A recent report published in the Lancet medical journal, that explores ‘Ethnic differences in SARS-CoV-2 infection and Covid-19’ has revealed that in UK’s second wave of coronavirus (from September to December 2020), the South Asian communities were more likely to test positive for Covid, become severely ill and die than any other minority ethnic groups.
Though other minority ethnic groups did better, all minority ethnic groups had a higher risk than the white community of testing positive for Covid, ending up in hospital, being admitted to intensive care, and dying, after accounting for any underlying health conditions.
One must never forget that the first ten doctors who died with coronavirus in Britain were from ethnic minorities, including Jitendra Rathod, Mohamed Sami Shousha, Alfa Sa’adu and Syed Haider.
In the UK, new ethical guidance from the British Medical Association also suggested that if the situation is grave enough, it might be necessary to prioritise essential workers over saving commoners fighting the virus in hospitals.
However, that guidance was also very clear that if such a step were necessary, it should not be for doctors to decide: the government would need to indicate clearly what categories of workers were essential and should be favoured. No such decision has been made to date.
It was utterly disappointing to see that even after the exodus of South Asian doctors from the NHS citing institutional racism and poor work culture the situation remained the same. According to a letter written by Doctors, nurses and NHS bosses on behalf of 1.4m workers to Boris Johnson, there are almost 90,000 vacancies at NHS England, while sickness and stress may prompt more to leave.
Last year, a report by the Royal College of Physicians (RCP), which represents 30,000 of the UK’s hospital doctors, found that ingrained “bias” in the NHS made it much harder for BAME doctors to become a consultant compared with their white counterparts.
‘One-size fits all’ approach does not work
The Lancet medical journal has categorically reported the “Ethnic differences in SARS-CoV-2 infection and Covid-19” and it further mentions that, to improve Covid-19 outcomes, we urgently need to tackle the wider disadvantage and structural racism faced by these communities, as well as improving access to care and reducing transmission.
Dr Chaand Nagpaul, BMA chair of council, in an exclusive interview told Asian Voice, “This study shows that even though disparities for many ethnic minority groups have improved, worryingly infection rates, ICU admissions and deaths from Covid remain much higher among South Asian communities.
“This paper also demands that we need to take a much more granular approach to addressing race disparities with culturally competent policies that factor in specific ethnic minority groups. We know there are structural and socio-economic factors which impact adversely on the South Asian community including exposure to the virus through working in key and public facing jobs, language barriers, overcrowding in homes and living in multigenerational households, as well as variations on vaccine uptake.
“There must be no ‘one-size fits all’ approach to tackling race inequalities. The government must develop solutions that consider the specific circumstances, socio-economic factors and experiences of those from south Asian communities and form public health policies and messaging that is tailored to their needs, and which commands their trust and confidence.”
Dr Ramesh Mehta, Founder and President BAPIO agrees that structural racism exists. “That’s very unfortunate and we know the extra impact of Covid on the South Asian population because of discrimination and racist practices. The second wave is not going to go away quickly, but fortunately Covid has revealed this problem. I believe that the government is keen to take steps to tackle this problem,” he told Asian Voice.
“It is imperative to follow the basic requirement of avoiding the jab. It is wearing the mask, washing hands, and keeping a safe distance. Of course, if there are symptoms, we need to get immediate help, a lot of morbidity happens amongst those who have associated conditions like obesity, diabetes, and heart disease. So, it is very important to ensure that people take proper precautions to control these health conditions,” Dr Mehta added.
He further said, “Vaccination is one of the most important things. We believe it is going in the right direction. We know that there are some pockets of resistance against vaccination amongst the South Asian population. We have translated the advice for vaccination in different languages to ensure that people understand the importance of the vaccine.”
Yet, many South Asians live in a multigenerational setting which may not be the best way in the time of social distancing. “The socio-economic status of the family is a problem. For it to improve it’s going to take a long time,” said Dr Mehta. “We are aware of government efforts to improve the employment of people from the ethnic communities. We do believe that joint family is important and there should be opportunities for people to live in the joint family. Having said that we cannot be careless, and life cannot be the same as it was before Covid. If people want to move back to the joint family, the most important thing is the second dose of vaccine. And at least three weeks after the second dose of vaccine. Even when that’s done, please follow a safe distance at home and wash hands, wear a mask.”
Encouraging leadership positions to formulate policies
Speaking to Asian Voice about this report, Dr Rakesh Sharma, Clinical Advisor/ Lead MH NHS East Lancashire said, “Ethnic minority doctors and staff should be encouraged to take up leadership positions so that the administration which formulates policies, is inclusive. Recently commissioned report to look at discrimination has rightly received lot of criticism and this should be addressed as well. The biggest protective factor against catching Covid is increasing vaccination by reducing vaccine hesitancy, setting up vaccination centres in places of faith and religious activity, community centres etc and letting role models and leaders of the community to dispel myths using national TV and other media channels.”
Dr Irtiza Qureshi, Visiting Academic - Institute for Health Research, University of Bedfordshire, said, “We don't need to cut off from our loved ones. However, we do need to continue with sensible behaviour around hand hygiene, use of masks, social space, especially as restrictions lift from 17 May and even more so from 21 June.
“Local Government should be supported to work with local communities in co-creating culturally tailored interventions. By this, I mean Public Health teams in Local Authorities should be supported to engage with trusted members of local communities (not just the usual suspects) to help develop key messages around Covid-19 and they should be supported to deliver those messages to the community via community spaces and community media.
“Unfortunately, structural racism and inequality is deeply embedded within many institutions, and to tackle some of the specific consequences such as health outcomes, further national changes are required across education, criminal justice, health and care sectors. This requires long term political courage and commitment.”