COVID-19 data shows triple the number of suspected cases and twice the risk for ethnic minorities

There were three times as many suspected COVID-19 cases presented to GPs during the peak of the pandemic than shown in official COVID-19 test results, according to research led by Queen Mary University of London.

The study, published in the British Journal of General Practice, also shows that black, Asian, and minority ethnic (BAME) groups were twice as likely to present with COVID-19, and this is not explained by other factors such as other health conditions, obesity and social deprivation.

Lead author Dr. Sally Hull from Queen Mary University of London said: "Our results suggest that COVID-19 prevalence during the peak of the epidemic was higher than previously thought. The official COVID-19 test statistics are likely to have underrepresented the extent of the epidemic, as many people with COVID-19 would not have been tested, including those with milder symptoms or those who could not access testing centers. Much of the COVID-19 epidemic is being managed in primary care which has had to adjust rapidly to online consultations. We need timely reporting of COVID-19 test results to practices, and diagnostic information from NHS 111, so that practices can provide continuing care to patients with more severe episodes. It's going to be very important how GPs record and manage cases in their community, as this can provide an early warning system if cases are rising again in an area and if we're about to see a second wave of infection."

Attention on COVID-19 initially focused on hospital presentations and intensive care, but little was known about the pattern of early presentations at GP surgeries. Community testing ceased in England on 12 March 2020, hence the extent of asymptomatic and milder symptomatic cases in community settings remains unknown.

The researchers studied anonymised data from the primary care records of approximately 1.2 million adults registered with 157 practices in four east London clinical commissioning groups (Newham, Tower Hamlets, City and Hackney, and Waltham Forest) during the peak of the London epidemic during March and April. Three of the four boroughs had death rates in the top five for London boroughs and 55 percent of the population are from ethnic minorities, hence the area is well placed to examine the over-representation of black and South Asian populations in suspected COVID-19.

The study found that:

• GPs recorded 8,985 suspected COVID-19 cases between 14 February and 30 April 2020—triple the number who tested positive at government test centers over that period.
• There was a two-fold increase in the odds of suspected COVID-19 for South Asian and black adults compared with white adults. This risk remains even after accounting for other factors, such as multiple health conditions, obesity and social deprivation, which are also strongly associated with increased risk of a suspected COVID-19 diagnosis.
• The odds of suspected COVID-19 increased with social deprivation, numbers of long-term conditions and BMI.
• There was a seven-fold increase in risk of suspected COVID-19 for those with dementia, which may reflect the excess risks to older people living in care homes.
• In contrast with other studies, the current study did not find an excess of male cases, but found that females had a slight increase in risk of suspected COVID-19, which suggest that the known higher risks for men emerge later in the disease trajectory.
• There was a sharp seasonal decline in upper and lower respiratory infections during the period that saw a rise in suspected COVID-19 cases, which may have been magnified by social distancing.