nellums & Manish Pareek

Published:

The Lancet, 12 November 2020

https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(20)30374-6/fulltext

Abstract:

Background 

Patients from ethnic minority groups are disproportionately affected by Coronavirus disease (COVID-19). We performed a systematic review and meta-analysis to explore the relationship between ethnicity and clinical outcomes in COVID-19. 

 

Methods 

Databases (MEDLINE, EMBASE, PROSPERO, Cochrane library and MedRxiv) were searched up to 31st August 2020, for studies reporting COVID-19 data disaggregated by ethnicity. Outcomes were: risk of infection; intensive therapy unit (ITU) admission and death. PROSPERO ID: 180654. 

 

Findings 

18,728,893 patients from 50 studies were included; 26 were peer-reviewed; 42 were from the United States of America and 8 from the United Kingdom. Individuals from Black and Asian ethnicities had a higher risk of COVID-19 infection compared to White individuals. This was consistent in both the main analysis (pooled adjusted RR for Black: 2.02, 95% CI 1.67–2.44; pooled adjusted RR for Asian: 1.50, 95% CI 1.24–1.83) and sensitivity analyses examining peer-reviewed studies only (pooled adjusted RR for Black: 1.85, 95%CI: 1.46–2.35; pooled adjusted RR for Asian: 1.51, 95% CI 1.22–1.88). Individuals of Asian ethnicity may also be at higher risk of ITU admission (pooled adjusted RR 1.97 95% CI 1.34–2.89) (but no studies had yet been peer-reviewed) and death (pooled adjusted RR/HR 1.22 [0.99–1.50]). 

 

Interpretation 

Individuals of Black and Asian ethnicity are at increased risk of COVID-19 infection compared to White individuals; Asians may be at higher risk of ITU admission and death. These findings are of critical public health importance in informing interventions to reduce morbidity and mortality amongst ethnic minority groups.

Medical Xpress, 26 May 2020 - Evidence shows cloth masks may help against COVID-19

Title:
Evidence shows cloth masks may help against COVID-19

Published:
Medical Xpress, 26 May 2020
https://medicalxpress.com/news/2020-05-evidence-masks-covid-.html

From the article:
"The evidence shows that cloth masks, particularly those with several layers of cotton cloth, block droplet and aerosol contamination of the environment, which may reduce transmission of COVID-19."

Scholarly Article (2020) - Applying principles of behaviour change to reduce SARS-CoV-2 transmission

Title:
Applying principles of behaviour change to reduce SARS-CoV-2 transmission

Authors:
Robert West, Susan Michie, G. James Rubin & Richard Amlôt 

Published:
Nature Human Behaviour, 2020

Available:
https://www.nature.com/articles/s41562-020-0887-9

Abstract:
Human behaviour is central to transmission of SARS-Cov-2, the virus that causes COVID-19, and changing behaviour is crucial to preventing transmission in the absence of pharmaceutical interventions. Isolation and social distancing measures, including edicts to stay at home, have been brought into place across the globe to reduce transmission of the virus, but at a huge cost to individuals and society. In addition to these measures, we urgently need effective interventions to increase adherence to behaviours that individuals in communities can enact to protect themselves and others: use of tissues to catch expelled droplets from coughs or sneezes, use of face masks as appropriate, hand-washing on all occasions when required, disinfecting objects and surfaces, physical distancing, and not touching one’s eyes, nose or mouth. There is an urgent need for direct evidence to inform development of such interventions, but it is possible to make a start by applying behavioural science methods and models.

Scholarly Article (Science, 1 May 2020) - Substantial undocumented infection facilitates the rapid dissemination of novel coronavirus (SARS-CoV-2)

Title:
Substantial undocumented infection facilitates the rapid dissemination of novel coronavirus (SARS-CoV-2)

Authors:
Ruiyun Li1, Sen Pei, Bin Chen, Yimeng Song, Tao Zhang, Wan Yang & Jeffrey Shaman

Published:
Science, 1 May 2020
https://science.sciencemag.org/content/368/6490/489

Abstract:
"Estimation of the prevalence and contagiousness of undocumented novel coronavirus [severe acute respiratory syndrome–coronavirus 2 (SARS-CoV-2)] infections is critical for understanding the overall prevalence and pandemic potential of this disease. Here, we use observations of reported infection within China, in conjunction with mobility data, a networked dynamic metapopulation model, and Bayesian inference, to infer critical epidemiological characteristics associated with SARS-CoV-2, including the fraction of undocumented infections and their contagiousness. We estimate that 86% of all infections were undocumented [95% credible interval (CI): 82–90%] before the 23 January 2020 travel restrictions. The transmission rate of undocumented infections per person was 55% the transmission rate of documented infections (95% CI: 46–62%), yet, because of their greater numbers, undocumented infections were the source of 79% of the documented cases. These findings explain the rapid geographic spread of SARS-CoV-2 and indicate that containment of this virus will be particularly challenging."

Scholarly Article (The Lancet, 27 April 2020) - Impact of contact tracing on SARS-CoV-2 transmission

Title:
Impact of contact tracing on SARS-CoV-2 transmission

Authors:
Kaiyuan Sun & Cécile Viboud

Published:
The Lancet, 27 April 2020
Availavable: https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30357-1/fulltext

From the scholarly article:
"As the far-reaching impacts of the coronavirus disease 2019 (COVID-19) pandemic expand to more and more countries, key questions about transmission dynamics and optimal intervention strategies remain unanswered. In particular, the age profile of susceptibility and infectivity, the frequency of super-spreading events, the amount of transmission in the household, and the contribution of asymptomatic individuals to transmission remain debated."

Scholarly Article (The New England Journal of Medicine, 24 April 2020) - Presymptomatic SARS-CoV-2 Infections and Transmission in a Skilled Nursing Facility

Title:
Presymptomatic SARS-CoV-2 Infections and Transmission in a Skilled Nursing Facility

Authors:
Melissa M. Arons, R.N., Kelly M. Hatfield, M.S.P.H., Sujan C. Reddy, M.D., Anne Kimball, M.D., Allison James, Ph.D., Jesica R. Jacobs, Ph.D., Joanne Taylor, Ph.D., Kevin Spicer, M.D., Ana C. Bardossy, M.D., Lisa P. Oakley, Ph.D., Sukarma Tanwar, M.Med., Jonathan W. Dyal, M.D., et al., for the Public Health–Seattle and King County and CDC COVID-19 Investigation Team

Published:
The New England Journal of Medicine, 24 April 2020
Available: https://www.nejm.org/doi/full/10.1056/NEJMoa2008457?query=recirc_curatedRelated_article

From the abstract:
"Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can spread rapidly within skilled nursing facilities. After identification of a case of Covid-19 in a skilled nursing facility, we assessed transmission and evaluated the adequacy of symptom-based screening to identify infections in residents."

Scholarly Article (The Lancet, 27 April 2020) - What policy makers need to know about COVID-19 protective immunity.

Title:
What policy makers need to know about COVID-19 protective immunity

Authors:
Daniel M. Altmann, Daniel C. Douek & Rosemary J. Boyton

Published:
The Lancet, 27 April 2020
Available: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30985-5/fulltext

From the article:
"About a third of the world is under lockdown as a public health measure to curb the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 (COVID-19). Policy makers are increasingly pressed to articulate their rationales and strategies for moving out of lockdown; the process of re-emergence is already cautiously starting in Austria, Switzerland, Denmark, Wuhan, and some US states. As the counterpoise between further disease spread and socioeconomic costs is debated, it is essential that policy makers in all affected countries have the best possible data and understanding to inform any course of action."