The Darkest of Data - The Information We Choose to Ignore

Despite its dubious past the spirometer may help scientists understand how Covid19 spreads and why it harms some of us more than others.

Few medical instruments have a history quite as controversial as the humble spirometer. Covid19 should have seen this simple piece of technology fly off the shelf. Unfortunately blowing hard into anything, even something designed to measure lung function, risks spreading the virus and manufacturers are warn against using their product as a diagnostic device.

Roman doctors took a keen interest in the performance of the human lung but it was not until nineteenth century spirometers were first used to diagnose respiratory illness. Today, you breath into one of these devices when buying an expensive life insurance policy or being traded between football teams and there is even a low-cost handheld version for the worried well. When the smartphone was launched it was thought uploading spirometer readings to a personal healthcare record would become as popular as taking a selfie. This never happened, instead, in the context of Covid19 the spirometer has produced what Professor David Hand described in his book ‘Dark Data’ information that is missing due to our tendency to self-select data.

Gender influences lung development and physiology and lung function varies as a person grows older or becomes overweight. The severity of Covid19 within any given demographic appears to correlate closely with lung function. This might explain why one particular group suffers disproportionately from the effects of the virus. The respiratory systems of people who originate from countries with a hot climate, where the oxygen content of the atmosphere is low, is different in structure and performance from that of a person from a cold country with an oxygen rich atmosphere. At this point spirometry runs headlong into a brick wall because it was slave traders who first pointed out ethnicity influenced lung function. But rather than accept the respiratory system of a black person differed from that of someone who was white, traders claimed here was defect which could be used as a bargaining chip when agreeing the price paid for a slave. This perception of a black person’s lungs as inferior persisted long after the slave trade ended. Even today spirometers in the US use a correction factor of 10% for those identifying as ‘black’ and there are almost as many papers written on the racist history of the spirometer as on spirometry itself.

Few would deny there is a causal link between racism and deprivation and, by extension, between deprivation and poor health. People who live in poverty are prone to a range of illnesses and die early; data proves this, it is one of the healthcare sector’s worst kept secret. Claiming an enquiry is needed to establish why BAME medical staff are more likely than their white colleagues to die of Covid19 smacks of kicking the can down the road. But nor should we hobble science by ignoring other factors which may make BAME health workers particularly vulnerable to the virus. Here researchers tend to self-edit and sometimes would rather ignore data than court controversy. Data that shows even when factoring in deprivation, black males are more likely to die of Covid19 than any other group of health workers, including black females. There is a reluctance to draw attention to physiology creating a vulnerability to Covid19 for fear of feeding into the victimisation narrative promoted by certain politicians, a fear that in some cases is justified. Unfortunately, this reluctance has resulted in people are dying for the sake of political correctness.

It is not only members of the BAME community who are disproportionately at risk of contracting and dying from Covid19. Employees in meat processing plants in Germany and the US seem particularly prone to the disease. The low paid work in this industry attracts people who may already have health issues due to poor diet and lack of exercise; they also less likely, than higher paid workers, to be issued with PPE, the two key reasons they are at risk. However, there are other industries with equally dire working conditions and employees forced to share unhygienic dormitories. So, why is the meat industry particularly prone to outbreaks of Covid19? Could it be the damp atmosphere in which the virus clings to the airborne droplets of water which travel deep into a person’s respiratory system. In abattoirs workers are breathing in air which is much like that found during winter months when cases of influenza and other coronaviruses reach their natural peak. It is also the same atmosphere found in meat markets such as the one in Wuhan.

Focussing on deprivation as the sole factor driving the spread of Covid19 will prevent science finding a way of preventing a second wave. While deprived regions of Britain have become Covid19 hotspots the virus was carried their by someone wealthy enough to fly business class in a long haul jet.

The long-term goal of a society that considers itself fair and equitable is to eliminate prejudice and poverty. Unfortunately, as far as Covid19 is concerned, in the long term we are all dead. When it became obvious BAME frontline staff in our hospitals were at risk they should have been offered top of the range PPE, not the vague promise of increased risk assessment. If your house catches fire you expect firemen to douse the flames, not merely shrug their shoulders and tell you there are plans an enquiry into why modern furniture is so flammable. And using Covid19 to campaign against prejudice and inequality is equally short sighted as once a vaccine becomes available, or the virus burns itself out, politicians will claim ‘mission accomplished’ and little will have changed.

Covid19 became politicised when images of George Floyd’s suffocation were broadcast around the world. Researchers were already struggling to untangle the web of social, economic, environmental and physiological factors influencing the spread and impact of the virus. Now, thanks to politicians who prefer to guide science rather than being guided by it, Covid19 has become a Gordian knot. Unfortunately, the device which might help scientists and clinicians unpick this knot is, itself, ensnared in the long running controversy over the link between ethnicity and health.