GPs diagnosed three times as many suspected COVID-19 cases during the peak of the pandemic than were shown in official results, according to research published today (8 September 2020).

The study, led by Queen Mary University of London and published in the British Journal of General Practice, also reveals that black, Asian, and minority ethnic (BAME) groups were twice as likely to present with COVID-19 symptoms, and this was not explained by factors such as health conditions, obesity and social deprivation.

Lead author Dr Sally Hull from Queen Mary University of London said: “Our results suggest that COVID-19 prevalence during the peak of the epidemic was higher than previously thought. The official COVID-19 test statistics are likely to have underrepresented the extent of the epidemic, as many people with COVID-19 would not have been tested, including those with milder symptoms or those who could not access testing centres.”

The researchers studied anonymised data from the primary care records of about 1.2 million adults registered with 157 practices in four east London clinical commissioning groups during the peak of the London epidemic in March and April. Three of the four boroughs had death rates in the top five for London boroughs and 55% of the population are from ethnic minorities. The study found that GPs recorded 8,985 suspected COVID-19 cases between 14 February and 30 April 2020, which is triple the number who tested positive at government test centres over that period.

There was a seven-fold increase in risk of suspected COVID-19 for those with dementia and a two-fold increase in the odds of suspected COVID-19 for South Asian and black adults compared with white adults. The odds of suspected COVID-19 increased with social deprivation, numbers of long-term conditions and BMI. The research team also found a sharp seasonal decline in upper and lower respiratory infections during the period that saw a rise in suspected COVID-19 cases, which may have been magnified by social distancing.

“The high prevalence among BAME patients remains a big concern, and we now know that ethnicity is still a risk factor even after you take account of social deprivation, long-term conditions and BMI,” said Dr Hull. “So there is something else driving this, which urgently requires more research.”

She called for timely reporting of COVID-19 test results to practices, and diagnostic information from NHS 111, so that practices can provide continuing care to patients with more severe episodes. She added that it will be important how GPs record and manage cases in their community because this will provide an early warning system if cases rise again, suggesting a second wave of infection.

Royal College of GPs chair Professor Martin Marshall said the findings showed how practices managed successfully to stay functioning during lockdown. “This data shows the significant role GPs and our teams have played in tackling COVID-19 and delivering care to patients during the pandemic – and how the virus has impacted on all parts of the health and care services. General practice has been open throughout the pandemic with GPs and our teams continuing to deliver the vast majority of NHS patient care to patients with both COVID and non-COVID conditions.”

He added: “The College has recently written to the Minister for Equalities calling for an update on the implementation of recommendations made in the Fenton report earlier this summer. Specifically, we want to know what progress has been made in developing risk assessment tools for BAME staff across the NHS to ensure they are safe to work and feel confident in doing so; and for public health campaigns to be more effectively targeted to people from BAME communities.”