Abstract
On the 9th March 2020, the first patient with COVID-19 was admitted to ICU in the Royal Gwent Hospital (RGH), Newport, Wales. We prospectively recorded the rate of ICU admissions of 52 patients with COVID-19 over 60 days, focusing on the epidemiology of ethnicity and deprivation because these factors have emerged as significant risk factors. Patients were 65% (34 of 52) male and had a median (IQR) age of 55 (48–62) years. Prevalent comorbidities included obesity (52%); diabetes (33%), and asthma (23%). COVID-19 hospital and ICU inpatient numbers peaked on days 23 and 39, respectively—a lag of 16 days. The ICU mortality rate was 33% (17 of 52). People of black, Asian, and minority ethnic descent (BAME group) represented 35% of ICU COVID-19 admissions (18 of 52) and 35% of deaths (6 of 17). Amongst the BAME group, 72% (13 of 18) of patients were found to reside in geographical areas representing the 20% most deprived in Wales, vs. 27% of patients in the Caucasian group (9 of 33). Less than 5% of the population within the area covered by RGH are of BAME descent, yet this group had a disproportionately high ICU admission and mortality rate from COVID-19. The interplay between ethnicity and deprivation, which is complex, may be a factor in our findings. This in turn could be related to an increased prevalence of co-morbidities; higher community exposure; larger proportion of lower band key worker roles; or genetic polymorphisms.
Highlights
Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection, originating from Wuhan, China is the underlying cause of coronavirus disease-2019 (COVID-19) [1]
During the first wave of the COVID-19 pandemic, data emerged indicating that people of BAME descent in the UK are at higher risk of intensive care unit (ICU) admission and death with COVID-19 [5]. In this case-series analysis we report the epidemiology of the first wave of COVID-19 patients in SouthEast Wales admitted into ICU, and describe the connection between ethnicity and social deprivation using data from the first 60 days of the COVID-19 pandemic in the Royal Gwent Hospital (RGH)
Between 9th March 2020 and 7th May, 52 patients (46 confirmed and 6 suspected) with COVID-19 disease were admitted to the ICU
Summary
Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection, originating from Wuhan, China is the underlying cause of coronavirus disease-2019 (COVID-19) [1]. The pandemic reached Italy in February and caused significant strain on the Lombardy critical care units [2]. The first known patient with SARS-CoV-2 infection was discovered in Wales on the 2nd March 2020. The first COVID-19 patient admitted to an ICU in Wales was admitted to the Royal Gwent Hospital (RGH) in Newport on the 9th March. Heeding the warning from Italy, the RGH moved early to cancel elective activity and prepare for a significant increase in admissions [3]. The RGH in Aneurin Bevan University Health Board (ABUHB) is the major specialist center, which provides secondary services to a population of ∼400,000 people.
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