As new re­port con­firms higher coro­n­avirus risk to mi­nori­ties, doc­tors say...

Eastern Eye (UK) - - Front page - By LAU­REN CODLING

LEAD­ING doc­tors have slammed min­is­ters for “pay­ing lip ser­vice” to eth­nic mi­nori­ties af­ter new anal­y­sis con­firmed pre­vi­ous find­ings that BAME groups are at higher risk of in­fec­tion and dy­ing from coro­n­avirus.

Peo­ple of Asian eth­nic­ity are 1.5 times more likely than white peo­ple to be in­fected, anal­y­sis from the Uni­ver­si­ties of Le­ices­ter and Not­ting­ham re­vealed last week. Pa­tients from Asian back­grounds are also more likely to be ad­mit­ted to in­ten­sive care and to die from the virus.

The lat­est find­ings are con­sis­tent with pre­vi­ous re­ports by Pub­lic Health Eng­land (PHE) and the Of­fice for Na­tional Sta­tis­tics (ONS), which noted the height­ened risk within BAME groups.

Since the ini­tial coro­n­avirus out­break in March, lead­ing Bri­tish Asian doc­tors, in­clud­ing the Bri­tish Med­i­cal As­so­ci­a­tion (BMA) chair Dr Chaand Nag­paul and Dr Kailash Chand, have raised con­cerns about the dis­pro­por­tion­ate im­pact of coro­n­avirus on eth­nic mi­nor­ity health­care staff and the wider com­mu­nity.

Dr Chand, honorary vice-pres­i­dent of the BMA, said the gov­ern­ment had not lis­tened to their con­cerns, de­scrib­ing its re­sponse as “lip ser­vice”. In his view, eth­nic mi­nori­ties should have been given “en­hanced pri­or­ity” by min­is­ters. “We’ve been say­ing, shout­ing, scream­ing about what the risk fac­tors are and (the gov­ern­ment) did not at­tempt to re­duce this en­hanced vul­ner­a­bil­ity of the BAME com­mu­nity,” Dr Chand told East­ern Eye on Mon­day (16).

The BMA coun­cil chair Dr Nag­paul agreed that “lit­tle to no tan­gi­ble ac­tion” had been taken by min­is­ters since the PHE’s ini­tial re­view in June, which in­di­cated that those from eth­nic mi­nor­ity back­grounds were most dis­pro­por­tion­ately im­pacted by Covid-19.

Dr Nag­paul said peo­ple from BAME back­grounds have not seen any im­prove­ments in the ad­verse im­pact of the virus on their lives.

He added: “We need bet­ter cul­tur­ally com­pe­tent pub­lic health com­mu­ni­ca­tions that re­flect the lives of mi­nor­ity groups, de­liv­ered by trusted voices in these com­mu­ni­ties, as we know the gov­ern­ment has lost the con­fi­dence of many peo­ple from BAME back­grounds.”

Both doc­tors have con­sis­tently called for ac­tion to pro­tect eth­nic mi­nor­ity NHS staff, urg­ing ad­e­quate risk as­sess­ments for BAME em­ploy­ees.

The most re­cent NHS risk as­sess­ment guid­ance from Novem­ber 4 ad­vised or­gan­i­sa­tions to en­sure line man­agers were sup­ported to have “sen­si­tive and

“com­pre­hen­sive con­ver­sa­tions” with BAME staff. It also said to iden­tify any ex­ist­ing un­der­ly­ing health con­di­tions that may in­crease the risks for eth­nic mi­nori­ties in un­der­tak­ing their front­line roles, in any ca­pac­ity.

How­ever, a re­cent BMA sur­vey re­vealed health­care staff were not sat­is­fied with ad­just­ments made af­ter their risk as­sess­ments. A sixth said they felt a fur­ther risk as­sess­ment was now re­quired.

Dr Nag­paul ad­mit­ted that med­i­cal col­leagues were “anx­ious” about the months ahead, as in­fec­tion num­bers con­tin­ued to rise. Staff from BAME back­grounds will be par­tic­u­larly con­cerned given the dev­as­tat­ing im­pact on these groups in the first wave, he added.

“It’s vi­tal that risk as­sess­ments are acted upon and not treated as a tick-box ex­er­cise – and should mean re­de­ploy­ing staff away from ar­eas where they are most likely to catch Covid-19,” he said.

There has been con­cern over the amount of PPE (per­sonal pro­tec­tive equip­ment) avail­able to NHS staff too. In June, anal­y­sis by the Na­tional Au­dit Of­fice (NAO) said there had been short­ages of PPE when the pan­demic first struck.

Dr Nag­paul re­ferred to a re­cent BMA sur­vey, which found BAME doc­tors were “par­tic­u­larly wor­ried” about PPE sup­plies ahead of the win­ter months.

“While we’re not yet ex­pe­ri­enc­ing a re­peat of the wide­spread PPE short­ages we saw ear­lier in the pan­demic, we need re­as­sur­ances from the gov­ern­ment that the stock­pile is enough to match any mod­elled worst-case sce­nario to en­sure that no staff are left un­pro­tected,” he said.

There have also been calls for the gov­ern­ment to ad­dress is­sues re­lat­ing to struc­tural racism, which many be­lieve has con­trib­uted to the dis­pro­por­tion­ate im­pact on BAME groups.

In Oc­to­ber, a gov­ern­ment ad­vi­sor said struc­tural racism was not a “rea­son­able ex­pla­na­tion” for black and south Asian peo­ple’s greater risk of ill­ness and death. Speak­ing dur­ing a gov­ern­ment brief­ing on the first quar­terly re­port on Covid dis­par­i­ties, Dr Raghib Ali said “it was time to stop us­ing eth­nic­ity when de­cid­ing who needed help”.

Days later, a Labour party re­port con­tra­dicted Dr Ali’s claims, calling for sys­temic racism to be in­ves­ti­gated in the UK as a po­ten­tial cause of dis­par­i­ties in Covid-19 out­comes.

Dr Nag­paul said the PHE re­view had made clear that fac­tors re­lat­ing to racism, dis­crim­i­na­tion, fear and trust had con­trib­uted to the dis­pro­por­tion­ate im­pact of

Covid-19 on BAME com­mu­ni­ties. “Work to ad­dress these struc­tural in­equal­i­ties must be stepped up,” he said.

Dr Chand agreed more needed to be done, ar­gu­ing that lit­tle pro­tec­tion had been put into place since con­cerns had been ini­tially flagged up.

“We have (BAME) front­line work­ers liv­ing in over-crowded houses with more than one gen­er­a­tion in the same house, and what have (the gov­ern­ment) done? They haven’t done any­thing about hous­ing, they haven’t pro­vided es­sen­tial or fool­proof PPE and the risk as­sess­ments we have been ask­ing for should be done more rig­or­ously,” he said. “None of that has been ac­com­plished.”

On Mon­day (16), it was re­ported that a vac­cine which was 95 per cent ef­fec­tive against the virus had been pro­duced by US com­pany Moderna. Ger­man phar­ma­ceu­ti­cal cor­po­ra­tion Pfizer an­nounced sim­i­lar re­sults last week, claim­ing their vac­cine was 90 per cent ef­fec­tive.

Al­though the lat­est gov­ern­ment guide­lines have said there is not “a firm po­si­tion on pri­or­ity groups at this time,” re­ports have said the el­derly and health­care work­ers would be con­sid­ered first.

Dr Chand has called for eth­nic mi­nor­ity groups to be pri­ori­tised. Not­ing the new re­search by the Uni­ver­si­ties of Le­ices­ter and Not­ting­ham, he high­lighted pre­vi­ous data show­ing BAME com­mu­ni­ties have lower life ex­pectancy than their white coun­ter­parts.

“There’s a good rea­son for it,” Dr Chand ar­gued. “(Eth­nic mi­nori­ties’) life ex­pectan­cies are lower than peo­ple from af­flu­ent com­mu­ni­ties and white com­mu­ni­ties. Pri­or­ity should be given to BAME com­mu­ni­ties for a vac­ci­na­tion.”

Dr Chand has rec­om­mended that mes­sag­ing re­lated to the vac­cine be cul­tur­ally com­pe­tent. Shar­ing sim­i­lar sen­ti­ments, Dr Nag­paul said cul­tur­ally sen­si­tive mes­sag­ing was “par­tic­u­larly im­por­tant” when com­mu­ni­cat­ing the im­por­tance of the vac­ci­na­tion to those groups most at risk.

It was also vi­tal that the re­search and data from vac­cine tri­als were pre­sented trans­par­ently, he added. “(The re­search should be) used to in­form rec­om­men­da­tions around who should get the vac­cine first, en­sur­ing that those most at risk and for whom the vac­cine is most ef­fec­tive can be pri­ori­tised.”

Dr Nag­paul has re­peat­edly called for cul­tur­ally sen­si­tive mes­sag­ing through­out the pan­demic, telling East­ern Eye in July it was “vi­tal” for eth­nic com­mu­ni­ties.

Re­spond­ing to East­ern Eye, a spokesper­son for the gov­ern­ment’s Equal­ity Hub said: “Through­out the Covid-19 pan­demic, we have pri­ori­tised pro­tect­ing the most vul­ner­a­ble in our so­ci­ety.

“In Oc­to­ber, the min­is­ter for equal­i­ties pro­vided her first quar­terly up­date on the work we have car­ried out so far which high­lights and seeks to min­imise the key risk fac­tors that are hav­ing an im­pact on these com­mu­ni­ties.

“Ac­cess to the lat­est pub­lic health in­for­ma­tion and pro­tec­tions should be avail­able to ev­ery­one. To en­sure that is the case, we have in­vested in a strong pack­age of mea­sures to tar­get mes­sag­ing, de­velop the data we have avail­able and make sure ev­ery­one is as safe as pos­si­ble at home or in the work­place.”

MI­NOR­ITY RE­PORT: Dr Chaand Nag­paul (be­low left) and Dr Kailash Chand want min­is­ters to of­fer more pro­tec­tion from the spread of Covid in­fec­tion to BAME com­mu­ni­ties

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