When asked in late September about what the end of the year may look like for the United Kingdom Professor Chris Whitty, the government’s chief medical advisor, bleakly answered “we have a long winter ahead of us”. However, will this continue to be a long winter for all of us, or will this be disproportionately longer for certain groups within the UK?
With a series of protracted lockdowns that have been on and off for the past few months, this question is increasingly relevant. It has been well documented that the COVID-19 pandemic did not affect all populations and communities equally. For example, the most significant findings from early reports during the first peak suggested that the BAME community had a greater proportion of hospital deaths compared to White British groups. Using reports by Public Health England (PHE) and by the Labour party, this article investigates whether the UK government has a plan to protect the BAME community during the remainder of the winter as previous evidence has shown gaps in the solutions proposed.
Who is Most Affected?
Growing evidence that COVID-19 is having a greater impact upon certain groups led to PHE reviewing the disparities in the risk and outcomes of COVID-19. They found that older age, male sex, ethnicity and geographic location were associated with greater chances of becoming infected, experiencing more severe symptoms and higher rates of death. However, all of these factors, except for ethnicity, replicated existing inequalities in mortality rates seen across previous years. The report did not investigate this further, nor did it address the higher proportion of BAME healthcare workers that died from COVID-19. Accusations were made that sections which suggested discrimination was contributing to the increased risk from COVID-19 were removed from the original report.
Additionally, some of the groups which contributed to the report were mortified by what was published. Zubaida Haque, the interim director of the Runnymede Trust (a race equality Think Tank that was consulted for the report), stated that, “People are upset, angry, astonished, and appalled. It’s completely lacking in any plan of action on how to save lives. I was absolutely flabbergasted…The impression was always that this would not only identify the factors that are likely to be contributing to higher risks of serious illness in relation to COVID-19 but find the answers.”
Following the criticism, an additional report was commissioned by PHE. Additionally, the Labour party tasked Baroness Lawrence, the party’s race relations adviser, to address this topic. Both authors aimed to identify ways to reduce the disproportionate effect that COVID-19 had on minority groups. PHE rapidly reviewed the published literature and engaged with a broad range of stakeholders (defined as individuals with interests in BAME issues) to provide seven recommendations, whereas Baroness Lawrence utilised the latter to deliver her twenty recommendations.
The literature review identified that i) the highest diagnosis rates of COVID-19 per 100,000 population were in people of Black ethnic groups (the lowest were in White ethnic groups); ii) individuals of Chinese, Indian, Pakistani, other Asian, Caribbean and other Black ethnicities had a 10-50% higher risk of death when compared to White British citizens; and iii) death rates from COVID-19 were higher for Black and Asian ethnic groups when compared to White ethnic groups. The two reports’ stakeholder engagement mirrored each other, highlighting that barriers to healthcare, overexposure to COVID-19, stigmatisation, poor governmental communication and engagement alongside a lack of reporting of ethnicity data were reasons for the disproportionate effect of COVID-19 on the BAME community.
A noticeable difference between the reports was how the authors addressed racism. PHE did acknowledge that racism experienced by BAME key workers was, ‘a root cause affecting health, and exposure risk and disease progression risk.’ Unfortunately, this was not explored further, making the statement appear superficial. On the other hand, Baroness Lawrence delved into how structural racism led to health inequalities through which COVID-19 thrived. Within this section, she implored that the COVID-19 pandemic must be a watershed moment and bring about the necessary change which countless preceding reports have not.
Reactions to the Reports
The report and recommendations put forward by PHE once again displeased its audience. Despite critics seeing the relevance and need to employ the recommendations proposed, they were considered ‘generic with recycling and reframing of previous PHE publications’, as well as ‘vague sweeping statements and straplines at best.’ The Lawrence review has not been critiqued since its publication. However, will the proposed recommendations see the light of day? Perhaps Baroness Lawrence predicted the fate of her recommendations. She stated that very few of the 200 previous recommendations aimed at tackling health inequalities and structural racism have been implemented.
Having read all three reports and the media surrounding them, I have to conclude that this may continue to be a long winter for the BAME community. The themes explaining why minority groups were disproportionately affected by the COVID-19 pandemic were identified in previous studies asking the same question in relation to Tuberculosis or swine flu. Despite the problems being well known, the current government does not appear to be protecting this community as we face the second and third waves of COVID-19, especially following the Christmas and New Years periods which have been accompanied by a worrying new and more easily spread strain.
By Benjamin Zuckerman
Benjamin Zuckerman is a final stage medical student with an iBSC in Regenerative Medicine and Innovation Technology. Ben is also project managing a novel medical device that is being fully funded by the NIHR over three years. One of Ben’s interests lies in how medical research can translate into guideline or policy changes influencing patient care globally.
The featured image is by August de Richelieu on Pexels.
ITV. 2020. “Covid-19: Chris Whitty warns ‘we have a long winter ahead of us’ with virus ‘going in the wrong direction.’” ITV, September 30, 2020. https://www.itv.com/news/2020-09-30/covid-19-chris-whitty-warns-we-have-a-long-winter-ahead-of-us-with-covid-going-in-the-wrong-direction.
Kirby, Tony. “Evidence mounts on the disproportionate effect of COVID-19 on ethnic minorities.” The Lancet Respiratory Medicine 8, no. 6 (2020): 547-548.
Lawrence, Doreen. 2020. “An Avoidable Crisis: The disproportionate impact of Covid-19 on Black, Asian and minority ethnic communities.” https://uploads-ssl.webflow.com/5f5bdc0f30fe4b120448a029/5f973b076be4cadc5045fad3_An%20Avoidable%20Crisis.pdf.
Lacobucci G. Covid-19: Review of ethnic disparities is labelled “whitewash” for lack of recommendations. BMJ (Clinical Research ed.). 2020 Jun;369:m2208. DOI: 10.1136/bmj.m2208.
Moore, Alisson. 2020. “Exclusive: Government censored BAME covid-risk review.” HSJ, June 2, 2020. https://www.hsj.co.uk/coronavirus/exclusive-government-censored-bame-covid-risk-review/7027761.article.
Pillaye, Jayshree. “Covid-19 and ethnic minorities: the Public Health England report distracts from proactive and timely intervention.” BMJ 370 (2020).
Public Health England. 2019. “HPR volume 13 issue 27: news (2 and 5 August).” Gov.uk. https://www.gov.uk/government/publications/health-protection-report-volume-13-2019/hpr-volume-13-issue-27-news-2-and-5-august.
Public Health England. 2020. “Disparities in the risk and outcomes of COVID-19.” Public Health England. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/908434/Disparities_in_the_risk_and_outcomes_of_COVID_August_2020_update.pdf.
Public Health England. “Beyond the data: Understanding the impact of COVID-19 on BAME groups.” (2020). https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/892376/COVID_stakeholder_engagement_synthesis_beyond_the_data.pdf
Singh, Carter. “PHE and BAME inequalities: too little, too late?.” British Journal of General Practice 70, no. 699 (2020): 498-498.
Razaq, Abdul, Dominic Harrison, Ben Barr, Miqdad Asaria, Ash Routen, and Kamlesh Khunti. “BAME Covid-19 Deaths-what do we know?: rapid data & evidence review.” Oxford COVID-19 Evidence Service (2020).
ZHAO, H., R. J. HARRIS, J. ELLIS, and R. G. PEBODY. “Ethnicity, Deprivation and Mortality Due to 2009 Pandemic Influenza A(H1N1) in England during the 2009/2010 Pandemic and the First Post-Pandemic Season.” Epidemiology and Infection 143, no. 16 (2015): 3375–83. doi:10.1017/S0950268815000576.