Three times as many suspected Covid-19 cases presented to GPs during the peak of the pandemic than shown in official Covid-19 test results, according to new research.

Researchers from Queen Mary University of London also found that black, Asian, and minority ethnic (BAME) groups were twice as likely to present with Covid-19, and this is not explained by other factors such as other health conditions, obesity and social deprivation.

The study, published in the British Journal of General Practice, used anonymised data from the primary care records of approximately 1.2 million adults registered with 157 practices in four adjacent east London clinical commissioning groups. 

Three of the four boroughs had death rates in the top five for London boroughs and 55% of the population are from ethnic minorities, hence the area is well placed to examine the over-representation of black and South Asian populations in suspected Covid-19.

Much of the Covid-19 epidemic is being managed in primary care

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.

“Much of the Covid-19 epidemic is being managed in primary care which has had to adjust rapidly to online consultations.  We need 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.

“It’s going to be very important how GPs record and manage cases in their community, as this can provide an early warning system if cases are rising again in an area and if we’re about to see a second wave of infection.”

Attention on Covid-19 initially focused on hospital presentations and intensive care, but little was known about the pattern of early presentations at GP surgeries. Community testing ceased in England on 12 March 2020, hence the extent of asymptomatic and milder symptomatic cases in community settings remains unknown.

The study found that:

  • GPs recorded 8,985 suspected Covid-19 cases between 14 February and 30 April 2020 – triple the number who tested positive at government test centres over that period.
  • There was a two-fold increase in the odds of suspected Covid-19 for South Asian and black adults compared with white adults. This risk remains even after accounting for other factors, such as multiple health conditions, obesity and social deprivation, which are also strongly associated with increased risk of a suspected Covid-19 diagnosis.
  • The odds of suspected Covid-19 increased with social deprivation, numbers of long-term conditions and BMI.
  • There was a seven-fold increase in risk of suspected Covid-19 for those with dementia, which may reflect the excess risks to older people living in care homes.
  • In contrast with other studies, the current study did not find an excess of male cases, but found that females had a slight increase in risk of suspected Covid-19, which suggest that the known higher risks for men emerge later in the disease trajectory.
  • There was 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.

GPs need rapid access to testing results for patients

Professor Martin Marshall, Chair of the Royal College of GPs said: “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.

“GPs and our teams will continue to be on the frontline of managing the effects of the Covid-19 virus in the community and access to high quality data will be essential as we approach a busy winter season and prepare for a potential risk of a second wave of the virus. What’s notable is that this research is mostly looking at ‘suspected’ cases of Covid, because of the lack of testing at a community level throughout the pandemic, particularly towards the start.

"To ensure we have a good understanding of the virus at a community level and help us to give patients the care they need, it is essential that GPs have rapid access to testing results for patients – and that as newer, quicker tests for Covid-19 are available, GPs and our teams have access to them when necessary and appropriate."