Inner London and deprived urban areas of England and Wales have suffered far higher death rates from coronavirus than more prosperous and rural locations, according to the Office for National Statistics.
The huge geographical differences were revealed in the first detailed analysis of those killed by Covid-19, which showed the pandemic exacerbating existing large health inequalities.
The virus may have infected both Prince Charles and prime minister Boris Johnson, demonstrating that no one was immune, but the ONS study found that those infected in the most deprived communities in inner cities were much more likely to die.
Some of the poorest parts of London, where population density is high, were hardest hit. Coronavirus killed 86 people per 100,000 in the capital, compared with an average of 36 people across the whole of England and Wales, according to the ONS.
The study looked at the 20,283 people whose deaths were registered by April 17 where Covid-19 was listed on the death certificate.
Three London boroughs — Newham, Brent and Hackney — stood out as the worst-hit areas with standardised death rates up to four times the national average.
Brent, in north-west London, was identified as a hotspot early on in the pandemic with a concentration of cases forcing local Northwick Park hospital to declare a critical incident in late March when it ran out of intensive care beds.
In Newham, 144 people per 100,000 were killed by coronavirus, according to the study, the highest rate in the country.
Mayor Rokhsana Fiaz said the borough in London’s east end was the most diverse in the UK, with 78 per cent of the population from ethnic minorities. It is also the poorest in London, with 48 per cent living in poverty after rent and household income are taken into account.
“The population has been particularly exposed to being infected because of the high density of the population, with many people in low-wage work, working in the service economy, and going back to overcrowded multigenerational households, exposing older members,” said Jason Strelitz, the borough’s director of public health.
He added that there was also a strong link with longstanding health issues in the community, with a prevalence of cardiovascular disease and diabetes that has contributed to comorbidity during the pandemic.
“It has been profoundly painful,” said Ms Fiaz. “When I announced the first death that was really hard. On Wednesday morning, I was announcing 212 people had died and on the same day we had confirmation from the police that a 24-year-old NHS worker was murdered.
“The emotional impact on us as a community needs to be addressed as part of our recovery response. We are all experiencing trauma,” she said.
Philip Glanville, the mayor of Hackney, blamed “the links between inequality, poverty, ethnicity and health” for his borough’s death rate of 127 per 100,000.
Hospital data from NHS England had already shown that the death rate among black Caribbean people was three times that of white people. The ONS study underlines that poverty and population density significantly increase the risk of being killed by the virus.
The ONS found that the most deprived 10 per cent of postcodes across England and Wales had a death rate of 55 per 100,000, more than twice that of the most affluent tenth of postcode areas where the rate fell to 25 per 100,000.
Helen Barnard, acting director of the Joseph Rowntree Foundation, said while everyone in the country had faced disruption “it can never be right that someone’s life chances are so profoundly affected by where they live or how much money their family has”.
Poorer families had jobs that did not suit homeworking and had no savings to fall back on, while often living in cramped conditions and working in essential low-paid jobs in retail and caring. Ms Barnard said it was vital that the government looked again at “how we treat the lowest-paid members of our society who have sustained us and kept us safe during this crisis”.
Other large cities in England and Wales also suffered outbreaks and death rates significantly worse than rural areas. The virus has killed a disproportionate number of people in Manchester, Birmingham and Liverpool.
Rural areas were relatively unscathed, underlining how population density helps propagate disease. But one prosperous market town that was unusually hard hit was Cheltenham, with a standardised death rate of 49 per 100,000, statistically significantly higher than the English average.
Some 250,000 people attended the four-day Cheltenham festival that finished on March 13, just 10 days before the government imposed the lockdown.