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Them there genes

Baroness Lawrence’s report downplays the importance of genetic factors that predispose BAME communities to Covid-19 vulnerability

Baroness Doreen Lawrence has published a Labour Party report into the impact of Covid-19 on BAME groups, An Avoidable Crisis, and concluded that “structural racism” is mainly to blame. This is hardly a surprise, since London’s mayor Sadiq Khan, some BAME MPs, and several commentators were blaming structural racism as soon as the correlation between ethnicity and Covid-19 fatalities first emerged. “If coronavirus doesn’t discriminate,” asked super-woke Guardian columnist Afua Hirsch, “how come black people are bearing the brunt?”

The term “structural racism” is not far from the term “institutional racism”, which first emerged in this country in the 1999 MacPherson report into the murder of Baroness Lawrence’s son Stephen, so she already has quite a lot invested in the concept. The current crisis “has been generations in the making,” she writes in her foreword to the report. BAME people have been:

Overexposed, under protected, stigmatised and overlooked … The impact of Covid-19 is not random, but foreseeable and inevitable – the consequence of decades of structural injustice, inequality and discrimination that blights our society. We are in the middle of an avoidable crisis. And this report is a rallying cry to break that clear and tragic pattern.

BAME people living in the UK have fewer opportunities to absorb sunlight

But has the Lawrence Report given sufficient weight to other factors that might help explain the sinister correlation between BAME people and Covid-19? Back in April, I wrote an article in which I challenged the assumption that social and economic factors were necessarily the prime cause of excess BAME deaths from Covid-19. Indeed, I was the first commentator to do so. Instead, I argued, that just as likely to be a significant causal factor in so many BAME deaths from Covid-19 was the prevalence of obesity and type 2 diabetes among Black Caribbeans, Pakistanis, and Bangladeshis, since these ethnic groups are particularly susceptible to these underlying conditions, while Black Africans are particularly susceptible to strokes.

According to the National Obesity Observatory’s January 2011 study, Obesity and ethnicity:

Women of Pakistani ethnicity are over five times more likely, and those of Bangladeshi or Black Caribbean ethnicity over three times more likely, than women in the general population to be diagnosed with diabetes. Bangladeshi men are almost four times more likely, and Pakistani and Indian men almost three times more likely, to have doctor-diagnosed diabetes compared to men in the general population.

The US Centres for Disease Control and Prevention includes sickle cell disease along with severe obesity, type 2 diabetes, and smoking, among those medical conditions which put patients at increased risk of Covid-19 mortality. Sickle cell disease is more common among persons of African descent, as well as persons of Middle Eastern, Asian, Indian, and Mediterranean descent. The UK’s National Institute for Health and Care Excellence reckons that “there are between 12,500 and 15,000 people with sickle cell disease in the UK” and that “the prevalence of the disease is increasing because of immigration into the UK and new births”.

Then there is the question of vitamin D deficiency among BAME people. Black and brown people are less able to absorb vitamin D through their skins than white ethnic groups. One scientific study found that the prevalence of vitamin D deficiency and type 2 diabetes is disproportionately elevated in African Americans compared to other ethnic groups in the United States and that insulin secretion and insulin sensitivity are reduced when vitamin D levels are deficient. Obesity, hyperglycaemia, cardiovascular disease, and minority race are common among people with type 2 diabetes and vitamin D deficiency.

These phenomena are known precursors to the development of type 2 diabetes and exacerbate the risk for complications where diabetes exists. Poverty, urban living settings, and lactose intolerance are also common among African Americans. These conditions promote opportunities for vitamin D deficiency to manifest and attenuate opportunities for participation in health-promoting behaviours by those affected.

There are various genetic factors that predispose BAME people to Covid-19 vulnerability

In July, the journal Clinical Medicine published an article entitled “Does vitamin D deficiency increase the severity of Covid-19?” by professors E. Kenneth Weir, Thenappan Thenappan, Maneesh Bhargava, and Yingjie Chen. The authors found that the severity of Covid-19 is determined by the presence of pneumonia, severe acute respiratory distress syndrome, myocarditis, microvascular thrombosis, and/or cytokine storms, all of which involve underlying inflammation. Low vitamin D levels have been associated with all the above conditions as well as thrombotic episodes, obesity, and diabetes, all of which carry a higher mortality rate among Covid-19 patients. The professors concluded that vitamin D supplements would help reduce the impact of the pandemic.

By the end of April 335 British Jews had died of the virus, which is more than five times their proportion in the population. Might a common factor here be reduced exposure to sunlight? We know that Covid-19 has wreaked havoc in Jewish communities in both the UK and the US. Orthodox Jews rarely allow their skin to be exposed to sunlight, thus accounting for their extreme skin pallor. BAME people living in the UK have fewer opportunities to absorb sunlight over here than in the countries of their ethnic origin.

Even David Lammy MP, the black Labour MP for Tottenham, was getting worked up about the relationship between vitamin D and Covid-19 at one stage. “Pleased the Government has ordered a review of into vitamin D and its effects on survival rates of patients with Coronavirus,” he tweeted on 18 June. “They need to hurry – BAME communities are confused about whether to take supplements and if so, how much. This could save lives!” It will be interesting to see how Lammy reacts to the Lawrence report.

Only last month, evidence of another genetic factor in Covid-19 emerged. In an article for Nature published on 30 September, scientists Hugo Zeberg and Svante Pääbo, argued that the major genetic risk factor for severe Covid-19 is inherited from Neanderthals. Some 60,000 years later, around 50 per cent of people in South Asia and 16 per cent of people in Europe carry this length of DNA that makes them vulnerable to death from Covid-19.

“I almost fell off my chair because the segment of DNA was exactly the same as in the Neanderthal genome,” explained Hugo Zeberg, an assistant professor at the Karolinska Institute in Stockholm, when interviewed by the Guardian. According to their study, the gene variants on chromosome three are most commonly found in Bangladesh, where 63 per cent of the population carry at least one copy of the DNA sequence. “The genes in this region may well have protected the Neanderthals against some other infectious diseases that are not around today,” said Pääbo. “And now, when we are faced with the novel coronavirus, these Neanderthal genes have these tragic consequences.”

Dr Raghib Ali, a senior clinical research associate at the MRC Epidemiology Unit at the University of Cambridge, has expressed scepticism about straightforward claims that structural racism is to blame for the disproportionate impact of Covid-19 on BAME people:

If structural racism was an important problem, not saying it doesn’t exist, but if it was an important problem in healthcare outcomes, you’d expect it to be reflected not just in Covid-19 but with other outcomes as well. But the truth, as we know from data, particularly from Scotland but also from England, is that most of ethnic minority groups actually have better overall health and lower rates of all-cause mortality than white groups.

For Dr Chris Udenze, a GP with a special interest in multiple deprivation, “ethnicity is still a relevant factor and not paying attention to this will not help communities vulnerable to Covid-19. Similarly, structural racism may not be a reasonable explanation by itself but it is one of many factors that contributes to disparity and this has been backed up by many reports.”

So, while it may be true, as the Lawrence report argues, that BAME people are over-represented in public-facing industries where they cannot work from home and that they tend to live in overcrowded housing, nonetheless there are various genetic factors that predispose them to Covid-19 vulnerability.

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