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Ignoring ethnicity: Crash test dummy in Intensive Care. Photo credit: Tim Cooper

Serious Corona cases higher among migrants in Netherlands and Sweden

For fear of stigmatization, it was recognized much later in the Netherlands than in other countries that certain population groups run a higher risk in terms of the Corona pandemic. Professor of health care Maria van den Muijsenbergh and Armand Girbes, head of intensive care at the Amsterdam UMC, both confirmed the observation

Published: May 25, 2021, 10:55 am

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    The outcome of the Covid-19 study among inhabitants of Amsterdam with a migration background showed that during the second wave Turkish, Moroccan and Ghanaian residents more often fell ill, ended up in hospital and died. This has been clearly shown in health data in the Netherlands.

    This outcome came as no surprise to ICU doctor Armand Girbes. He warned at the start of the second wave, in October last year, that his IC was full of non-Western migrants. At the time, it concerned immigrants from the first generation, he told Dutch public broadcaster NOS.

    The overrepresentation was not unexpected for Girbes at that time. He had also received similar signals from Paris and America from colleagues and there was also American research available showing that migrants were much more affected by the virus.

    This has to do with their living conditions and the work they do outside the home as well as common health complaints, he said. To test his observation, Girbes called heads of the ICs in other cities and his observation was confirmed, but much to his disappointment those doctors did not repeat it when journalists asked them the same question.

    Girbes himself recently advocated on a TV program for faster vaccination of “high-risk groups”. He consciously chose these words, because he no longer dared to mention that he actually meant first-generation migrants. “Colleagues said to me, ‘how brave that you raised it,’ but I got no public support from anyone.” He is happy that it is now well substantiated but admits that the problem should have been recognized much earlier.

    Van den Muijsenbergh, professor by special appointment of health inequalities, has also been looking for the consequences for certain population groups since the start of the pandemic. She suspected this not only from the research from the US, but also studies from Great Britain and Norway.

    In the Netherlands, it is much more difficult to quickly obtain solid information, “because we do not register ethnicity here,” says Van den Muijsenbergh. “General practitioners should write about their patients in the file what their ethnicity – named by the patient – is, what the country of birth of the parents is and the level of education,” she said. According to Van den Muijsenbergh, there is a reluctance to name problems within different population groups. “There is a fear that it will be abused to discriminate. Which also surfaced right away when that IC doctor from Amsterdam sounded the alarm.”

    Similarly in Sweden, the risk of being intensively cared for or dying with Covid-19 is significantly higher for people born in Africa, compared with Swedish-born people, a report from the Public Health Agency showed.

    For people born in Africa, the risk of dying with coronavirus is 3,4 times higher than for Swedish-born people, and for people born in the Middle East, the risk is 2,8 times higher.

    Regarding the possibility that a person becomes seriously ill and needs intensive care, immigrants run the greatest risk. People born in Africa or the Middle East are five times more likely than Swedes born to end up in IC. The greatest risk is for people born in Somalia and Turkey, who have nine and six times as great a risk as Swedish-born patients.

    Even though Africans and Arabs are at greatest relative risk, Swedish-born still make up a majority of those who are intensively cared for or die. Of the 5034 IC cases that the Swedish Public Health Agency presented in its report, Swedish-born accounted for 2985 cases, just over 59 percent. The concept of Swedish-born is in this context refers to everyone born in Sweden, both ethnic Swedes and people with an immigrant background.

    Of the 12 714 deaths in the report, Swedish-born account for 10 252 cases, just under 81 percent.

    When calculating the relative risk, however, it is not only based on the over-representation in the number of IC cases or deaths compared with the group’s share of the population. This is because the age variations between the groups are very large. To calculate the relative risk, age differences are cleared to make the statistics comparable.

    Immigrants’ risk is thus greatest when it comes to IC care. Although they are also at greater risk of dying, the difference is smaller.

    “There are not as drastic differences as for IC care,” writes the Public Health Agency about the differences between the birth regions in the number of deaths.

    The Swedish Public Health Agency believes that the over-representation of immigrants is about socio-economic factors and overcrowding. It is already known that people with vitamin deficiencies can suffer from the Coronavirus, and that people with dark skin have a very difficult time meeting their need for vitamin D in Nordic countries. An African needs a nine times higher UV dose than Swedish-born to fill the vitamin D need, according to information from the Cancer Foundation. However, these biological differences are not mentioned by the Swedish Public Health Agency.

    The propensity to vaccinate is also highest among Swedish-born and lowest among Africans, which applies to all age groups. Among people aged 80 and older, 95 per cent of Swedish-born people are vaccinated, but just over 50 percent of Africans. The study was released in spring already, but the mainstream SVT only reported on the facts this week.

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