‘Covid advice still needs to be culturally specific’

By Prof Kiran Patel and Prof Kamlesh Khunti

COVID-19 has affected us all. Early data in the pandemic gave rise to concern that there was a dispropor­tionate impact on black, Asian and minority ethnic (BAME) patients and NHS staff. This resulted in many theories about why the inequality in risk and outcome was so stark.

Public Health England (PHE) was asked to produce a report detailing why there was an increased risk of Covid-19 in BAME populations and NHS staff. Many considered the PHE report disappointing as it lacked rec­ommendations for individuals, the NHS and authorities.

Anxiety remained following the re­port and in some corners, it was re­placed by anger. A vacuum was cre­ated which started to be filled with hypotheses, myth, rumour and inac­curate information. A need for clarity and balanced information was there­fore essential. Eastern Eye hosted an important roundtable of experts to highlight important issues and con­cerns, and such events were pivotal in the development of subsequent guid­ance, such as the report launched this week from the South Asian Health Foundation (SAHF), a UK charity.

The report has reviewed a wealth of evidence on the topic of BAME and Covid-19 and has come up with guid­ance for individuals, communities, employers, health services and gov­ernment. It has highlighted that re­ducing the risk of Covid-19 for BAME people is everybody’s business.

There are some immediate actions that must be taken. Most important is that individual risk can be reduced by adopting good hygiene measures such as hand-washing, social distanc­ing and isolating when ill.

However, not all of our communi­ties understand or take seriously such advice and therefore a key recom­mendation from SAHF is to ensure that all public health messaging is culturally appropriate. Community leaders have an important role in en­suring that individuals understand the behaviours necessary to reduce risk. Such advice is even more impor­tant when we realise that levels of overcrowding and congregation tend to be a significant risk factor in BAME households, making social distancing and isolation difficult.

The risk of poor outcome and even fatality following infection with Cov­id-19 is determined by many factors. There is strong evidence to show that conditions such as diabetes, high blood pressure, kidney disease and heart disease increase the risk of poor outcomes. Such conditions are more prevalent in BAME populations and therefore it is essential that BAME in­dividuals ensure these health condi­tions are well managed.

There has never been a better time than now to adopt a healthier lifestyle by stopping smoking, taking up exer­cise and eating healthily to avoid or reduce obesity. It is extremely impor­tant to seek medical attention when required and not avoid seeking healthcare. In particular, if there is any con­cern that one has coronavirus symp­toms, it is important to get tested and to adhere to advice to isolate if in­fected, in order to reduce the risk of transmitting the virus to others.

In the NHS, where there are a dis­proportionate number of BAME staff delivering frontline services, the SAHF report recommends that all employ­ers should note the disproportionate risk in BAME staff and offer manda­tory risk assessment and risk reduc­tion. It is disappointing to hear of some employers not being sufficient­ly diligent in taking the health of their staff seriously. Government, both lo­cal and national, can help by enforc­ing advice from the Health and Safety Executive so that employers do not risk the lives of their employees.

Most of the recommendations in the SAHF report come from analysis of evidence. There are, however, some areas where there is no evidence or where it is weak, so the charity is rec­ommending that future research be of high quality and enable conclusions for ethnic groups to be made.

One of the most important sections of the SAHF report pertains to cultur­ally specific recommendations to BAME communities. There is advice for places of worship and community centres with regard to festivals and religious schools, advising communi­ty leaders to avoid a return to pre-Covid levels of activity and congrega­tions. At funerals, burials and wed­dings, there is no room for compla­cency and sadly, we must avoid con­gregation in order to protect commu­nities. At the very least, those who do attend must wear face coverings and avoid directly touching others.

Social distancing at places of wor­ship is essential if we are to avoid ex­posure to Covid-19. For the foreseea­ble future, events will not be what they once were and we must become accustomed to smaller events limited to direct family. It is vital that all com­munity centres and places of worship start to hold registers detailing names and contact details of all who set foot inside establishments. Only in this way will the NHS Test and Trace ser­vice be able to protect BAME individ­uals who attend these places. To not do so could be seen as negligent.

In the longer term, there are many actions which need to be taken to re­duce health inequalities. The SAHF reports says we need to stop discuss­ing and debating what we already know; rather we should be delivering on these strategies.

Overall, the good news is that levels of Covid-19 are falling. However, with such a high number of high-risk indi­viduals in BAME communities, there is no room for complacency and ad­vice such as that from SAHF must be adhered to if we are to stem the tide of premature morbidity and mortality from Covid-19.

Professor Kiran Patel is a trustee of the South Asian Health Foundation and University Hospitals of Coventry and Warwickshire; while Professor Kamlesh Khunti is a trustee of the South Asian Health Foundation and University of Leicester.