Abstract
England has experienced a large outbreak of SARS-CoV-2, disproportionately affecting people from disadvantaged and ethnic minority communities. It is unclear how much of this excess is due to differences in exposure associated with structural inequalities. Here, we report from the REal-time Assessment of Community Transmission-2 (REACT-2) national study of over 100,000 people. After adjusting for test characteristics and re-weighting to the population, overall antibody prevalence is 6.0% (95% CI: 5.8-6.1). An estimated 3.4 million people had developed antibodies to SARS-CoV-2 by mid-July 2020. Prevalence is two- to three-fold higher among health and care workers compared with non-essential workers, and in people of Black or South Asian than white ethnicity, while age- and sex-specific infection fatality ratios are similar across ethnicities. Our results indicate that higher hospitalisation and mortality from COVID-19 in minority ethnic groups may reflect higher rates of infection rather than differential experience of disease or care.
Highlights
England has experienced a large outbreak of SARS-CoV-2, disproportionately affecting people from disadvantaged and ethnic minority communities
After adjusting for the performance characteristics of the test and re-weighting to be representative of the population, overall antibody prevalence was 6.0%
Prevalence was highest at ages 18–24 years (7.9%, 95% CI 7.3, 8.5) and in London (13.0%, 95% CI 12.3, 13.60) (Supplementary Table 1)
Summary
England has experienced a large outbreak of SARS-CoV-2, disproportionately affecting people from disadvantaged and ethnic minority communities. Hospital admission and mortality data show an asymmetrical burden of COVID-19 in England, with high rates in older people and those living in long-term care, and in people of minority ethnic groups, Black and Asian (mainly South Asian) individuals[3,4,5,6] It is unclear how much of this excess is due to differences in exposure to the virus, e.g. related to workplace exposures and structural inequality, and how much is due to differences in outcome, including access to health care[7,8,9]. We obtained estimates of the cumulative community prevalence of IgG antibodies for SARS-CoV-2 infection among a representative sample of over 100,000 adults aged over 18 years in England, and specific sub-groups of the population, e.g. by ethnicity and occupation, to mid-July 202018. As well as measuring community prevalence and identifying groups at most risk of infection, we estimated the total number of infected individuals in England and the infection fatality ratio (IFR) overall and by age, sex and ethnicity
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