ON HOW not to catch Covid, this is the practical advice to British Asians from Jaspal Kooner, the eminent Professor of Clinical Cardiology at Imperial College London who has done some 20,000 heart operations over the last 20 years and trained 200 cardiologists.
He focuses on what Covid has taught Asians: “As far as the pandemic is concerned, probably the single most important thing that Asians need to do is be even more rigorous than anybody else in terms of making sure that they are keeping to the rules – social distancing, wearing of masks, hygiene. That cannot be over emphasised where Asians are living in crowded environments. And also they need to be careful about the ways in which they socialise. That is probably the most important thing that Asians can do at this stage.”
Speaking from Hammersmith Hospital, where he is a consultant cardiologist, Kooner goes on: “Over and above that, of course, they need to take care and exercise control over the important factors which may additionally put them at higher risk. And that is lifestyle, making sure that they follow healthy lifestyles, are eating properly, exercising well, keeping their weight down and keeping diabetes and blood pressure under control.”
He draws attention to well-known facts: “(Compared with the white population), Asians are at two fold higher risk of cardiovascular disease, three fold higher risk of diabetes and five fold higher risk of kidney failure.”
So far as the pandemic is concerned, he asks a fundamental question: “Some Asians did not get Covid; others got Covid and survived; and others succumbed to Covid. Why?”
This is what he is trying to untangle. To try to understand what is going on with Asians, he says it is not enough simply to “take a snapshot” at any given moment in time.
To get a proper answer, what is required is a “longitudinal study” – this is research done on selected individuals over several decades.
He explains: “A longitudinal study is having a group of people about whom you collect data, for instance, at baseline, and then you continue to follow up their health over decades to come.
“Let’s say you have a large cohort of 100,000 people. In 10 years’ time, say 10,000 people have had heart attacks and 10,000 have not.
You can then look back at the data you’ve collected at baseline, and subsequently, to begin to understand what made those 10,000 people susceptible to heart attacks and what protected the other 10,000 people from heart attacks.
“That is an unbiased way of actually understanding the disease. It allows you to make an accurate assessment of the effects of exposures like smoking, blood pressure and diabetes on the disease itself.
“If you were to take just a snapshot, and you have a heart attack and diabetes in someone, you don’t know if the diabetes came first or the heart attack came first. In a longitudinal study, you’re able to follow through an individual over a long period of time, and you can try understanding the cause and the disease.”
The Wellcome Trust is funding a “biobank” which Kooner is setting up, with 250,000 people – 100,000 of them in the UK, and the remaining 150,000 chosen from India, Pakistan and Bangladesh. Kooner, who is the director of the project, says the study is being sponsored by Imperial College. Depending on how his research works out, his results may benefit a quarter of the world’s population, given the size of the subcontinent and the Asian diasporas.
His work on the biobank was disrupted by the pandemic.
He also witnessed a marked drop off in the number of heart patients he was seeing.
He says: “To give you a typical example, in March last year (before the lockdown), we would normally have two to three patients, if not more, presenting an acute heart attack every day requiring emergency angioplasty or surgery. During the pandemic, particularly during the early part from March to August- September, the surprising thing was we only saw one to two patients per week. This was true in this country, in Europe and many other parts of the world.
This was largely because of fear of coming into hospitals and contracting Covid. It affected many other conditions as well, like cancer.”
On relatively poor Covid outcomes among Asians, he says these “have been attributed in many parts of the media to, ‘Oh, they’re obese; oh, they have diabetes; oh, they have cardiovascular disease.’ What we do know is south Asians are at higher risk of Covid.
“We’ve known that India, for instance, has been a major global epicentre for Covid. So the question really is: are these individuals more susceptible because they carry risk factors like obesity and diabetes? Or are they actually at risk because they live in close proximity in crowded conditions?
“So, more recent data suggests that the lifestyle of south Asians in the UK of living as family units and having greater contact with each other is a very important risk factor for the higher prevalence of Covid among south Asians. But truly, this is again something that requires a large scale perspective, a longitudinal study, to get an accurate assessment of the outcomes and the contributions of exposures to the increased risk of Covid in south Asians.”
In order to study the effect of Covid on Asians, he has applied for funding to the Medical Research Council, which he says has smaller budgets than governments. Again, the trick is to follow the same people over a long period of time.
He sets out the scenario: “For argument’s sake, if you had assembled 100,000 people right at the beginning 10 years ago, you were tracking their health. Then last year you would have been able to identify from your cohort those people who died, those people who survived Covid and those people who are protected from Covid. You could then look at your data which is already pre-collected because you’re following up these individuals over a period of time to understand why it was that one group died from Covid and another group survived Covid.”
He is worried that if the pandemic is seen to go away as a result of a successful vaccination roll out, the crucial research on British Asians and the Covid pandemic will be shelved.
Kooner was born in Kenya and came to Britain aged 12 in 1968. Although a Sikh, he laughs and says he has retained his trim physique by not tucking in like a traditional Punjabi – “I have no more than one chapati for dinner”.
