New Study Examines Why Minorities Are Disproportionately Affected By COVID-19
New Study Examines Why Minorities Are Disproportionately Affected By COVID-19
LONDON —Does genetics play a role in why COVID-19 has hit ethnic minorities disproportionately harder than whites?
A study now underway at Nottingham University Hospitals involving blood samples taken from 628 of its frontline health care workers is examining whether there is evidence that genes are involved. It's also investigating if lower levels of vitamin D among people of color may also contribute to a susceptibility to contracting the novel coronavirus (called SARS-Cov-2 by scientists).
In the United Kingdom, around a third of patients admitted into critical-care units are blacks, Asians and minority ethnic people (referred to as BAME populations in Britain), even though they make up just 13% of the total population. Another study found that between early February and the end of April, the COVID-19 death rate for blacks in England was 71% higher than for whites, and 62% higher for Asians.
Similar disparate outcomes have occurred in other countries, as well. In the United States, black Americans account for 30% of reported cases, but comprise just 14% of the total population. Moreover, a recent study found that black Americans have a mortality rate that's 2.4 times higher than the rate for whites, and 2.2 times higher than the rate for Latinos and Asians. Norway's relatively small Somalian population has an infection rate 10 times that of the rest of the country.
Scientists have largely pointed to socioeconomic (including inequality), cultural and environmental reasons for the disparity. For instance, low income-based diets can leave ethnic populations prone to ailments that put them at a higher risk to more severe reactions to the virus, including cardiovascular diseases, diabetes and obesity. Moreover, because minority populations are often poorer, many of their members live in neighborhoods that are crowded and cramped, rely more on public transport and often work in people-facing jobs – conditions and circumstances that provide fertile breeding grounds for the virus.
But Ana M. Valdes, an associate professor of musculoskeletal genetics at Nottingham, who is leading the study, says those reasons don't seem to entirely account for the higher infection rates among minorities.
She notes, for example, that "some of the people we had in our (Nottingham) hospitals who had the worst cases, really serious issues, were consultants and surgeons," so they're not low-income workers. Also, Valdes says, "exposure in the hospitals is really the same for Asians, blacks and whites. They are in the same wards. And at the same level of exposure, we see our Asian colleagues had a much higher prevalence of the symptomatic disease."
Valdes' study will assess DNA differences and antibody levels in blood samples taken from the 628 health care workers, who represent a variety of ethnic groups. She hopes to have the data back by July and a report written by August.
"It's not going to be the be-all and do-all, and we would need to do further studies. But at least it should point out if there really is a genetic contribution to it," Valdes says.
The investigation will also look at vitamin D levels among its subjects. Vitamin D plays a key role in bolstering the immune system, and the best source is sunlight. But dark-skinned people, particularly during the winter months, often have deficient levels because they absorb less of the sun's ultraviolet light, which produces vitamin D.
Research shows there can be disparities in immune systems between ethnic populations because different groups from different parts of the world had to genetically adapt to different pathogens.
Two 2016 studies, for instance, found that humans of European descent, probably because of DNA they acquired from breeding with Neanderthals and having to cope with different pathogens than their brethren in Africa, have immune systems that respond differently to infections than those of African descent. The studies also determined that people of African descent have more robust immune systems, but that also places them at more risk to autoimmune diseases such as lupus.
Skepticism of Ethnicity and Susceptibility
But some researchers are skeptical that genetics has a role in ethnic differences in susceptibility to the coronavirus.
Winston Morgan, a reader in toxicology and clinical biochemistry at the University of East London, writing in the Guardian last week, says that while genetic mutations that vary among some ethnic groups can play a part in immune response, the data compiled by the U.K.'s Office for National Statistics is muddled because it's mainly based on skin color as a loose definition of ethnicity. "There is no evidence that genes used to divide people into races (primarily genes for skin color) are linked to how our immune system responds to viral infections." The ONS data find that black males are more than 4.6 times more likely to die from COVID-19 than white males, that Pakistanis/Bangladeshis are slightly more than four times more likely to die, and Chinese and Indians are 2.5 times more likely to succumb. But Morgan points out that genome-wide association studies include all south Asians. "Yet, at least in the U.K., COVID-19 can apparently separate Indians and Pakistanis, suggesting genetics have little to do with it." Morgan argues that structural racism accounts for the higher infection rates among minorities. And Ewan Birney, director of the European Bioinformatics Institute told the Financial Times in May that it was "unlikely" that genetics made some ethnic groups more susceptible to the coronavirus than others, though it may play a role in how it affects individuals. The critics may be right, Valdes admits. "But the way to find out is to test it." If a genetic link is established, she says, those most at risk could be advised to change their diets to help bolster their immune response. It could also encourage pharmaceutical companies to look for small molecule drugs that would improve the immune response of affected patients. If the study finds that low levels of vitamin D among people of color places them at greater risk for infection, Valdes says, then the simplest remedy would be to encourage them to take a vitamin D supplement. In his Guardian article, Morgan indicates he's open to the possibility that vitamin D deficiency may place darker-skinned people at greater risk. But while vitamin D is essential to a healthy immune system, as yet there's no proof that a low level of it can make it harder for people to fend off COVID-19, he says. However, Morgan adds, "very little work on this has been done and the pandemic should prompt more research on the medical consequences of vitamin D deficiency generally."
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Winston Morgan, a reader in toxicology and clinical biochemistry at the University of East London, writing in the Guardian last week, says that while genetic mutations that vary among some ethnic groups can play a part in immune response, the data compiled by the U.K.'s Office for National Statistics is muddled because it's mainly based on skin color as a loose definition of ethnicity. "There is no evidence that genes used to divide people into races (primarily genes for skin color) are linked to how our immune system responds to viral infections." The ONS data find that black males are more than 4.6 times more likely to die from COVID-19 than white males, that Pakistanis/Bangladeshis are slightly more than four times more likely to die, and Chinese and Indians are 2.5 times more likely to succumb. But Morgan points out that genome-wide association studies include all south Asians. "Yet, at least in the U.K., COVID-19 can apparently separate Indians and Pakistanis, suggesting genetics have little to do with it." Morgan argues that structural racism accounts for the higher infection rates among minorities. And Ewan Birney, director of the European Bioinformatics Institute told the Financial Times in May that it was "unlikely" that genetics made some ethnic groups more susceptible to the coronavirus than others, though it may play a role in how it affects individuals. The critics may be right, Valdes admits. "But the way to find out is to test it." If a genetic link is established, she says, those most at risk could be advised to change their diets to help bolster their immune response. It could also encourage pharmaceutical companies to look for small molecule drugs that would improve the immune response of affected patients. If the study finds that low levels of vitamin D among people of color places them at greater risk for infection, Valdes says, then the simplest remedy would be to encourage them to take a vitamin D supplement. In his Guardian article, Morgan indicates he's open to the possibility that vitamin D deficiency may place darker-skinned people at greater risk. But while vitamin D is essential to a healthy immune system, as yet there's no proof that a low level of it can make it harder for people to fend off COVID-19, he says. However, Morgan adds, "very little work on this has been done and the pandemic should prompt more research on the medical consequences of vitamin D deficiency generally."
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