Coronavirus: Are ethnic minorities at greater risk from Covid-19?

Behind the grim daily announcements of more deaths linked to the coronavirus disease lie heartbroken families. Across the country thousands of people are coming to terms with the effects of this virus.

While every death is a tragedy, there is growing concern about the numbers of black and minority ethnic patients affected by the disease. At first glance the data suggests Bame people are the preferred choice of victim for the Covid-19 virus.

Particularly stark are the numbers of frontline NHS Bame staff who appear to be paying the heaviest of prices for serving the public. After the first 10 UK doctors named to have died from Covid-19 were all Bame, Dr Chaand Nagpaul, head of the British Medical Association, called for the government to act to find out whether there were factors that put ethnic minorities more at risk.

“We have heard the virus does not discriminate between individuals but there’s no doubt there appears to be a manifest disproportionate severity of infection in Bame people and doctors,” he said. “This has to be addressed – the government must act now.”

We cannot yet be sure about the evidence of how the coronavirus targets ethnic minorities or if, indeed, it even is.

The latest data, as of 10 April, from the Intensive Care National Audit and Research Centre (ICNARC) shows there were 3,883 patients admitted to critical care units by 9 April with a coronavirus infection.

The report found that of these patients, 2,236, around 66 per cent, were white, followed by 486 people of Asian origin, 14 per cent, and 402 people who were black, around 12 per cent.

In total, non-white patients made up around a third of the total number of patients with coronavirus in critical care.

Compared to the population of the UK, that would suggest Bame people are more at risk given the UK has an ethnic minority population of around 14 per cent, according to data from the Office for National Statistics.

But coronavirus is not sweeping through all communities equally. By definition, the virus spreads organically between people as they come into contact with each other and travel through their communities. It takes advantage of our individual lifestyles and cultures, and this varies naturally between different ethnic groups.

As a result, you have to consider the data at a far more granular level than the simplistic national data we have at the moment allows.

For example, London has a much higher number of people who identify as non-white, at around 40 per cent of the city, and we know London has been hit hardest by the virus with more infections than anywhere else, so it stands to reason a significant number of those affected in the capital will have a Bame background.

Compared to somewhere like the northeast, where 93 per cent the population is white, then this will stand out.

But the 2011 census is nearly a decade out of date, so even this data has to be considered with a pinch of salt. Like all of the data on coronavirus, it gives a hint of insight but not the definitive truth.

We need to consider other factors, such as poverty and housing and the fact Bame patients, in London, for example, may be living in densely populated homes and living with large numbers in multi-generation homes.

They may have more public facing roles, for example as bus drivers, Tube drivers, street cleaners etc, which means they may have had a higher risk of exposure to the virus.

Take the number of Bame victims who work in the NHS. In March 2019, more than 1.2 million people were employed by the NHS, of which one in five was a non-white ethnic minority.

In terms of the work they do, 45 per cent of medical staff were from an ethnic minority, meaning they could be at risk of exposure to large amounts of the virus if caring for a coronavirus patient.

In 2018, Bame nurses made up around 26 per cent of all nursing roles at band 5, the starting band for a nurse, whereas less than 10 per cent of nurses at the most senior levels were Bame. Those at the frontline face far more risk of exposure.

As the peak of the virus moves from London and the West Midlands to other parts of the UK, we may see the proportion of Bame patients suffering complications and needing critical care drop.

Another potential explanation is the existence of underlying health problems such as diabetes, high blood pressure and obesity. The coronavirus is particularly unforgiving in any patient where these comorbidities, as doctors refer to them, are found.

It is a fact that such conditions are significantly higher among black and Asian ethnic minorities, so this could explain their representation in the critical care admission figures. But again, we cannot be certain of this.

There is a possibility that Bame patients are susceptible to the virus because of their genetic profile but Duncan Young, professor of intensive care medicine at the University of Oxford, said it was unlikely because the effect was being seen across different ethnic groups as opposed to just one.

He too suggested the explanation was more to do with social or cultural factors.

We are in the middle of a pandemic, it has swept the globe in a matter of months and changed our lives in weeks. Our social structures and systems have barely had time to respond to the threat let alone begin to explain some of its intricacies.

It is inevitable that more patients will succumb to the disease, whether in coming days or weeks or months down the line as second and third waves of the virus arrive. This is a tragedy for every life lost, but as the numbers increase so too will our data and epidemiological understanding of the virus and its effects.

Much more research will be needed to unlock the secrets of the coronavirus and only then will be able to answer some of the troubling questions we face today.