Chaand Nagpaul: The disproportionate impact of covid-19 on ethnic minority healthcare workers

In February, The BMJ devoted an edition to the issue of race inequalities in medicine. At that time, no one could have foreseen that new race disparities would manifest themselves just a couple of months later in the form of a pandemic that is disproportionately affecting our minority ethnic healthcare workers.

The death of any healthcare professional from covid-19 is distressing enough, but it was alarming that nine of the first 10 doctors who were named as having died of the virus in the UK were from an ethnic minority background. Further, all but two had graduated overseas. These were doctors who had travelled from across the globe to dedicate their lives to the NHS and to save the lives of others, but who paid the ultimate sacrifice themselves.

At time of writing it is reported that over 50 healthcare workers have died from covid-19 in the UK of which 75% were from an ethnic minority background. While doctors from an ethnic minority represent about 40 per cent of the medical workforce, these figures belie any margins of normal variation.

This trend is mirrored more widely in the ethnic minority population, with the ICNARC (Intensive Care National Audit and Research Centre) finding that 34 per cent of those critically ill with covid-19 were from an ethnic minority, while ethnic minority people make up only 14 per cent of the population as a whole.

As we mourn the deaths of our colleagues, we must ask why this is happening and what can be urgently done to prevent further deaths. It is likely, as with the impact on the wider ethnic minority community, that this is multi-factorial.

Following calls from The BMA for an urgent national investigation, the government has announced an official inquiry and has involved the BMA in initial discussions on this work.

The BMA is clear that the inquiry must be underpinned by good quality data which is not currently available. This should be collected in real time and broken down by protected characteristics and should also record co-morbidities as well as occupation to try and identify any workplace factors that might have contributed. Further investigation could include specialty, grade, working hours, shift patterns and exposure to covid-19 patients.  

Many factors affecting the wider ethnic minority community, as covered in The BMJ last week, apply to ethnic minority doctors too, such as the greater prevalence of medical risk factors including hypertension, diabetes and coronary heart disease, which are thought to increase the severity of covid-19 infection. 

Given the risk of serious illness and mortality from this virus, it is vital that employers identify all workers in high risk groups and consider appropriate mitigation including redeploying them to work in non-infectious areas or to work remotely. Employers have a legal and moral obligation to keep their staff safe.

We know that access to personal protective equipment has been a major concern. The BMA’s most recent snapshot survey found that half of all doctors reported shortages or no supply of long-sleeved disposable gowns and eye protection. Worryingly, just under half of doctors felt under pressure to treat patients without adequate protection even in highly contagious areas where Aerosol Generating Procedures (AGPs) were performed.

In Italy, doctors have openly voiced their concerns of the relationship between lack of adequate PPE and the death rates of doctors and healthcare professionals. It has also been widely reported that one of the doctors who died from the virus, Abdul Mabud Chowdhury, had previously raised concerns about the lack of adequate PPE for NHS workers.  

Given these known issues with the supplies of PPE to the frontline we cannot discount the possibility that some healthcare workers were infected in the course of their duties as a result of insufficient protection.

We know from a previous major BMA survey that doctors from an ethnic minority are nearly twice as likely to say that they would not feel confident in raising workplace safety concerns, and fear being unfairly blamed or suffering adverse consequences if they did so. They also face greater levels of bullying and harassment.  We need to ensure that ethnic minority doctors, alongside all medical staff, can confidently speak up if they feel they have inadequate personal protection. They must not risk their lives due to feeling inhibited from doing so.

The pandemic has brought into sharp focus the immeasurable and vital contribution of our multicultural workforce to our nation as we combat the virus and its impact.

While the inquiry progresses, it is imperative that the government takes all necessary steps to protect our ethnic minority communities and healthcare staff while we develop a detailed understanding of the causes of this disproportionate impact of the virus on some population groups.

A failure to take such steps now will mean that more lives could be lost and the heart-breaking questions of the families, friends and colleagues of those who have died before their time will remain. 

Chaand Nagpaul, Chair, BMA Council. 

Competing interests: None declared.