A new study has found that racism and social inequality have contributed to the increased risk of Black, Asian and minority ethnic communities (BAME) contracting and dying from Covid-19. On Tuesday 16thJune, Public Health England (PHE) finally released a complete report confirming that disproportionately higher number of BAME individuals died of Coronavirus. The complete report was released as Asian Voice went to press and after it emerged that some pages were missing from the original review published last week.
Besides highlighting that ‘structural racism and social inequality’ were primary factors for higher BAME deaths, the new report also incorporates recommendations from the PHE about measures that ethnic minorities must take to prevent themselves during the pandemic.
The stakeholders pointed to racism and discrimination experienced by communities and more specifically by BAME key workers as a root cause affecting health, and exposure risk and disease progression risk. It said, “Racial discrimination affects people’s life chances and the stress associated with being discriminated against based on race/ethnicity affects mental and physical health. Issues of stigma with Covid-19 were identified as negatively impacting health seeking behaviours. Fear of diagnosis and
“Once infected, many of the pre-existing health conditions that increase the risk of having severe infection are more common in death from Covid-19 was identified as negatively impacting how BAME groups took up opportunities to get tested and their likelihood of presenting early for treatment and care. For many BAME groups lack of trust of NHS services and health care treatment resulted in their reluctance to seek care on a timely basis, and late presentation with disease.”
The British Medical Association (BMA) has been asking the government why higher number of BAME NHS staff died of coronavirus. Commenting on the new report, Chaand Nagpaul, Council Chair of the BMA said,“Now that the second part of the PHE report with recommendations has been fully published we must see urgent and tangible action.
“This pandemic has brought to sharp focus the longstanding inequalities affecting BAME communities in this country, with greater numbers of people from a BAME background living in deprived areas and overcrowded housing, and a higher proportion as key workers that exposed them to the virus and who were often not provided with necessary protections.
“As recommended in the report, the BMA believes that comprehensive data collection, risk assessments that recognise ethnicity as a potential risk factor and the use of culturally appropriate education and prevention campaigns, to name just a few, will be key in protecting those most at risk from this deadly disease - indeed we have long been calling for such measures.
“The Government who commissioned this review must now produce a clear action plan with timescales of how these recommendations will be implemented. The time for reviews, reports and commissions is over. What matters now is that the ministers must act swiftly to provide fair protection to people from ethnic minority backgrounds and to address the socio-economic and racial inequalities that have pervaded our nation for far too long.”
The government has been dodging questions about institutional racism now prevalent within the NHS. In the aftermath of the Black Lives Matter protests, the question has become more pronounced. Yet, Health Secretary Matt Hancock is quick to insist that the UK has one of the “most diverse cabinet” in history under Boris Johnson with names such as Rishi Sunak and Priti Patel securing top cabinet positions. In his interview to Sophy Ridge, he said,
“We’ve a whole series of people from a black and minority ethnic background... the two cabinets I’ve sat in... listens to a diversity of views and it’s diversity of thought that is the really important thing.”
Mirza appointed for the formation of racial inequalities commission
On the contrary, however, Downing Street has appointed Munira Mirza, for the formation of the commission assessing racial inequalities. Mirza has previously questioned if at all there was any form of institutional racism in the UK. It is now, believed that Trevor Phillips can be recruited as part of the commission. Former chair of the Equalities and Human Rights Commission, Phillips had previously referred to Muslims as being a “nation within a nation”.
But the first report published by the PHE had already noted that “historic racism and poorer experiences of healthcare or at work” meant BAME people were susceptible to seeking adequate care from the NHS. The report had also underlined that members of the BAME community were sceptical of visiting the hospitals for fear of deportation. This is a similar concern echoed for the implementation of the contact-tracing track and trace program which can violate privacy and data sharing regulations.
Commenting on the new report, Liberal Democrat Home Affairs Spokesperson Christine Jardine said, “It is appalling that the Conservatives’ discriminatory Hostile Environment policies and their refusal to suspend the ‘No Recourse to Public Funds’ rule are preventing migrants and other BAME people from accessing the healthcare they need during this pandemic.
“If the Government is serious about tackling racial injustice, the Home Secretary must end the Hostile Environment and give migrants access to Universal Credit during this crisis.”
New recommendations for the BAME community
Now, the new report recommends the following:
- Mandatory collection of ethnicity data at death certification, and ensure that data are readily available to local health and care partners to inform actions to mitigate the impact of Covid-19 on BAME communities.
- Support community participatory research to understand the social, cultural, structural, economic, religious, and commercial determinants of Covid-19 in BAME communities, and to design programmes to reduce risk and improve health outcomes.
- Improve access, experiences by BAME communities including: regular equity audits; use of health impact assessments; good representation of BAME communities among staff at all levels
- Accelerate the development of culturally competent occupational risk assessment tools that can be employed in a variety of occupational settings and used to reduce the risk of employee’s exposure to and acquisition of Covid-19 especially for key workers working with a large cross section of the general public or in contact with those infected with Covid-19.
- Fund, develop and implement culturally competent Covid-19 education and prevention campaigns, working in partnership with local BAME and faith communities to reinforce individual and household risk reduction strategies, reinforce messages on early identification, testing and diagnosis; and prepare communities to take full advantage of interventions including contact tracing, antibody testing and ultimately vaccine availability.
- Accelerate efforts to target culturally competent health promotion and disease prevention programmes for non-communicable diseases promoting healthy weight, physical activity, smoking cessation, mental wellbeing and effective management of chronic conditions including diabetes, hypertension and asthma.
- Ensure that Covid-19 recovery strategies actively reduce inequalities caused by the wider determinants of health to create long term sustainable change.
Commenting on these recommendations, Professor Raj Bhopal, an emeritus professor of public health, from the Usher Institute, at EdinburghUniversity, told BBC News: "We need to have cultural sensitive message, but if you look at our press briefings, it is not culturally sensitive. No message is ever given out in any language other than English. The message does not reflect the diversity of this country.
“Get better workplace risk assessment for minorities, specially assessed PPEs, training how to use them and minorities often are the front face of our society. Everyone needs workplace assessment but priority is BAME community at the moment.”
Report is ‘a whitewash’
Barring clause 4 however, most of these recommendations have already been in place and are required to be implemented within the health administration. Speaking to the Asian Voice, Dr Ramesh Mehta OBE, National Chairman of BAPIO, said,“This report is again a whitewash of the facts. BAPIO had conducted a survey of healthcare workers in early stages around mid-April. We discovered that ethnicity itself is an independent factor besides comorbidities or other social status. This paper is not mentioning that.
“Second, 70-80% of frontline healthcare workers are of BAME origin, while only 35% are NHS staff, the paper also ignores that fact.
“Third, the bullying and harassment of healthcare workers, forced to work in the frontline without proper PPE, has also not been mentioned!
“BAPIO has been raising these issues for a while. We have written to every single Trusts that BAME healthcare workers should have proper risk assessments. It has still not being carried out. Still proper PPEs are not available. It is very unfortunate that ‘spade is not called spade’ and BAME frontline workers especially BAME staff are thrown in the war without proper equipment.”
Children are not addressed
The report however, fails to make any observations around the long-term and sustained impact of coronavirus on children from BAME backgrounds.
As part of the initial response to the pandemic the statements released from ’The Royal College of Paediatrics and Child Health’ said that most children and teenagers do not become seriously ill with Covid-19. But now with the dynamic experience and knowledge doctors are seeing a very small number of patients with an unusual condition which seems to be linked to the virus. This syndrome is very rare, and most children will not be seriously affected. In April, however doctors in the UK reported cases of serious illness in around twenty young patients, some of whom needed to be treated in intensive care.
The children had serious inflammation throughout their body. Inflammation is a normal response of the body’s immune system to fight infection. But sometimes the immune system can go into overdrive and begin to attack the whole body and if this happens, it is important to have a heightened awareness so that these children can receive urgent medical attention.
Doctors are concerned of the disease heterogeneity and in severe cases of PIMS the inflammation spreads to the blood vessels (vasculitis), particularly those around the heart. If untreated, the inflammation can cause tissue damage, multi-organ failure or even death. Some of the symptoms of PIMS can overlap with other rare conditions, such as Kawasaki disease and Toxic Shock Syndrome. Some people have referred to the condition as ‘Kawasaki-like disease’. Like PIMS, complications from Kawasaki can cause damage to the heart. Kawasaki tends to affect children under five whereas PIMS seems to affect all ages, but mostly older children and teenagers.
Dr Prabu Rajendran, an NHS Paediatrician speaking to Asian Voice newspaper said, “It is unfortunate that the recent PHE report, Impact of COVID-19 on BAME groups does not talk about the effect of Covid-19 on children, especially from the BAME community.”
“Official data from Great Ormond Street Hospital (GOSH) has pointed out that 87% of children treated for this syndrome are BAME, though children themselves as a risk of transmission is very low, only 52% when compared to an adult.”
However, an open letter by the UK paediatricians about the return of children to schools said, “As paediatricians we are increasingly concerned by the continued absence of millions of children from schools. This interruption is without precedent and risks scarring the life chances of a generation of young people. Clinically, most young people have been spared the worst effects of Covid-19 but the health and social impact will be severe. The brunt of the impact of Covid-19 is and will continue to be borne by children and families who have the fewest resources and need the most support. The attainment gap was significant long before the pandemic.
“Children from disadvantaged backgrounds are twice as likely to leave school without national qualifications in English and maths compared with better off peers. Left unchecked, Covid-19 will exacerbate existing problems and deepen structural social and health inequalities. School is about much more than learning. It is a vital point of contact for public health services, safeguarding and other initiatives. This includes access to mental health support, vaccinations, special therapies, free school meals, physical activity and early years services that help children get the best start in life. For many children and their families, these interventions are the difference between surviving and thriving. In their absence our already frayed safety net cannot function, and we risk failing a generation.
“We recognise the efforts of school leaders, local authorities, teachers and other professionals, who have worked tirelessly to facilitate learning for our children and young people. They deserve decisive leadership from the top of government. We note that plans have been published for children to begin returning to school in Scotland and Wales. We call on the UK government and the Northern Ireland Executive to urgently publish clear plans for getting children back to school; and for all UK governments to deliver recovery plans for children and young people. Without such action, the effects of Covid-19 will linger far beyond the pandemic itself and will limit the life chances of children and young people for years to come.”
Dr Rajendran added, “The debate about the reopening of schools has become polarised. We all agree that children and young people have a right to a school-based education. It is equally right that teachers and parents feel reassured and have confidence in official guidance. We won’t have a clear answer to many questions for some time, and it is impossible to choose a date that does not involve a serious conversation about balancing priorities and mitigating risks. There is little doubt that the balance of risks for children and young people is that a return to school is in their best interests. Getting back to school is particularly important for those children and young people we class as vulnerable. Whether reopening schools presents a risk to adults and the broader population R number is much more uncertain, although there are very encouraging signs from other European countries that have begun to open schools. We regret the division and polarisation on this issue, the road ahead is a long one with many difficult choices and questions ahead. It is vital that we work together to build trust and find consensus.
“The UK Government has advice on ‘shielding’ during the Covid-19 outbreak, to protect those ‘clinically extremely vulnerable’ at very high risk of severe illness from coming into contact with the virus. This definition applies to a small number of children, and they will most certainly be known to specialist children’s services. The majority of children with conditions including asthma, diabetes, epilepsy, and kidney disease do not need to continue to shield and can return to school as it reopens.
“There are a group of children who are known to specialist services (in secondary and tertiary care) for their underlying condition where it will be important to have a discussion between the clinician, the child and their family to determine the right course of action. Such conversation will need to weigh up the clinical risk for that child on balance with the consequences of the child missing out on attending school. The vast majority of children who don’t require shielding will benefit from returning to school. This includes children who are ordinarily under the care of their GP.”
Government’s U-turn on free school meals
The government has been insisting for the re-opening of the schools. But at the same time, it was reluctant on the continuation of the free meals scheme in the schools. In her column in Huffington Post, Tulip Siddiq, wrote, “Food insecurity has doubled in this pandemic, and we know that more than 200,000 children have skipped meals that their parents couldn’t afford to pay for. I dread to think about the fact that this is only going to get worse over summer as the full economic impact of Covid-19 starts to bite.”
Later Boris Johnson announced a humiliating U-turn over free school meals for the poorest families over the summer with a new £120m voucher scheme after pressure from footballer Marcus Rashford. All the above only shows that the UK continues to have a racism problem.
