Tag: BAME

How is your COVID-19 prehabilitation going?

We are close to 4 months into the SARS-CoV-2 pandemic and two months since my blog post and my MS-Selfie microsite entry explaining how to prepare yourself for COVID-19. Are you ready? 

Despite being redeployed to general medicine during which time I was exposed to COVID-19 patients I didn’t get infected with the virus. I am anti-SARS-CoV-2 antibody negative. However, I spent the last 3 months prehabilitating myself to get myself ready in case I get COVID-19. I am a strong believer in walking-the-talk and setting an example for my patients; you can’t tell your patients to do something for their general health if you are not prepared to do it yourself. 

1. I have put in place an advanced directive with my wife and we are in the process of redoing our wills. I have also decided not to cancel my life insurance policy, which I was meant to do in April.  
2. I have purchased a pulse oximeter for home monitoring of my oxygen saturation so that if I did get COVID-19 and had to self-manage and self-monitor at home I could do it with confidence.
3. I have purchased a battery pack for my mobile phone if I need to be admitted to hospital and have a spare mobile phone charger at hand in case my main charger malfunctions or goes missing. I also have a back-up old mobile phone for the same reason.
4. As for comorbidities; I have managed to get my BMI below 24, which is the first time in about 10 years that I have done this. 
5. I have flattened the area under my insulin curve by being on a low carbohydrate diet. My last fasting blood glucose was 2.7mmol/L. I intermittent fast at least twice a week. I am keto-adapted and feel more alert as a result. 
6. I am now normotensive with a resting blood pressure of around 116/ 78mmHg.
7. I exercise 4-5 times a week and even ran a half-marathon last weekend albeit a South London meander. The latter was in response to a challenge from a good friend of mine who did the same in Orlando, Florida.  He now wants me to run a marathon with him on the original course from Marathon to Athens as a treat to ourselves once we survive and get out the other side of the pandemic.
8. I am not sleep-deprived; I am getting 6-7 hours a sleep a night which beats the 4-5 hours I used to sleep. 
9. I am vitamin D, zinc and magnesium replete from taking supplements.
10. I have a natural suntan from spending between 6-8 hours a week outdoors; running, working in the garden, walking our dog who sadly passed away a few weeks ago, or sipping a G&T before sundown.
11. I do breathing exercises (stacking) once or twice a day in my office.
12. I am less anxious than before. Why?
    • I have stopped watching the news in the evening
    • I don’t read a daily newspaper 
    • I only read specific articles from newspapers I subscribe to (selective reading)
    • I restrict my consumption of social media feeds to specific times of the day
    • I am spending a lot of time in the garden
    • I am listening to more music than I used to, which is very relaxing. I have recently discovered Melody Gardot and American jazz singer who is my current favourite and I have fallen back in love with Bob Marley.
13. I am practising social distancing and adopting the personal hygiene recommendations of the government.

I am as ready as I will ever be to get COVID-19. I think I have given myself the best chance of (1) having mild disease, (2) staying out of the hospital, (3) and in the event of getting severe COVID-19 of surviving. In the unlikely event of dying from COVID-19, I have made some preparations to provide for my family and to make it easier for them. I also have personal ambitions for what I plan to do when we get over the pandemic.

It is clear that there are some risk factors that you cannot modify in a three month period when it comes to getting severe COVID-19 and potentially dying from it. The study below from colleagues in my hospital show just how the BAME (Black, Asian and Minority Ethnic) community in East London are bearing the brunt of this pandemic. I suspect it is not because they are BAME but is due to social determinants of health, which will require a new political order and will to address over the next few decades. Sadly I am not convinced the current British government and leadership are up to the task.

Apea et al. Ethnicity and outcomes in patients hospitalised with COVID-19 infection in East London: an observational cohort study. MedRxIV doi: https://doi.org/10.1101/2020.06.10.20127621

Background: Preliminary studies suggest that people from Black, Asian and Minority Ethnic (BAME) backgrounds experience higher mortality from COVID-19 but the underlying reasons remain unclear. 

Methods: Prospective analysis of registry data describing patients admitted to five acute NHS Hospitals in east London, UK for COVID-19. Emergency hospital admissions with confirmed SARS-CoV-2 aged 16 years or over were included. Data, including ethnicity, social deprivation, frailty, patient care and detailed risk factors for mortality, were extracted from hospital electronic records. Multivariable survival analysis was used to assess associations between ethnic group and mortality accounting for the effects of age, sex and various other risk factors. Results are presented as hazard ratios (HR) or odds ratios (OR) with 95% confidence intervals. 

Findings: 1996 adult patients were admitted between 1st March and 13th May 2020. After excluding 259 patients with missing ethnicity data, 1737 were included in our analysis of whom 511 had died by day 30 (29%). 538 (31%) were from Asian, 340 (20%) Black and 707 (40%) white backgrounds. Compared to white patients, those from BAME backgrounds were younger, with differing co-morbidity profiles and less frailty. Asian and black patients were more likely to be admitted to intensive care and to receive invasive ventilation (OR 1.54, [1.06-2.23]; p=0.023 and 1.80 [1.20-2.71]; p=0.005, respectively). After adjustment for age and sex, patients from Asian (HR 1.49 [1.19-1.86]; p<0.001) and black (HR 1.30 [1.02-1.65]; p=0.036) backgrounds were more likely to die. These findings persisted across a range of risk-factor adjusted analyses. 

Interpretation: Patients from Asian and Black backgrounds are more likely to die from COVID-19 infection despite controlling for all previously identified confounders. Higher rates of invasive ventilation in intensive care indicate greater acute disease severity. Our analyses suggest that patients of Asian and Black backgrounds suffered disproportionate rates of premature death from COVID-19.

CoI: none