BAME Communities & COVID-19: Why this cannot be ignored

The coronavirus does not discriminate between individuals. It can affect anyone and no one is immune from its impact. However, recent data suggests that the severity of the COVID-19 infection amongst the Black And Minority Ethnic (BAME) population is disproportionate.

What is the problem?

• Data from the Intensive Care National Audit and Research Centre (ICNARC) suggests that 34% of the critically ill coronavirus patients are from BAME backgrounds. This research was based on 3300 patients from ICUs across England, Wales and Northern Island.

• The first 10 doctors to die in the UK from COVID-19 were all BAME. 70% of the 54 front line healthcare workers that have died in the UK because of COVID-19, were BAME. These numbers worsen on a daily basis. According to the 2011 census, just 14% of the UK population are from BAME backgrounds.

• In the US, both the overall number of confirmed cases and deaths is broken down by ethnicity. In Chicago, approximately 70% of the coronavirus victims were black, despite black people representing only a third of the population. Similar numbers have also been seen in New York, Detroit and New Orleans.
  

What could be the reasons?

Several reasons could be underpinning this, but we know that Coronavirus has amplified the racial and economic disparities that still sadly exist in our world today.

The Science

It is widely known that certain diseases are more prevalent in particular ethnic groups. Although the precise mechanisms are unclear, it is likely that genetics play a huge part. For example, people from Afro-Caribbean or Asian descent are more likely to suffer from cardiovascular disease and diabetes than their European counterparts. Two conditions that have been shown to be associated with more severe outcomes from COVID-19. Although the direction of cause and effect is yet to be determined, many healthcare professionals attribute the racial disparity of COVID-19 deaths to this reason. Additionally, the biopsychosocial effects of racism may lead to high levels of stress, which is a known risk factor of hypertension and as a result, cardiovascular disease. This suggests that the increased prevalence amongst the BAME community may be the result of a complex interaction between genetics and environmental factors; wherein a genetic component is further exacerbated by social stressors. There may indeed be genetic differences or factors of genetic susceptibility, however this disproportionality is occurring across different ethnic groups; making a genetic cause less likely. This highlights the pressing need for further research before any solid conclusions can be made. Nonetheless, we must not forget that the overwhelming determinants of health are socially created.

Determinants of Health

Socio-economic factors

UK BAME communities rank poorly in socio-economic indicators of poverty and deprivation; an outcome of longstanding structural inequalities in Britain as well as the institutional racism in government policies relating to immigration, housing, criminal justice and social welfare support. A large proportion of the BAME population having public facing occupations. They make up a large share of jobs considered essential in tackling the virus, the very roles that are making our self-isolating process more manageable; from the essential cleaners to the healthcare professionals; customer assistants in our local supermarkets to delivery staff, transport workers and many more. However, this means that the racialised aspect of the crisis is further compounded. So whilst many of us are able to stay at home, they cannot. Therefore, their risk of contracting the virus is substantially greater.

Cultural differences

Another factor to consider is different cultural beliefs and behaviours. Amongst BAME communities there is a stronger culture of multi-generational living. This is when multiple generations in a family live in the same home. As a result, there is over-crowding in households and under recent circumstances, places the elder population and those with co-morbidities at a greater risk. Researchers at the University of Oxford have suggested that this factor contributed to the accelerated spread and crisis in Italy, as a large proportion of their population are elderly and people are more likely to live with their grandparents.

The message needs to be clear. Is enough being done to ensure that everyone is fully receiving and comprehending the guidance that is out there?

Is the information being translated for those whom English is not their first language? Due to new policies in preventing the spread of disease, family members are no longer allowed to visit their relatives in hospitals and therefore are not able to assist in translating. As many of our readers are BAME healthcare professionals, it is key that we use our voices to properly educate our families, friends and our respective communities and debunk the many, many myths (many of which are arising from the hundreds of forwarded WhatsApp messages) and spread information not fear.

What next?

Both the British Medical Association (BMA) and the Labour Party have called on the government to launch an enquiry and urgently further investigate this disparity. On the 16th of April, the government announces that they will be launching a formal review into why people from a black and minority ethnic background appear to be disproportionately affected by COVID-19. This enquiry will be particularly beneficial by providing an intersectional analysis exploring associated the risk factors of COVID-19 and ethnicity-based data in order to better inform healthcare providers and prevent the further loss of lives. This will undoubtedly uncover more evidence on the complex yet striking relationship between health and racial inequality in Britain. BAME healthcare workers make up a significant proportion of the victims of this virus. Although there may be several reasons underpinning this, this unfortunate situation has further revealed the underlying inequalities facing BAME communities as a whole.

We need to ensure that all healthcare workers are safe and appropriately protected with Personal Protective Equipment (PPE), our population is safeguarded, and the government takes action.

The NHS has always heavily relied on its ethnic minority staff. They make up a significant proportion of the NHS workforce and unfortunately many are losing their lives in the battle against COVID-19. To all the healthcare professionals; the vast majority of whom came from overseas and gave their lives to the NHS to save others, as well as our other essential key workers who have sadly lost their lives, may their souls rest in perfect peace and our condolences to their loved ones.

Written By Khadija Owusu, Olamide Dada and Ife Akano-Williams