Saturday 9 May 2020
Not far from where I live is the London School of Hygiene and Tropical Medicine (LHSTM), a place that I have normally associated with exotic diseases from far-flung lands, conditions with names I cannot pronounce. Onchocerciasis, paragonimiasis, or how about cutaneous larva migrans? See what I mean? Any one of them could be a challenging tongue-twister.
These days, LSHTM is playing a key part in Covid-19 and has just finished the largest study, anywhere on the planet to date, to look at the health data of 17.4 million UK adults. In their sample were 5683 deaths caused, it is thought, by Covid-19. Like so much research during this crisis, it has appeared on a preprint server, as this seems the best way of spreading the word widely, although the work is not peer-reviewed. The aim of LSHTM was to find out who was at greatest risk of popping off from Covid-19. I read the paper because I was hoping I might be seen as exempt. It appears I have been overoptimistic, as their conclusions suggest I am a goner.
Being male doubles my chance of dying from the virus when compared with a lady and being 67 years old also doubles my chances of death. I might as well shoot myself now. However, I am not too chubby, apart from a chocolate obsession that refuses to go away. If I was overweight, I would opt for a crash course in starvation, as really fat people have a more than twice chance of death. Being an ex-smoker – not me – is not a good thing to be and previous chest or heart disease is a no-no. Diabetes is not good, cancer less than a year ago is risky and cancers of the blood can treble the chances of death. Then there is liver disease, dementia, neurological diseases, kidney trouble and transplanted organs. Some of these can increase risk more than fourfold.
The reason why men are more at risk than women is being investigated at the moment at King’s College Hospital in London. A menopause specialist there says that oestrogen may play a protective role for the ladies and is looking more closely at this. Who would have thought that men would end up by taking Hormone Replacement Therapy (HRT) when they reached a certain age? Yet with Covid-19, it seems that anything is possible.
Where I struggle to understand is why there is an increased risk for Black, Asian and Minor Ethnicity (BAME) folk, as this simply does not make sense. Most of my friends in this category are much fitter than me. Yet the fact is, the risks to so-called BAME individuals are almost twice the risks for those who are white. No one can explain why, except that this finding appears not to be related to any underlying health conditions. The Deputy Chief Medical Officer, Professor Jonathan Van-Tam, would not be drawn on the matter at the evening Downing Street briefing. He is seriously brainy and has said there is much work going on behind the scenes to work out what might be happening. Roll on the results as they are clearly important. The NHS is held together by BAME practitioners. It would fall apart if they upped sticks and left.
The same distribution of deaths can be seen elsewhere, and certainly in the USA. Although the full picture remains unclear, researchers have found that black counties disproportionately account for more than half of coronavirus cases and nearly 60% of deaths. This may in part be because of the overrepresentation of black and Latino Americans in exposure-prone professions, as well as a racial gap in wealth and income that has left them more vulnerable to being laid off. Only 23% of these lower-income Americans say they have the funds to last three months. Whatever the reasons, these findings are horrific.
After reading the LSHTM paper, and further around the subject, too, I was filled with gloom for both myself and plenty of colleagues. Consequently, the words of Grant Shapps, the UK’s Transport Secretary, have brightened up my day. He has said that if we wish to socially distance whenever lockdown finishes, public transport does not have the capacity to carry us. We will all have to walk or cycle to work and the government is looking closely at e-scooters. For a surgeon, this is good news as our jobs are assured. In January this year work was published from San Francisco to say that e-scooter injuries had risen by 222% in four years, with adults aged 18-34 years being the most commonly injured. Records are incomplete but it appears that 66% of those injured were not wearing helmets, with the most common injuries being closed head injuries, such as concussion and bleeding or bruising of the brain. These are followed by facial cuts or abrasions. About 5% of injuries are fractures, the same as broken bones. Grant Shapps is promising plenty of work for the medics as there are some e-scooters that can travel more than 50 miles per hour. People have died on e-scooters, including TV presenter Emily Hartridge who was squashed by a lorry two years ago when she was riding, you guessed it, an e-scooter.
Care homes in the UK continue to be a problem and it is clear that the level of fatalities in these institutions is only now being recognised. There is also a suggestion that up to 1000 care homes could close after the Covid-19 pandemic settles. There were already problems with closures before the pandemic, let alone what may happen afterwards. The public sector had seen the biggest drop in the number of care home beds before Covid-19 appeared. Despite having an already shrinking 2% market share, the public care-home
sector lost 6.6% of its beds more recently, compared with approximately 0.3% in both the private and not-for-profit sectors. Of the closing homes, 29% had an inadequate report by the Care Quality Commission. Roughly the same had a “Requires Improvement” rating. Approximately half of all closures are down to economic reasons. Whatever the reasons, the closure of care homes in England has led to the displacement of approximately 7700 vulnerable, older people. All of this was before Covid-19.
Care homes in the USA have also been attracting a lot of attention recently. Especially so, since it has been learned that at least 27600 care home residents and workers have died from Covid-19. The virus has infected more than 150,000 people in approximately 7700 facilities. Although 11% of the country’s cases have occurred in long-term care facilities, they account for more than one-third of the country’s fatalities. If I am to believe the data, should you need residential care, then avoid West Virginia. There, 81% of the deaths from Covid-19 have occurred in its 27 care homes. These are not good numbers.