The report which reviews why black, Asian and minority ethnic (BAME) people may be disproportionately affected by Covid-19 by Public Health England (PHE) has confirmed what was already known - that racial and health inequalities amplify the risks of Covid-19.
Those in the poorest households and people of colour are definitely disproportionately affected than White ethnic groups and those living in deprived areas, with the Bangladeshi community being the hardest hit. However they have failed to answer how to reduce this disproportion and mitigate risks.
These findings largely replicate existing inequalities in mortality rates in previous years, except for BAME groups, as mortality was previously higher in White ethnic groups. These analyses take into account age, sex, deprivation, region and ethnicity, but they do not take into account the existence of comorbidities (combination of pre-existing factors such diabetes, hypertension, obesity etc), which are strongly associated with the risk of death from Covid-19 and are likely to explain some of the differences.
Professions such as those in a range of caring occupations including medics, social care and nursing auxiliaries and assistants; those who drive passengers in road vehicles for a living including taxi and minicab drivers and chauffeurs; those working as security guards and related occupations are more disproportionately hit.
The highest age standardised diagnosis rates of Covid-19 per 100,000 population were in people of Black ethnic groups (486 in females and 649 in males) and the lowest were in people of White ethnic groups (220 in females and 224 in males).
An analysis of survival among confirmed Covid-19 cases shows that, after accounting for the effect of sex, age, deprivation and region, people of Bangladeshi ethnicity had around twice the risk of death when compared to people of White British ethnicity. People of Chinese, Indian, Pakistani, Other Asian, Caribbean and Other Black ethnicity had between 10 and 50% higher risk of death when compared to White British.
On Monday the Sky News reported that sources said the delay in publishing this report due on 31 May, was related to the ‘close proximity to the current situation in America’, where protests are flaring following the killing of George Flyod, a black man in the US by a police officer. The social media has been taken by storm as hashtags #blacklivesmatter, #notoracism and #icantbreathe gain momentum, as many took to the streets of London to show solidarity. The Labour party emphasised that the BAME review becomes more relevant now.
Critcism from organisations and politicians
Dr Chaand Nagpaul, BMA council chair, said, “The BMA first called for a review at the beginning of April in order to understand why there were such disproportionate deaths and serious illnesses in BAME healthcare workers and in the community, and so that action could be taken protect them. Two months later, this report is a missed opportunity.
“It is a statistical analysis, which while important, gets us no closer towards taking action that avoids harm to BAME communities.
“More specifically, the report fails to mention the staggering higher proportion of BAME healthcare workers who have tragically died from Covid-19 – with more than 90% of doctors being from BAME backgrounds. The report has also missed the opportunity for looking at occupational factors; the BMA was clear we needed to understand how job roles, exposure to the virus and availability of PPE were risk factors.
“The BMA and the wider community were hoping for a clear action plan to tackle the issues, not a re-iteration of what we already know. We need practical guidance, particularly in relation to how healthcare workers and others working in public-facing roles will be protected.
“With the global conversation so focused on inequalities and discrimination it is for the Government to instill confidence that all people will be protected equally. We need action, and we need action now.”
Dr Ramesh Mehta from BAPIO speaking to Asian Voice exclusively said, “I am pleased that the government ordered the review, however unfortunately the outcome is not helpful. We as a organisation have done two surveys. First survey revealed BAMEs irrespective of other comorbidities. Ethnicity itself was a factor for having Covid-19. The PHE report is not saying anything new and we are not sure how is it going to be useful to the government.
“We need some constructive work to ensure that the high morbidity and mortality of BAME population cannot continue as it is. Although the curve is flattening, it is highly likely there will be a second wave of Covid 19. We hope in the second wave, there is significant protection for the BAME population.
“We will raise this issue again with the government. We are embarking on solution through research – why the mortality among BAME population is high, especially among healthcare workers, who have a very high proportionate number of deaths.”
Marsha de Cordova MP, Labour’s Shadow Women and Equalities Secretary said, “This review confirms what we already knew - that racial and health inequalities amplify the risks of Covid-19. Those in the poorest households and people of colour are disproportionately impacted.
“But when it comes to the question of how we reduce these disparities, it is notably silent. It presents no recommendations. Having the information is a start – but now is the time for action.
“The Government must not wait any longer to mitigate the risks faced by these communities and must act immediately to protect BAME people so that no more lives are lost.”
Liberal Democrat Health, Wellbeing and Social Care spokesperson Munira Wilson MP said,"The findings from the report showing that BAME people are being disproportionately affected by the coronavirus crisis are incredibly worrying and confirm what was tragically already obvious. Many of the consequences of the pandemic are exacerbated by the existing inequalities in our society, yet this report does little to address those issues.
"People from BAME communities, due to socio-economic inequalities and health inequalities, face an increased risk of contracting the virus. However, this report has failed to analyse those important issues and fails to provide proper recommendations. We need urgent action from the Government to stem the tide of the disproportionate number of BAME people losing their lives to coronavirus.
"The Government must come forward and explain what it will do to try and tackle the factors contributing to this inequality. We know that people from BAME groups make up a significant percentage of those working on the frontline and in other key worker roles, yet this Government has utterly failed to properly protect them from the virus. Ensuring they have proper protective equipment and access to testing would be a good place to start."
Data collected in hospitals only
When this data was analysed, the majority of testing had been offered to those in hospital with a medical need. Confirmed cases therefore represent the population of people with severe disease, rather than all of those who get infected. This is important because disparities between diagnoses rates may reflect differences in the risk of getting the infection, in presenting to hospital with a medical need and in the likelihood of being tested.
As the numbers of new Covid-19 cases decrease, monitoring the infection among those most at risk will become increasingly important. It seems likely that it will be difficult to control the spread of Covid-19 unless these inequalities can be addressed.
Occupation not considered?
The report was meant to probe into the disproportionate deaths in the BAME community as 11 out of 12 GPs who have died with Covid-19 in England so far were of BAME origin and practices have been told they should risk assess stuff. But the analyses were not able to include the effect of occupation. This is an important shortcoming because occupation is associated with risk of being exposed to Covid-19 and we know some key occupations have a high proportion of workers from BAME groups.
These analyses were also not able to include the effect of comorbidities or obesity. These are also important factors because they are associated with the risk of death and are more commonly seen in some BAME groups. Other evidence has shown that when these are included, the difference in risk of death among hospitalised patients is greatly reduced.
NHS England released updated guidance on risk assessment of BAME workers last week, but has not endorsed a specific risk scoring tool. GPs in Manchester have developed their own scoring system, and primary care experts have supported the suggestion to move away BAME staff from patient facing roles. Speculations suggest that BAME community may face higher chances of Covid-19, due to various underlying health issues which includes Vitamin D deficiency, obesity, hypertension, heart diseases and diabetes.
A study by Surrey and Southampton Universities revealed that people who are overweight or obese and have darker skin tones could be at greater risk of catching Covid-19. It has also been found that vitamin D levels are crucial to determine the effect of coronavirus within the community. Among the Asians, so far the highest number of deaths has been in the Asian community.
Dr Sreedhar Krishna, who is a Consultant Dermatologist in Croydon University Hospital, has a MPhil degree in Public Health in University of Cambridge and researched on the effects of physical inactivity on the risk of heart attacks. He has also published on the relationship between obesity and high blood pressure in Gujaratis. Speaking to Asian Voice, Dr Krishna said, “While this is undoubtedly important work which highlights the adverse health outcomes experienced by BAME communities, I cannot help but feel that it doesn't tell the whole story. Due to the woeful testing capacity up until quite recently, many cases of Covid-19 are not recorded in official data - thus any conclusions drawn are lacking given that we are not dealing with the entire dataset. We still don't have a good handle on the effect of other illnesses (e.g. diabetes) on the risk of dying. Furthermore, many who live in vulnerable populations (e.g. migrant workers living in overcrowded properties or hard-to-reach groups) are not adequately covered by this report.
Members of minority ethnic groups in the UK often have lower socioeconomic status, which is in turn associated with a greater risk of obesity in women and children.
Dr Krishna added, “Moreover anyone from the ethnic minority is disproportionately represented in frontline roles such as medics, retails or in transport. If you are not given PPEs, people from ethnic minority are less likely to report about it. It is often cultural as we don’t want to disrespect higher authority. As an ethnic group, we don’t make enough fuss, even when we should.”
Rehana Azam, GMB National Secretary, said, “Matt Hancock has lost valuable time by commissioning a report on facts that were already in the public domain. Either Black and Minority Ethnic lives matter or they don’t, and Ministers have lost valuable time in commissioning a report that doesn't set out how working lives are to be protected.
“This report confirms what we already knew – BAME workers have made a disproportionate sacrifice during this pandemic. In the context of global events, with the spotlight on structural and institutional racism, the publication of this report which carries no recommendations is just going to heighten distrust of the claim that all lives matter to the government.
“People are dying and Ministers have been too slow to protect lives. They say that this virus doesn’t discriminate, but the response to this virus and the lives it has taken most definitely experienced a discrimination that ended in their deaths.
“No plan is in place that gives confidence that the government is going to protect lives of people disproportionately impacted by this terrible disease. That’s why GMB has joined the call for an independent public inquiry into the government’s response.”
Silver Star Diabetes calls for submissions for further review
A National Charity dedicated to raising diabetes awareness in the UK and abroad has welcomed Prime Minister Boris Johnson's decision to ask PHE to carry out a review into the disproportionate impact of the coronavirus on BAME communities in the UK and it has noted the results of the review.
Silver Star Diabetes has asked Dr Radhika Balu, the Clinical Director of Harrow CCG and working at the Covid-19 hub at Harrow to Chair a Committee that will co-ordinate submissions sent to the Charity. An analysis of the findings will be submitted to the Equalities Minister Liz Truss. Other members of the Committee will include Nura Ali from Birmingham and Ravi Premananthan from North London. BAME Communities who have had experience of Coronaviris will be asked to send in their comments to Silver Star Diabetes which will form part of the Submission.
Dr Radhika Balu said "I am delighted to lead this important initiative on behalf of the Charity and submit the findings to The Equalities Minister. The NHS Review was important but more work needs to be done.”
Silver Star Diabetes was founded 10 years ago by Rt Hon Keith Vaz and has amongst its patrons Amitabh Bachchan and Rev Jessie Jackson. Submissions can be emailed to [email protected].
