Parth Patel was working as a junior doctor at the start of the Covid-19 pandemic when he saw for himself how the outbreak was disproportionately hitting people from minority ethnic backgrounds. In June, a report from Public Health England confirmed what Patel and many others in the NHS already knew: people of Bangladeshi ethnicity had around twice the risk of dying from Covid-19 while those from other minority ethnic backgrounds had between a ten and 50 per cent greater risk of dying than those from a white British background.
In July, Patel started working on a report for the Institute for Public Policy Research (IPPR) that he hoped would help mitigate what he describes as “some of the starkest inequalities in health that we’ve seen in recent times.” Matt Hancock, the health secretary, seemed to be on a similar page. A month earlier, in the wake of the PHE report he pledged further action on health inequality in the pandemic.
Instead, the inequalities Patel saw at the beginning of the pandemic have continued to play out. The parts of England with the highest rates of transmission – particularly the northwest – tend to have higher-than-average populations of BAME residents. In those regions, the highest rates of transmission are among Asian communities. Yet when Boris Johnson’s government introduced the latest series of restrictions on Tuesday to try and quash the mounting threat posed by the winter resurgence of Covid-19, there were still no policies announced to protect the populations shown to be the most vulnerable to the pandemic.
Describing the new rules and ongoing local lockdowns as ‘one size fits all, broad brush measures,’ Patel points out that while a series of research projects have been funded into why minority groups have been disproportionally affected by Covid-19, there is a drastic need for action to prevent more deaths from happening.
“People were warning that Covid-19 was going to expose and amplify inequalities way before it even took hold earlier in the year,” he says. “Fair enough, there was a lot going on at the time, but we’ve now had the whole summer, and we’re back in this position where we’re starting to see these disparities play out. There’s not been any tailored action to try and stop Covid-19 running unchecked through minority ethnic communities again.”
When published in early October, the IPPR’s report will set out a series of policies which it believes need to be urgently implemented to try and protect BAME populations from the second wave. One of the key issues which Patel believes has not been addressed is inadequate testing and tracing among these communities.
He describes the current test and trace strategy which revolves around a centralised hub, supported by local outbreak control teams, as flawed. Instead, he says a more effective way of contact tracing, and halting the chains of transmission among BAME communities, would be to place the onus on the local teams.
“Doing it centrally is actually the issue,” Patel says. “There’s a huge disparity in the funding. Central NHS Test and Trace got £10 billion, while local authorities received £300 million. But if you want to reach communities that are harder to reach and maybe have more distrust in the state, you need to go through the local outbreak control teams. They know their areas, they can collaborate with community organisations, and work out a way to contact trace effectively which accounts for differences in culture and language.”
The Public Health England report attempted to identify why BAME communities had been afflicted so heavily by the pandemic. It suggested that half of the excess risk they faced compared to white communities, was linked to social factors. One example of this is the data showing that BAME individuals are more likely to work in public facing occupations which expose them more to the coronavirus. Amidst the recent steep rise in Covid-19 cases, researchers are calling for the government to do more to ensure that these employers conduct sufficient PPE audits and occupational risk assessments to protect their workers.
“The government stands in paralysis and fails to implement key recommendations from PHE and Independent SAGE to protect people from within BAME communities,” says Halima Begum, director of the Runnymede Trust, an independent race equality think tank which is conducting its own research into the impact of Covid-19 on BAME populations. “The government must also urgently carry out impact assessments of BAME key workers, and ensure that safeguards are implemented to guard them from the greater risks of Covid as winter sets in.”
In addition, the higher risk of severe Covid-19 among BAME populations has been linked to the fact that some of these communities are living in less advantageous circumstances, making it harder for those diagnosed with the virus to isolate and prevent further spread. Naveed Sattar, physician and professor of cardiovascular and medical sciences at the University of Glasgow, believes this makes them more likely to receive a higher viral load, should they become infected, which in turn may increase the risk of a worse outcome. With most viruses, higher viral loads are associated with worse health outcomes but it’s still not clear if this is the case with Covid-19.
He feels that this is not an easy problem to solve. “It’s really tricky,” he says. “I think some South Asian communities, in particular, do find it harder to socially distance. They live in closer family networks. You often have multiple generations living together in some houses. The main thing the government can do is to try and get clear messages across through religious and community leaders, emphasising things like regular hand washing and perhaps wearing masks indoors if you meet family members from other households.”
Patel says that while some recent government announcements – such as the new isolation pay support scheme for the vulnerable – are welcome, they need to be tailored more to the needs of communities who might find it hard to access such schemes. “The isolation pay support is valuable as we know minority ethnic communities are more likely in general to be in financially precarious circumstances in terms of debt and fears about paying their debts for the next three months,” he says. “But it’s something you claim back later, so you isolate, and then you go through your local authority to claim your £500. For many people who live on a day to day basis, that’s not going to be of much help, and all we’re going to see is how that will maybe widen inequalities. And in terms of pandemic control, we know that structural inequalities fuel spread.”
Another issue could be unwillingness to access healthcare services among some ethnic minorities, due to perceptions of hostile attitudes towards migrants. Patel says how this was illustrated earlier this year by the case of a Filipino man who died alone in his home of Covid-19, because he was afraid of having to pay NHS tariffs had he gone to hospital. Tragically he was unaware that Covid-19 cases are exempt from all NHS charging regulations. “Despite cases like this, there’s still no communication from the government, to say, ‘Please come and use healthcare,’” says Patel. “That’s in everyone’s interest from a population health perspective.”
Over the coming months, the IPPF, Runnymede and other think tanks are hoping to persuade policy makers to introduce emergency strategies to better protect BAME communities from Covid-19. However with the second wave already underway, time is running out.
“We have these disparities, we know they exist, but we’ve done nothing to try and mitigate them,” warns Patel. “Now we’re here again at the foothills of a second wave, very much in a similar position to before and we’re going to see all these disparities play out again.”
This article was originally published by WIRED UK
