Emerging public health challenge in UK: Perception and belief on increased COVID19 death among BAME healthcare Workers

18 Nov 2022 CategoryCurrent affairs on URG's Author Umain Recommends

Originally published here.

Corona virus infection disease 19 (COVID-19) first casewas reported from Wuhan, China, in the later part of 2019.COVID-19 rapidly infected other parts of the world, subse-quently the World Health Organisation declared a Pandemicin March 2020.1Most of the developed and developing coun-tries went into lockdown measures to avoid morbidity andhigh mortality rates.2In UK, COVID19 peaked in April 2020. The Office of National Statistics (ONS) data analysed the initialmortality data and reported worryingly disproportionatedeath among Black, Asian and Minority Ethnicity group(BAME).3Ethnicity and disproportionate death rate wasreported particularly in Black males are 4.2 times andBlack females are 4.3 times higher than white ethnicity.However, the adjusted risk for Black Ethnicity is 1.9for both sexes.

This reduction was due to living mainlyin London which doubled the risk of anyone living inLondon. The ONS data also reported people of Bangladeshi,Pakistani, Indian and Mixed ethnicities also had statisti-cally significant raised risk of death involving COVID-19compared with those of White ethnicity. Intensive careaudit data reported increase admission of BAME patients inintensive care unit with COVID-19.3It is also reported localauthorities such as London and Birmingham with increased proportion of BAME residents and lower income group hadincreased COVID-19 mortality.

Each percentage point increase in the proportion of thepopulation experiencing income deprivation associated with2% increase mortality rate [IRR =1.02, 95% CI 1.01–1.04].UK government swiftly ordered a committee to inves-tigate the reasons for increased death among BAMEpopulation and we are now awaiting the report. Severalfactors were linked with the increased mortality7–10 whichincludes lower socio-economic status, social deprivation,Vitamin D Deficiency, Genetics, co-morbid medical con-ditions and obesity.

Urbanization is also linked to thedisparity in risk and death among BAME workers.28It is interesting to note the disproportionate death is alsohigh in BAME population in USA.16 The death rate is high inBlack Americans and Asians when compared to white pop-ulation.17,18 Different fatality rate reported due to COVID-19 in developing countries when compared to developedcountries.19 Various factors linked to increased death in thedeveloping countries are prevalent, particularly co-morbidity,poor socio-economic status and housing, however case fatal-ity rate is low.

Health inequality and ethnic variation incertain chronic diseases may be another reason and it is oneof the public health challenges currently emerging in UK.20NHS manpower is hugely relying on international workforce particularly from developing countries. Data from NHS(In June 2019) 13.3% of NHS stay in hospitals and com-munity services in UK reported a non-British nationality.6BAME health work force is obviously concerned with dis-proportionate mortality among BAME healthcare workers assome of the factors already linked such as social deprivation,low social economic class, poor housing do not apply. Recentsurveys among NHS workforce on COVID including a recentsurvey by Royal College of Physicians London, among theirmembers also reported 48% were very much concerned andthis is raised to 76% of those from BAME members.

rom our survey, it is evident that the clear majority ofthe BAME healthcare workers are on the front line in theirroutine work, therefore they are at higher risk of contractingCOVID-19.It may be one of the reasons for increased death. Ourstudy respondents perceived BAME doctor’s disproportion-ate death may be due to co-morbidity and lack of PPE andtesting. With limitation in our study, we are unable to draw aconclusion based on this. Majority of the BAME work forceis anxious about the working condition and family particularlyliving in a social isolation during COVID-19 and reportedhad significant impact in their mental health. There were nostudies comparing the difference of mental health impact inNHS health work force with different ethnicity in a pandemic,clear research is needed exploring the mental health issues in BAME workforce.

Lack of PPE and lack of testing is one of the reasons high-lighted for increased death in BAME work force in our survey.It is important to have these issues investigated seriously andclear consistent risks stratification guide for BAME workforceis implemented in workplace urgently. The risk stratificationneeds to be consistent and should be culturally competentfor BAME workforce.25 Culturally competent mental healthsupport for BAME health work force need to be organized bythe local healthcare providers to alleviate the anxiety amongBAME workforce.26,27 NHS five plan is a welcoming move toreduce the risk and improve the working life of BAME workforce in NHS. Evaluation of the newly developed risk strati-fication framework in real life and implement any innovativemeasures to improve the confidence of BAME workforce in NHS.

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