Why are coronavirus death rates higher than the national average in the Black Country?
There have been many sobering statistics to emerge from the coronavirus pandemic as it has developed into a global crisis.
More than 19,000 people have now died in the UK after contracting Covid-19 and analysis has revealed how tireless NHS staff in the Black Country are facing a relentless battle to keep patients alive.
The Black Country and Birmingham has been one of the main hotspots since the deadly virus reached our shores, and is second only to London for the number of cases and deaths.
That should come as no surprise as Birmingham is the UK’s second largest city and the Black Country a densely-packed urban conurbation of more than a million people.
But closer scrutiny of the data appears to show that more people are dying in some areas than others - even when there are similar numbers of cases - suggesting surviving coronavirus could depend on both where and how you live.
With the full number of cases in the UK not known, we do not know what the percentage of people dying in our country is. But what we can see is the number of people who have died compared to the number of confirmed cases ie the number of people who have tested positive.
Figures suggest that nearly one in four confirmed cases of Covid-19 in the four Black Country boroughs, Birmingham and Staffordshire have resulted in deaths.
That compares to more than one in seven nationally and includes rural Staffordshire where the figure is comparatively low.
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As of Friday 7,311 people had tested positive for coronavirus across the Black Country, Birmingham and Staffordshire and 1,694 patients had died in the region's hospitals. That is one death for every 4.3 confirmed cases or 23.1 per cent.
Across the UK the equivalent numbers were 143,464 cases and 19,506 hospital deaths. That is one death for every 7.35 cases or 13.6 per cent.
Thus it is clear that our region has a comparatively high death rate.
Across our region
When analysing local statistics, it is important to note that the data for positive tests is provided by council area - such as Wolverhampton, Sandwell, Dudley, Walsall, Staffordshire and Birmingham - while the death data is provided by hospital trust, such as the Royal Wolverhampton NHS Trust which runs the city's New Cross Hospital.
Not all patients who test positive will go on to be treated by a hospital in the same council area, meaning the local ratio cannot be 100 per cent certain . For example someone who tests positive in Cannock (ie Staffordshire County Council) may be treated at New Cross Hospital (Wolverhampton Council).
However the majority of patients are likely to be treated at hospitals in the same council area that they tested positive in and are almost certain to have stayed in the general Black Country, Birmingham and Staffordshire region.
As of Friday, there were 656 confirmed coronavirus cases in Wolverhampton and 218 deaths at the Royal Wolverhampton NHS Trust. That is one death to every three confirmed cases.
Meanwhile in the Walsall Council area there were 778 cases, while 146 patients had died at Walsall Manor Hospital. That is a ratio of one death to every 5.3 confirmed cases.
In Dudley there were 653 cases, while at the Dudley Group NHS Trust, which runs Russells Hall Hospital, 199 patients had died. That is a ratio of one death to every 3.3 confirmed cases.
In Sandwell and Birmingham there were a combined 3,408 cases, while at the NHS trusts with hospitals across the two boroughs 970 patients had died. That is a ratio of one death to every 3.5 confirmed cases. The borough statistics must be merged due to the Sandwell and West Birmingham NHS Trust running hospitals in both areas.
Across the Staffordshire County Council and Stoke-on-Trent City Council areas there were 1,816 cases but at hospitals in the county there were 161 deaths. That is a ratio of one death to every 11.2 confirmed cases.
Why is the ratio so different?
They are startling statistics, but until all this passes and the figures are analysed properly we probably won’t know the full reasons behind the differences between certain regions.
There is absolutely no suggestion the care being given by dedicated staff hospitals in our region is anything other than exemplary, but scientists have looked at how social factors can increase risk.
There have also been suggestions that obesity, race, poverty and even pollution could be a factor in determining different death rates between areas. It makes sense that the risk rises in urban areas, where people are in closer proximity to each other and where extended families may live together in smaller homes, compared to rural parts of Staffordshire.
It has been also been reported how more black and minority ethnic (Bame) people are dying from Covid-19, and our region has a richly diverse population.
Public Health England is currently analysing the ethnicity data to measure the impact of Covid-19 across different ethnic groups.
According to city council data, 35 per cent of people in Wolverhampton – more than one in three – are from a Bame background, while 16 per cent of the population were born outside the UK.
In Staffordshire, where the death rate is far lower, the figure for people from Bame backgrounds is just 6.4 per cent.
Experts are investigating why coronavirus is having more of an impact on Bame communities. Inter-generational households – children living with grandparents is not uncommon in some communities – is among the reasons to have been put forward.
Deprivation could also be another factor for all communities. The Black Country has always prided itself on being a largely working-class region and it could be a reason why so many are struggling to beat coronavirus. The median salary in Wolverhampton in 2015 was around £22,500. The average for Staffordshire is about £27,000.
Underlying health conditions, including those contributed to by smoking or drinking, are also likely to be a factor. For example, it was revealed last month Wolverhampton has one of the highest liver disease death rates in the country. The 2011 census showed Wolverhampton actually had fewer older people than the national average, meaning high death rates can’t be explained away as elderly people dying as there as many, and sometimes fewer, than everywhere else.
What do the experts say?
Dr David Rosser, chief executive of University Hospitals Birmingham NHS Foundation Trust which has the most deaths of any health trust in the country, said the data is difficult to unpick.
He told a West Midlands Combined Authority briefing that the link between deprivation and death rates was higher than with ethnicity.
Dr Rosser added: "Of course there is an overlap sadly between ethnicity and deprivation, so it's slightly difficult to unpick, we are also aware certain ethnic groups have a higher rate of renal failure, diabetes, hypertension, all of which we know are significant risk factors for doing badly if you contract Covid-19 in the first place."
Sue Ibbotson, Public Health England's director in the West Midlands warned against reading too heavily into the currently available statistics.
She said: "There is limited recording of ethnicity across almost all the data sets that we have and they don't all come together in one place at the moment, so we have to be very careful in making any assumptions and it is of course a really important issue and we're doing a whole raft of really detailed and careful work before we draw any conclusions about that.
"In addition we're working nationally and with local partners to ensure that ethnic minorities are informed and are confident about how they can stay safe."
Birmingham City Council's cabinet member for health and social care, Paulette Hamilton, said that deprivation is a "major issue".
But she warned: "Data given incorrectly can cause more issues than it actually solves and people in the communities want answers.
"At this moment there is lots of fear, they don't understand why they in certain communities feel as if they're dying more than other communities."
Not yet clear
West Midlands Mayor Andy Street believes early cases which appeared may have put the region on the back foot.
He said: “What is obvious is that both the Black Country and other West Midlands areas were into this quite early and there is now a lag in things moving through.
“That is one of the reasons the numbers were high quite early, and particularly so in Wolverhampton. I think what will happen as we progress through is the rate will become less out of line.”
Meanwhile David Nicholl, a consultant neurologist at a Black Country hospital, who is also a Liberal Democrat health spokesman, said: “The reasons aren’t clear. There may be a link with deprivation.
“Looking at the healthcare professionals who have died, the number who happen to be Bame is very striking.
“We’re a cluster. Being near the second city, there are much more cases than in more rural areas. The mistake was not getting testing up to scale.”
Milkinder Jaspal, a councillor and former Wolverhampton mayor, said: “In the Bame community, they are dying more than other groups.
“The truth is no-one really knows why but in some Asian families they live with three or four generations. The genetic make-up may be another aspect.
“We really need to explore and find out why coronavirus has hit the black and ethnic community harder.”
Councillor Jaspal criticised those suggesting messages weren’t getting through to certain communities because of a language barrier.
He said: “People go on about the language. Very few people don’t speak the language. I don’t think there’s a language barrier and it’s really disappointing some people are playing it up.”
