The global COVID-19 pandemic and the response to it has had massive health, financial, social and psychological ramifications; ten million infections and half a million deaths. Until last week, the UK had registered 59,537 excess deaths since the week ending March 20, indicating that the virus has directly or indirectly killed 891 people per million – the highest per capita death rate in the world (1). The GDP has dropped by 20% with tens of thousands job losses (2). Consequent proscription of freedom of assembly (imposed social isolation, lockdown) under Regulation 6 Health Protection (Coronavirus, Restrictions) (England) Regulations 2020 and enhanced surveillance has had major social and psychological effects.
Social isolation during COVID-19 has also exposed differences between people. The wealthy live in their second homes with garden, while zero hour contract workers are off work either via redundancy or furlough. Review of UK Office for National Statistics data has shown a two fold difference in age adjusted mortality rate between the least and most deprived London boroughs (3).
We are all in it together - NOT. Inequalities in age adjusted COVID-19 mortality rates associated with :
1. Ethnicity ( relative risk ratio 2.69 for BAME clinicians vs caucasian - ICNARC database) (4) . Confirmed by Institute for Fiscal studies research ( threefold)(5)
2. Deprivation (relative risk ratio 2.39 - see Fig from ONS) (6) and
3. Rural vs urban living. ( relative risk ratio 6 -see Fig from ONS) (7)
4. Gender : 70% ITU patients are men ( ICNARC database). 51% men die, 43% women die (8)
5. Obesity - a body mass index (BMI) of 30kg/ sq m doubled your chance of needing ICU care in New York. A BMI greater than 35 increases risk 3.6 fold. Remember survival rates in ITU are only 50 % (9)
6. Deprivation - UK areas where there is higher deprivation scores ( Newham, Brent, Hackney) have over twice the excess deaths of areas with low deprivation ( Office for National Statistics ) (6)
7. Religion - Jewish males had a mortality rate of 187.9 deaths per 100,000, compared with 92.6 deaths per 100,000 for Christian males.
For Jewish females, the rate was 94.3 deaths per 100,000, compared with 54.6 deaths per 100,000 for Christian females.
Muslim males had the highest rates of death involving Covid-19, with 199 deaths per 100,000 for men of all ages, and 98 deaths per 100,000 for women. (10)
The images of lockdown taken in a wealthy part of England highlight the differences described: Croquet hoops and post, a Porsche parked outside a cooperative supermarket, and a well-stocked cellar of vintage wines ( Alcohol sales in March 2020 during COVID-19 lockdown went up by 31.4% (11, 12)) which caused Baroness Ilora Finlay, Chair of the Commission on Alcohol harms to write an editorial in the British Medical Journal (13) .
Edith Tudor-Hart (1908 - 1973) was an Austrian-British photographer who studied photography at the Bauhaus. She submitted photographs on inequality for The Listener, The Social Scene and Design Today, dealing with issues such as refugees from the Spanish Civil War and industrial decline in the north-east of England. From the late 1930s, she concentrated more on social needs, such as housing policy and the care of disabled children.
To survive/ avoid COVID-19 It's best if you are a white woman and live in a castle/ hamlet 👸 or if you live in London, live in Henley ( or Windsor 🤴) 🚣♂️.