Complex interactions between physical landscapes and social factors increase vulnerability to emerging infections and their sequelae. Relative vulnerability to severe illness and/or death (VSID) depends on risk and extent of exposure to a virus and underlying health susceptibility. Identifying vulnerable communities and the regions they inhabit in real time is essential for effective rapid response to a new pandemic, such as COVID-19. In the period between first confirmed cases and the introduction of widespread community testing, ambulance records of suspected severe illness from COVID-19 could be used to identify vulnerable communities and regions and rapidly appraise factors that may explain VSID. We analyse the spatial distribution of more than 10,000 suspected severe COVID-19 cases using records of provisional diagnoses made by trained paramedics attending medical emergencies. We identify 13 clusters of severe illness likely related to COVID-19 occurring in the East Midlands of the UK and present an in-depth analysis of those clusters, including urban and rural dynamics, the physical characteristics of landscapes, and socio-economic conditions. Our findings suggest that the dynamics of VSID vary depending on wider geographic location. Vulnerable communities and regions occur in more deprived urban centres as well as more affluent peri-urban and rural areas. This methodology could contribute to the development of a rapid national response to support vulnerable communities during emerging pandemics in real time to save lives.

物理景观和社会因素之间的复杂相互作用增加了对新发感染及其后遗症的脆弱性。患重病和/或死亡 (VSID) 的相对脆弱性取决于接触病毒的风险和程度以及潜在的健康易感性。实时识别脆弱社区和他们居住的地区对于有效快速应对新的大流行病（例如 COVID-19）至关重要。在首例确诊病例和引入广泛社区检测之间的这段时间里，COVID-19 疑似严重疾病的救护车记录可用于识别脆弱社区和地区，并快速评估可能解释 VSID 的因素。我们分析了10多个的空间分布，000 名疑似重症 COVID-19 病例使用由参加医疗紧急情况的训练有素的护理人员做出的临时诊断记录。我们确定了 13 个可能与英国东米德兰兹发生的 COVID-19 相关的严重疾病集群，并对这些集群进行了深入分析，包括城市和农村动态、景观的物理特征和社会经济条件。我们的研究结果表明，VSID 的动态变化取决于更广泛的地理位置。脆弱的社区和地区出现在更贫困的城市中心和更富裕的城市中心 景观的物理特征和社会经济条件。我们的研究结果表明，VSID 的动态变化取决于更广泛的地理位置。脆弱的社区和地区出现在更贫困的城市中心和更富裕的城市中心 景观的物理特征和社会经济条件。我们的研究结果表明，VSID 的动态变化取决于更广泛的地理位置。脆弱的社区和地区出现在更贫困的城市中心和更富裕的城市中心城郊和农村地区。这种方法有助于制定快速的国家应对措施，在新出现的流行病期间实时支持弱势社区，以挽救生命。