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In the early days of the coronavirus pandemic, Dr Chaand Nagpaul found himself puzzled, and alarmed.
The north London GP was noticing high numbers of patients from Black, Asian and minority ethnic (BAME) backgrounds dying of Covid-19.
“At our practice, we experienced the death of BAME patients who we would have not expected to die including younger patients and it was very distressing.
“These were people who we would not have expected to die but they were succumbing to this disease.”
After it emerged that the first 10 doctors who died of Covid-19 in the UK were all of BAME origin, Nagpaul, who is also chairperson of the British Medical Association (BMA), called on the government in early April to urgently investigate the disproportionate impact coronavirus appeared to be having.
“We found out that the first 10 doctors that had died from coronavirus were all from a BAME background and all apart from one of them was from abroad.”
Nagpaul’s concerns deepened when figures published by the Intensive Care National Audit and Research Centre revealed that a third of people in the UK admitted to intensive care due to Covid-19 by that point were from a BAME background.
“We spoke out then as these statistics about BAME NHS doctors dying and about the high proportion of BAME intensive care admissions were stark, took us completely by surprise and were alarming.”
Nagpaul wrote formally to NHS England chief executive Sir Simon Stevens urging him to investigate the virus’s impact on BAME communities as well as the high number of deaths among BAME doctors specifically.
“We asked for action from the government to protect both health workers and people from BAME communities.” Nagpaul told HuffPost UK. “There wasn’t an understanding as to why this was happening. But there were things the government could have done.”
Nagpaul was invited by Simon Stevens to take part in an urgent meeting the following week about the impact of Covid-19 on the BAME population. The government subsequently announced the launch of the review led by Public Health England.
Nagpaul says the BMA has repeatedly called on the government and Public Health England to make sure the review looked at real-time data and factors such as the working hours and shift patterns of the deceased doctors; the personal protective equipment (PPE) they were supplied with and their level of exposure to Covid-19 patients.
The BMA also urged NHS England to develop risk assessments to protect healthcare workers at greatest risk of coronavirus so they could be protected and redeployed to other areas.
As the weeks passed, more health workers from BAME backgrounds were dying and Nagpaul says there have now been more than 200 deaths of healthcare workers from all backgrounds who have died as a result of coronavirus.
Of the doctors who have died, 90% have been from BAME backgrounds, while 70% of deceased nurses have been of BAME origin. Overall, more than 60% of healthcare workers who have died of Covid-19 have been BAME.
Nagpaul says NHS England finally wrote to all trusts to tell them that BAME healthcare workers should have a risk assessment – but he says they failed to explain how this should happen, prompting him to write another letter.
Then just over two weeks ago, NHS Employers published guidance tools for trusts on risk assessments. However, Nagpaul said the issue was these were not being implemented in a systematic manner, so he wrote to all doctors in the UK of a BAME origin telling them they were entitled to a risk assessment.
I don’t think anyone was expecting a clear scientific explanation instantly as to why there were such high numbers of BAME deaths to coronavirus. But what we were expecting was some practical action to protect those that we know to be at risk. Dr Chaand Nagpal, British Medical Association
Nagpaul admitted to HuffPost UK that the BMA had to repeatedly push for action as they felt it was critical for people to be protected while the review took place.
He said: “The BAME community has served the nation at every level throughout the lockdown from healthcare, public transport and serving in shops and supermarkets.
“Clearly, the BAME community and the medical profession feels they deserved more prompt action when these stark statistics came to light.
“I don’t think anyone was expecting a clear scientific explanation instantly as to why there were such high numbers of BAME deaths to coronavirus.
“But what we were expecting was some practical action to protect those that we know to be at risk.”
The awaited Public Health England report was published this week and identified a higher mortality risk among BAME people.
The research suggested that people of Bangladeshi ethnicity were twice as likely to die of coronavirus as those who are white British and that those of Chinese, Indian, Pakistani, other Asian, Caribbean and other Black ethnicities had a 10% to 50% higher risk of death than white people.
But the report has been surrounded by controversy and has been highly criticised for failing to bring any new facts to light and failing to make any recommendations.
“It’s like going to the doctor and being told you are ill,” said Weyman Bennett, co-convener of Stand Up To Racism. “It is completely stating the obvious.
“All they have done in this report is point out that BAME people are at higher risk to coronavirus. They haven’t explained why or said what they can do to prevent it.”
Bennett told HuffPost UK he first became aware of the early signs that high numbers of people from BAME communities were being affected by coronavirus in early March, as he was involved in organised a demonstration for anti-racism day on the 21st, but people began pulling out.
“There were lots of BAME people who were planning to attend the demonstration, but early on, people began saying they couldn’t come as they were sick. We identified coronavirus was becoming a problem even before the government lockdown and we announced we were cancelling the demonstration.”
It’s like going to the doctor and being told you are ill. It is completely stating the obvious. Weyman Bennett, Stand Up To Racism
But Bennett says his first real inkling of the disproportionate effect of Covid-19 on the BAME community came when a friend – a black man living in North London – told him he had lost 19 of his friends to the disease.
“I knew then that BAME people were being disproportionately impacted by this pandemic.
“My concerns grew when a friend of mine who works in ICU told me that there were high numbers of BAME people in intensive care fighting Covid.
“The warning signs were there and people were calling for action and investigations. Why didn’t the government listen?”
Bennett told HuffPost UK he believes institutionalised racism has played a role in the disproportionate numbers of BAME deaths to coronavirus as he feels many people from the community feel they cannot speak up about their concerns about being exposed to risk.
“The warning signs were there and people were calling for action and investigations. Why didn’t the government listen?” Weyman Bennett, Stand Up To Racism.
He said when Stand Up To Racism tried to raise the issue about BAME people being disproportionately affected by Covid-19, he felt they were made to feel as though they were exploiting the situation when they were actually trying to save lives.
Sabby Dhalu from Stand Up To Racism added that a key issue she feels has been ignored in the PHE report is the lack of PPE for doctors and nurses and the issue of BAME health workers feeling like they were being targeted to work on Covid wards.
She told HuffPost UK research had shown that NHS staff from BAME backgrounds were less likely to be in senior positions, more likely to be bullied and felt less confident about raising concerns around health and safety.
She said: “There needs to be a public inquiry looking at all the factors affecting the BAME community connected to coronavirus.
“The government has not only been slow to respond to this issue – it actually seems to have ignored certain issues.
“Now that lockdown has eased quite significantly, there are fears of a second wave – which could again disproportionately affect BAME communities.
“The government does not have a clear plan for protecting the health and safety of people and we feel people, particularly those from BAME backgrounds, are being led like lambs to the slaughter back to the workplace.”
GMB, Britain’s general union, has criticised the Public Health England report for telling people what they already know – that BAME workers have made a disproportionate sacrifice during this pandemic.
Rehana Azam, GMB national secretary, told HuffPost UK that people from BAME communities had been “massively let down.”
“People have been dying and government ministers have been too slow to protect lives.” she said. “They keep saying this virus doesn’t discriminate but the response and the lives lost definitely shows that BAME people have experienced a discrimination that ended in their deaths.
“But I don’t think it was down to the government not listening – I think they didn’t have a clue what they were doing and have been far too slow.
“We have had a chaotic dealing of this crisis from the start and they didn’t seem to take any notice of what was happening globally.”
Azam says her biggest criticism is that Secretary of State Matt Hancock commissioned Public Health England to carry out the review into the disproportionate BAME deaths due to Covid-19.
“You can’t mark your own homework.” she said. “Someone totally independent should have done this review.
“We have lost valuable time by having a report undertaken on facts that were already in the public domain.
“All this report does is give data on BAME deaths. We need answers and solutions.”
You can’t mark your own homework. Someone totally independent should have done this review.
Patrick Vernon, Windrush campaigner, has been personally affected by the coronavirus pandemic as he lost his brother-in-law to the disease at the end of March.
He told HuffPost UK he feels the government has not been listening to BAME voices, and an independent public inquiry is now needed for transparency.
“My brother-in-law was in his early 50s and had underlying health conditions and was admitted to hospital. While he was there, he had a Covid test and was positive and died within a week.
“We suffered the grief of losing a family member and the impact on my sister. I also know other BAME people who have died as a result of Covid-19.
“The warning signs were there early on in this pandemic that BAME communities were disproportionately affected as we could see what was happening around the world.
“We need evidence from frontline staff, families and experts to fully assess the impact of coronavirus on BAME communities and learn lessons from what went wrong.” Patrick Vernon
“The Public Health England review has been a complete botch job and we now need an independent public inquiry. They had a colourblind approach.
“We need evidence from frontline staff, families and experts to fully assess the impact of coronavirus on BAME communities and learn lessons from what went wrong.”
Dr Salman Waqar, general secretary of the British Islamic Medical Association, told HuffPost UK that the exact nature of the disproportionality of coronavirus deaths needs to be researched and that BAME groups must be an integral part of the conversation.
“As the first 10 doctors who died from Covid-19 were all from BAME backgrounds, it dawned on us all that this disturbing fact may not be a tragic coincidence,” he said.
“Nearly all explanations that have been offered are not new. We have known about differential attainment, workplace discrimination, health inequalities and even excess mortality amongst BAME groups for a long time.
“The solutions are not complex but require compassionate and inclusive leadership that has the trust of BAME communities.
“The recognition that this is wrong and a problem to be fixed is only the first step and requires everyone to do their part by aligning themselves as part of the solution.
“Focus must turn towards credible and enduring actions such as improving BAME representation and visibility in NHS management and public health communications which speak to BAME communities.”
Equality watchdog the Equality and Human Rights Commission has announced it will be carrying out an inquiry into “long standing structural race inequality” which it says has been thrown into stark relief by the coronavirus pandemic.
The EHRC says analysis and evidence based guidance is needed to tackle issues including Covid-19 death rates in minority groups.
A Public Health England spokesperson told HuffPost UK: “On Tuesday PHE published the rapid data review and this has been published in full.
“This was contributed to by Professor Kevin Fenton alongside a wide variety of PHE colleagues.
“Professor Fenton has been engaging with a significant number of individuals and organisations within the BAME community over the past couple of months, to hear their views, concerns and ideas about the impact of the virus on their communities.
“The valuable insight he has gathered will inform the important work the Equalities Minister Kemi Badenoch is now taking forward.”