*This is an update to a feature originally published on 24/04/20*
The much anticipated report from Public Health England into the impact of the novel coronavirus on Black, Asian and minority ethnic (BAME) communities has been released by the government. This follows threats to delay it, yesterday. Citing an anonymous government source, Sky News reported that the review's release was being pushed back due to 'worries' around global tensions, following the killing of George Floyd, a 46-year-old Black man living in Minnesota, by a policeman. The government has denied that this was the case.
When it comes to the findings, it affirms what was already widely understood to be true from myriad data – that COVID-19 has had a vastly disproportionate effect on BAME communities. It did not, however, explain why that is the case, or how we move forward.
Professor Gurch Randhawa, Professor of Diversity in Public Health and Director of the Institute for Health Research at the University of Bedfordshire, noted that the report fails to make recommendations to improve the situation it documents, despite this being its original brief:
'Sadly, but predictably, the report does a wonderful job of setting out the inequalities experienced by different communities under COVID-19, but that is just about as far as it goes. Unfortunately, the report makes no recommendations as to how the situation should be addressed, even though providing such recommendations was a key part of its original remit.
'The report is completely silent on the obligations of government and other public sector bodies to ensure COVID-19 policy responses adhere to the Public Sector Equality Duty. It is also silent on the urgent need for Equality Impact Assessments to inform all future policy planning to ensure protection for all members of the public, regardless of race or ethnicity.
'This omission can best be described as a lack of humility and honesty in learning from our past actions. It is vital that the government learns lessons from its early missteps in order to prevent a rise in health inequality being one of the principal outcomes of the COVID-19 pandemic.'
In April, WH contributor, Micha Frazer-Carroll, reported on the possible reasons for this disparity. Scroll for her piece.
As the names and photographs of the first UK doctors to die of COVID-19 gradually unfolded on the television screen, myself and my family made one, quiet, uncomfortable observation. None of them were white.
UK confirmed cases of the novel coronavirus have passed the 100,000 mark, and the death toll stands at over 17,000 – although the true figures are likely much higher. And from what we do know, the virus looks to be disproportionately affecting people from Black, Asian and Minority Ethnic (BAME) backgrounds.
Early figures from one study show that while only 13% of the UK population is BAME, we make up 35% of COVID-19 cases in intensive care, and 70% of frontline medical staff deaths. Meanwhile, data analysed by the Guardian and released this week indicates that 'of the 12,593 patients who died in hospital up to 19 April, 19% were BAME.'
This month, Chair of the Council of the British Medical Association (BMA) Dr Chaand Nagpaul called on the government to investigate, after the first 10 doctors in the UK to die from the virus were BAME. He said: 'There is growing evidence that BAME people are disproportionately likely to be exposed to and contract COVID-19, to suffer severely, and to die from the virus' – noting the startling statistics mentioned above. The government has agreed to an inquiry into this phenomenon, though no timescales have been released, yet.
These figures are staggering, and lead us to the question: why do so many people from BAME backgrounds appear to be being uniquely affected by the virus? The full picture is, of course, likely highly multifaceted. But, based on expert opinion and data, the below are possible contributors.
1/ Inadequate housing
Many experts suspect that poverty plays a significant role in the trend – in the UK, it's an uncomfortable truth that people from BAME backgrounds are more likely to be of low socioeconomic status. NHS GP Dr Gero Baiarda explains how living in poverty – specifically living in inadequate housing in densely populated, urban areas – creates conditions where the virus can be contracted more easily.
'Fifteen percent of Black African and 30% of Bangladeshi families live in overcrowded housing, compared to only 2% of the White British population according to government figures. Effective isolation is therefore extremely difficult.'
2/ Working in high-risk jobs
Relatedly, people from BAME backgrounds are more likely to be working in the jobs that are currently keeping society going. Over 18% of the doctors, nurses, porters, cleaners, transport and catering staff who sustain the NHS in this time of crisis are from black and Asian backgrounds. Working day-to-day with critically ill patients, and in many cases with reportedly inadequate protective equipment, makes these workers more likely to be exposed to the virus.
NHS GP Dr Adwoa Danso explains that not only are BAME individuals disproportionately represented among NHS staff, but they’re also more likely to work lower down the ranks. This only increases the risks they face: 'BAME individuals within the NHS are less likely to be promoted compared with their white counterparts [per a 2015 NHS equality analysis.]
'This may affect their pay, and in order to make the equivalent pay, one may choose to work longer hours and undertake less desirable shifts such as those during unsociable hours.'
BAME communities are also largely responsible for keeping things moving on our roads and rails. In London specifically, over 25% of transport workers currently operating our buses and tubes are from BAME backgrounds. Dr Baiarda explains: 'They have done an invaluable job in keeping the capital moving during the pandemic, but in so doing, have been potentially exposed daily to COVID-19 carried by infected but asymptomatic commuters.'
People in this demographic, a professor from University College London (UCL) has said, are also over-represented in things like shop and care work. These are roles that, of course, cannot be done from home, requiring people to be out and about in society and dealing with potential exposure to the virus.
3/ Vitamin D deficiency
A newer theory that has emerged in recent weeks surrounds vitamin D, also known as the 'sunshine vitamin'. Generated from sunlight exposure, vitamin D is crucial to the immune system, as well as healthy muscles, bones and teeth.
Dr Baiarda explains, however, that BAME communities are prone to vitamin D deficiency, because higher levels of melanin in the skin lead to lower levels of vitamin D absorption. This is only exacerbated in colder countries like the UK, which see less sunlight. He believes that there may be a connection between lower levels of the vitamin in BAME communities and higher levels of COVID-19 cases.
There is no firm data to demonstrate this alleged link right now – Dr Alison Tedstone, chief nutritionist at Public Health England, said this month that: ‘There is not sufficient evidence to support recommending vitamin D for reducing the risk of COVID-19'. However, there is a study currently underway at the Universidad de Granada in Spain to investigate a potential relationship between levels of vitamin and susceptibility to the virus, due to an impact on immune system strength.
While this is very much pending, know that the official PHE advice on the vitamin, from 2016, is that 'people who have a higher risk of vitamin D deficiency [including people with dark skin, from African, African-Caribbean and South Asian backgrounds] take a supplement all year round', in order to protect musculoskeletal health. How much? 10mcg, daily.
4/ Discrimination in the health system
Disproportionate BAME diagnoses and deaths also likely point towards larger inequalities that play out in the health system. BAME communities are subject to stereotyping and discrimination within this area as in every other area of life – with stats showing that black people are more likely to die in childbirth in the US and the UK, versus white individuals. American data, meanwhile, has suggested that black people are systemically under-treated for pain, when compared to white people.
These biases likely affect the treatment of black and minority ethnic patients during the pandemic, too. Earlier this month, for example, two French doctors were accused of racism after one suggested on a TV debate that coronavirus vaccines should be trialled 'in Africa'.
Dr Danso points out that instances of medical mistreatment has impacted on our communities’ faith in health services: 'In some BAME communities there’s a distrust of the health system which runs deep'.
5/ The Hostile Environment
Relatedly, Dr Danso raises issues regarding migration. In the UK, the Home Office’s 'Hostile Environment' immigration policy makes public services incredibly difficult to access for many migrants, including refugees and asylum seekers. Within the NHS, the policy requires staff to assess whether patients are UK residents, and migrants can also be asked to pay up-front charges stretching into the tens of thousands of pounds.
Because migrants are disproportionately BAME, members of our communities may be afraid of accessing health services when they experience coronavirus symptoms. Moreover, many migrants lack clear avenues of support through work or benefits, which might lead them to continue to go to work when it is currently unsafe to.
The reasons why people from BAME communities are on the sharp end of the coronavirus crisis are complex and many. As the crisis carries on, we must keep ourselves informed of the symptoms of the virus, practise good hygiene and isolation wherever we can, and, importantly, look out for one another.
But we should also remember that much of the impact on BAME individuals is likely to do with racism more broadly in our society; and to keep our communities safe, we must seek to tackle that at every turn.
What are the symptoms of COVID-19?
According to the NHS website, the primary symptoms of coronavirus are:
- A fever
- A new, consistent cough
Other coronavirus symptoms that have been reported include:
- Tiredness or fatigue
- A headache
- Shortness of breath
- A loss of smell or taste
- Muscle pain
What should you do if you have symptoms of COVID-19?
If you have symptoms of coronavirus you should use the NHS 111 Coronavirus service online. People are being urged to only call 111 if they cannot get help online.
To avoid infecting others, do not go to a GP surgery or pharmacy if you suspect you have coronavirus.
If you need urgent medical help that you cannot get online, call 111. In an life-threatening emergency call 999 for an ambulance.
Disclaimer: The information in this story is accurate as of the publication date. While we are attempting to keep our content as up-to-date as possible, the situation surrounding the coronavirus pandemic continues to develop rapidly, so it's possible that some information and recommendations may have changed since publishing. For any concerns and latest advice, visit the World Health Organisation. If you're in the UK, the National Health Service can also provide useful information and support, while US users can contact the Center for Disease Control and Prevention.
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