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.