New figures show over one in five in intensive care with COVID is Asian
By Barnie Choudhury
Leaders of doctors’ groups have accused the government of “letting down” south Asian communities in its handling of the pandemic.
Their criticism comes as new figures show that in the past month, 170 Asians were admitted to intensive care, making up 21 per cent of cases.
That is almost three times the proportion who should be there, according to 2011 Census figures.
“These statistics will make the Asian communities feel badly let down,” said the president of the British Medical Association (BMA), Dr Chaand Nagpaul.
“They have served the nation throughout the pandemic. They kept the nation functioning in key roles. They were essential workers, and they suffered badly in the first peak, and they will have rightly expected, that when the government said they would take seriously the impact on not just the Asian community, but also the whole BAME community, they expected that action would have been taken.”
Urging government
Eastern Eye can reveal that the BMA has been in regular contact with the health secretary and equalities minister, urging them to protect black and Asian communities that are much more vulnerable to contracting the virus.
In June, the government promised to “take forward” the work carried out by the now defunct Public Health England (PHE).
PHE reviewed how the virus disproportionately affected black and Asian communities, but the BMA said there has been nothing but “a deafening silence” since.
Dr Nagpaul said he does not understand why the government has been so slow to take extra measures.
“We know that the BAME status in its own right is a risk factor, and we know that people who have other comorbidities have a magnified risk,” he said.
“The government should be making sure that the BAME community is enabled to protect those at highest risk.
“This is a government that said they would take action on this issue. This report wasn’t given to them, they commissioned it. They published the review, therefore, I fail to understand how and why they have not put in place measures. The government need to rebuild trust, and [show] that they have the backs of the BAME community.”
Intensive care
The new data, from the Intensive Care National Audit & Research Centre (ICNARC), shows that up to August 31, just under 1,670 people, or 16 per cent, of those admitted were Asian. This means there has been a five per cent increase between September 1 and October 8.
When it comes to all non-white patients, those in intensive care number almost 35 per cent or over one in three admissions.
“The figures tell you that nothing was done to take the special care we called and hoped for, for BAME communities,” said Dr Kailash Chand, former vice-president of the BMA.
“The government is totally failing them, and other than lip service, nothing much is being done for frontline workers in the community, taxi drivers, restaurants and care workers, doctors and nurses as well. So, it’s a huge disappointment to the black and Asian people I’ve been talking to, and they feel totally let down.”
Of the 856 patients admitted to intensive care, 429 are still receiving critical care, according to data from the Centre. About 90 patients have “very severe comorbidities”, 50 of whom had either “acute or chronic leukaemia, multiple myeloma or lymphoma or were immuno-compromised owing to chemotherapy, radiotherapy, or daily high dose steroid treatment in the previous six months”.
“Doesn’t it tell you how big the failure is?” asked Dr Chand. “We all shouted and screamed about what happened during the first wave, about what was happening to the BAME communities, and nothing has been done. How can you trust what this government will do in the future?”
New measures
On Monday (12), the prime minister, Boris Johnson, announced a new system to tackle the pandemic. He has split England into three tiers – medium, high and very high – depending on the risk of contracting the virus. Each tier has different rules regarding what people can and cannot do.
Currently, the government has put the Liverpool city region as the only area at very high alert or tier 3. It is home to 1.5 million people, and the new measures mean pubs, clubs, betting shops, gyms, leisure centres and casinos will now close.
“This government’s serial incompetence has been shown once again following yesterday’s announcement,” said Afzal Khan, Labour MP for the nearby area of Gorton in Manchester, which is under tier 2 restrictions.
“They have ignored Sage (government’s scientific advisers) advice at the expense of public health. Why is it that local areas will only be provided with support for test, trace and isolate once they’re already in tier three?
“People are rightfully angry in the north and it’s clear that the government have lost control of the virus”.
Ignored Sage advice
Newly released documents show that the government’s scientific advisers called for a so-called “circuit breaker” at a meeting on September 21.
This measure would mean public places such as pubs, clubs and restaurants are closed to give the nation breathing space to halt the spread of the pandemic.
The Conservative mayor of the West Midlands, which has a high south Asian population, has criticised the new system.
The Labour MP for Birmingham Edgbaston, Preet Kaur Gill, echoed his views.
“My constituents are confused as to why the current restrictions are being replaced with the introduction of bans on mixing in hospitality venues and the loosening of restrictions in private gardens, when the evidence locally suggests that transmission in our city is occurring in household not hospitality settings,” Gill said.
“The British people have lost confidence in the government’s ability to keep them safe. The government’s poor handling of the crisis, mixed messages and failure to get test, trace and isolate working properly means that our country is heading into winter with little reassurance that enough is being done to protect health or jobs.”
Failed messaging
Dr Bharat Pankhania is a senior clinical lecturer at the college of medicine and health at the University of Exeter. He has advised national and international governments about tackling communicable diseases.
“We have failed in our messages, and the reason why we have failed is because every action has always been carried out reluctantly,” said Pankhania.
“You can tell when there is reluctance, the message is never delivered with consistency. When it’s clear there is no ambivalence, no double meaning nothing. The virus has not gone on holiday. We need that message from central government, please be very careful, the virus is still there.”
More evidence
Another study, this time from Kings College London, suggests that south Asian patients are more likely to die from the virus in hospital than those who are white.
Researchers analysed data from 1,800 adult patients with a primary diagnosis of Covid-19 between March 1 and June 2 2020, who were admitted to King’s College Hospital in south-east London.
They found that non-white patients were affected at different stages of the disease than white people in hospital.
South Asians did not have a higher risk of requiring hospital treatment than white patients, said researchers. But their death rate and need for intensive care after admission was higher than other ethnic groups.
“The finding that black versus Asian patients are affected in quite different ways, and that significant risk persists even after adjustment for deprivation and long-term health conditions, is striking,” said Professor Ajay Shah, head of the School of Cardiovascular Medicine & Sciences.
“It strongly suggests that other factors, possibly biological, are important and that we may need different treatment strategies for different ethnic groups. For Asian patients it may be how to treat life-threatening complications.”
So far, almost 2,050 south Asians or 7.6 per cent have died from the pandemic.
Dr Sonya Babu-Narayan, associate medical director at the British Heart Foundation said, “People from black, Asian and other minority ethnic backgrounds more often have heart and circulatory risk factors including high blood pressure and diabetes, and are more exposed to socioeconomic disadvantage.
“But this study indicates that the worse effects of Covid-19 are present even after these are accounted for.
“Research is now needed to assess how other structural and behavioural factors may contribute, including occupation, access to health messaging and health care, and differences in the patient journey once people reach hospital.
“As we see Covid-19 cases rise again in the UK, we must address these disparities with urgency.”
According to the latest NHS England figures, 7,618 of those who have died since March 31 this year already had diabetes, accounting for 27 per cent of those with a pre-existing condition.
Pre-existing conditions
Doctors acknowledge that south Asians are at a higher risk of suffering from diabetes. But they are concerned about what will happen this winter, and the expected rise in flu cases mixed with the pandemic.
“The government is too slow, too indecisive and not doing enough,” said Dr Chand, who is also the former chair of the Tameside and Glossop NHS Trust.
“My worst fear is that vulnerable people, the elderly, are being left to their fate, rather than the government actively doing something for them. There isn’t anything targeted at those who are vulnerable. With winter, it’s a triple whammy of the pressure on the NHS, the flu and the capacity in hospitals is much reduced.”
He also expressed serious concerns about healthcare workers on the frontline.
“When we asked about risk assessments for black and Asian healthcare staff on the frontline, the government opened up a review. Four months on, and we haven’t heard anything. That tells you about the interest of this government [in that].”
Post-traumatic stress
New figures released by the BMA show that 34 of the 37 doctors who have died while treating Covid-19 patients were from a BAME background. Dr Nagpaul, told Eastern Eye that doctors were concerned about a repetition of the first wave of cases in April and May. At the time, they were often left holding smartphones so relatives could say goodbye to their dying loved ones.
“They have found it extremely hard, including the trauma of colleagues, junior doctors treating their own consultants in critical intensive care,” he said.
“These are not experiences doctors have ever had to face before. We are concerned there will be post-traumatic stress for many healthcare professionals, doctors and nurses and others. In our own survey, about 34 per cent doctors say they already suffer with high stress levels.”
Dr Nagpaul warned that there was worse to come.
“We had an infection that was developing during the spring, going into summer. We’re now in autumn going into winter. So, the pressures on the NHS will be far higher anyway. We’re looking at a triple whammy of a backlog, second wave and winter pressures, all converging around the same time. So we’re very worried as a as a body representing doctors about how they will cope and be able to provide care.”
Government response
However, at the University Hospitals Coventry & Warwickshire NHS Trust, its chief medical officer and consultant cardiologist, Professor Kiran Patel, was more optimistic. “Across the NHS we now have a process of risk assessment for staff and across the population, and government advice to keep all of us safe should be adhered to,” he told Eastern Eye.
“There are challenges around how we quantify and address risk in the face of a limited amount of evidence and data. There are general messages around how to work safely in the NHS in terms of PPE (personal protective equipment) and social distancing.
“We know that some of the increased risk is due to social and behavioural factors, some of which are not so straightforward to address, for example multi-generational household living. Other factors are easier to address such as social behaviours, and we must all do what we can to reduce risks.”
Eastern Eye has been told that the equalities minister, Kemi Badenoch, will shortly publish the first update on “an ongoing piece of work furthering our understanding of how individuals are affected by the virus”.
A government spokesperson said, “We know coronavirus has had a disproportionate effect on people from BAME backgrounds and throughout this pandemic the government has introduced measures designed to tackle these disparities and protect our most vulnerable communities from the impact of the virus.
“We have taken key steps to ensure that NHS frontline staff from ethnic minority backgrounds are best protected and to ensure we fully understand the links between the virus and ethnicity.
“Crucially, we have made sure that all public health information is accessible, including translating advice into numerous languages and targeting messaging through specifically chosen channels.”
BMA warning
Doctors, and their leaders, however, remain sceptical.
“Sage produced a report which actually called on public health messaging for communities from different cultural backgrounds,” said Dr Chand. “They were very clear that this needs to be far more than the idea of simply translating information. They highlighted that many local communities felt so let down during the first peak that the government were unlikely to be held in a matter of trust.
“They need to put in place measures to rebuild trust and confidence, most importantly, in order to save lives and prevent people becoming disproportionately unwell.”
