Whilst there is still a lot more to learn about COVID-19, throughout the pandemic we have found that the virus disproportionately affects different demographics. Not surprisingly the virus is more lethal to those over 65 and also to those with serious underlying health issues. More interesting is the fact that men are more vulnerable to the virus than women.1 However, one portion of the British population that has been hardest hit is the Black, Asian and Minority Ethnic (BAME) communities. This article will look at possible reasons as to why this might be, as well as ways in which this could be mitigated.
According to a recent analysis conducted by University College London (UCL) on NHS data, BAME groups are two to three times more likely to die from COVID-19 than the general population. Specifically, UCL found that the risk to Black Africans was 3.24, Pakistanis 3.29 and Bangladeshis 2.41 times higher than the general population, with Black Caribbeans and Indians at 2.21 and 1.7 times higher respectfully.2 Further to this, medical journal The Lancet found that up to April 22nd, in the UK two-thirds of COVID-19 fatalities among health workers were in BAME groups.3 Despite these concerning figures, Nuffield Trust has pointed out that comparisons between ethnic groups are hard to make due to the COVID-19 pandemic not being evenly distributed across the country. The organisation also noted that from March to the end of April, London and the Midlands accounted for 45% of reported COVID-19 deaths, but also have a higher-than-average number of people from BAME groups, therefore presenting the possibility for skewed data.4 Globally this uncertainty in data has been compounded with the Lancet reporting that as of the date of publication (21st April 2020) only 7% of publications reported ethnically disaggregated data, and of the two that did, both did not specify the role of ethnicity in their outcomes. The report also found that, at time of publication, ‘none of the ten highest COVID-19 case-notifying countries reported data related to ethnicity’.5 However, more than enough data is available to show that the effects of COVID-19 have been disproportionate on BAME groups. Why is this?
A report jointly published by the Usher Institute and the University of Edinburgh identified ethnic inequalities in health, housing and employment as factors that make minority populations ‘more susceptible to illnesses’.6 Further to this, it is widely documented that higher rates of comorbidities are found in specific ethnic groups such as diabetes, hypertension and cardiovascular diseases, which increases the likelihood of COVID-19 being fatal.7 In addition to this, the Lancet has also pointed out ‘cultural, behavioural and societal’ differences which exacerbate the lethality of the virus such as ‘health-seeking behaviour and intergenerational cohabitation’.8 As touched upon in the introduction, London and the Midlands have been hotspots for COVID-19 cases and also contain areas with ‘overcrowded9’ households. BAME households are more likely to be overcrowded than white households, in part due to the increased likelihood of intergenerational cohabitation.10 According to government figures, 30% of the UK Bangladeshi population live in overcrowded housing, along with 16% of Pakistanis and 15% of Black Africans.11 Overcrowding means that those who are ill have limited means to self-isolate whilst also meaning that a greater number of people can become infected.
The fact that BAME populations are more likely to have ‘precarious employment’ or work in public-facing roles meaning that positions where working from home is a possibility is much less likely, thus further increasing the impact COVID-19 has on BAME groups.12 According to a report by Improvement Service the BAME population are more likely to work in jobs that hold a higher risk of exposure such as cleaners, public transport and retail – many of which deemed as ‘key workers’ by the government.13 14 The report also states that 40% of doctors and 20% in the NHS are people from BAME groups with 17% of the social care workforce comprising people from BAME backgrounds.15 A large proportion of the doctors, according to the Lancet work in ‘staff grade, specialist, and associate specialist roles, which are crucial, patient-facing roles’.16 In addition to the already high-level of exposure experienced by doctors, the exposure to BAME doctors, and the possibility of infection, has the potential to be much higher as, according to the Royal College of Psychiatrists, using data from a survey conducted by BMA, ‘BAME doctors were twice as likely as white doctors to feel pressured to see patients in high-risk settings without adequate personal protective equipment’. The same report also found that BAME doctors were twice as likely as their white colleagues to not feel confident raising concerns about safety in the workplace.17
Ways in which to mitigate this impact on the BAME population should be looked at as a matter of urgency, and the government have already announced a formal review into the disproportionate impact of COVID-19 on people from BAME groups. The review will be led by Public Health England and the NHS, and will also look into the effect gender and obesity has on the severity of the virus.18 19 20 In anticipation of the government’s findings on the impact of COVID-19 on BAME groups in the UK, the Royal College of Psychiatrists report on the matter also included ideas for how the virus’ impact could be mitigated. Many of the ideas posited by the organisation were of a practical nature and included such actions as staff testing, using PPE as a priority and social distancing – measures which have already been proven effective in combating COVID-19. The report also suggested that older, male BAME staff should consider redeployment to lower risk areas if possible.21 However, the report also suggests changes at an institutional level to mitigate the disproportionate impact of COVID-19 on the BAME population. These measures included the need for greater BAME staff engagement and more inclusive leadership, as well as a greater focus on psychological safety, staff wellbeing and support.22 It is integral that these suggestions of institutional change are considered seriously as, not only will they create an effective measure when combatting the current pandemic, they will also form the groundwork for a more effective economic recovery and allow the country to better deal with future health scares. These measures would likely bring about better integration and cooperation, as well as creating the means for a better relationship between the leadership and ground levels. The measures suggested by the Royal College of Psychiatrists may go a long way in giving BAME staff the confidence to voice their concerns over equipment and safety practices, which have contributed to the lethality and prevalence of COVID-19 within BAME communities. Whereas material and practical needs create short-term solutions to the COVID-19 problem, increased staff engagement, inclusivity and psychological wellbeing would likely ensure long-term solutions to present and future issues.
As documented, underlying health issues, housing situations and employment situations seem to be factors in why the impact of the COVID-19 pandemic is having a greater impact on BAME groups, among other factors. However, and as research also suggests, many of these issues may have been further aggravated by institutional inequalities which seem to exist and seem to be felt far more greatly by those in BAME groups and need to be addressed.