Indian physicians’ petition puts focus on race risks in the wake of COVID-19

A group of leading, ethnic Indian physicians has petitioned Britain's National Health Service (NHS) to formally include ethnicity as a COVID-19 infection risk factor for healthcare workers in the UK.

The petition was a 'rapid response' to a report in the British Medical Journal (BMJ) article titled 'COVID-19: Two-thirds of healthcare workers who have died were from ethnic minorities' that was published on 23 April.

A summary of the petition published 1 May in the BMJ says that available NHS occupational risk assessment tools are "variable and inconsistent and do not incorporate ethnicity as a risk factor". It asks for existing tools to be "replaced by a centrally administered assessment, with ethnicity included as a risk factor and appropriately weighted".

Citing a Health Service Journal article published 22 April, the BMJ said 18 of the 19 doctors and dentists who died of COVID-19 were from black, Asian and minority ethnic (BAME) backgrounds. The same was true of 71 per cent of 35 nurses and midwives who died, and 56 per cent of 27 healthcare support workers felled by the virus.

Researchers for the Health Service Journal had not indicated causes for the excess mortality among BAME healthcare workers but suggested that it could be biological, medical or sociological and that there was a need for a concerted effort to seek explanations and solutions.

As we understand the disease better, we need to move from the initial response of isolating the majority to focusing on the potential of highly susceptible individuals to fall victims to COVID-19."

Mohan Nair, a signatory to the petition and currently head of cardiology at the Holy Family Hospital, New Delhi, India.

Nair tells SciDev.Net that "it is well-established that people with BAME backgrounds are prone to metabolic, cardiovascular and cerebrovascular diseases, which can be partially explained by the higher incidence of hypertension and diabetes in the group which predispose a person to severe COVID-19 infection".

The petition emphasises that it is critical for NHS managers to be made aware and be instructed on the importance of dealing with the requirements and health concerns of this with BAME backgrounds in a sensitive and fair manner, including in the use of personal protective equipment (PPE).

"It will be fair to say that it is possible that BAME doctors are more hesitant in expressing themselves within the NHS. Or they may be less demanding of the facilities available to them at the workplace," the petition summary says. "Consequently, in an era of acute shortage of PPEs, they may not uniformly be supplied with essential PPE. These observations may well apply to non-medical staff in the NHS and social care sector."

A literature search by the petitioners — including Shiv Mohan Bhanot, consultant urological surgeon, King George and Queens Hospitals, and Rajat Bhushan, consultant endocrinologist at Total Healthcare, Baton Rouge, Louisiana, US — considered genetic susceptibility, socio-economic factors, lifestyle factors and the presence of co-morbidities like diabetes, hypertension and cardiovascular diseases.

Vaccination practices, including childhood vaccination coverage, and socio-cultural factors were also explored to provide background for the petition.

"Interestingly, factors that are now identified as markers of higher morbidity and mortality in COVID-19 have long been recognised as important risk factors for increased cardiovascular morbidity and mortality in South Asians in the US," the petition says.

The petitioners acknowledge that implementing measures to safeguard BAME doctors would inevitably reduce the workforce available on the frontline given that more than half of the workforce in some regions is from the BAME communities.

Nair suggests that younger, healthier staff with no risk factors such as for hypertension, diabetes and smoking be allowed to return to work.

Roy John, a cardiologist at the Vanderbilt University Medical Center, Nashville, US, tells SciDev.Net that all the petitioners are saying is that "there is a disproportionately higher number of black and ethnic minority physicians that have succumbed to the disease in the UK".

"Any viral infection that causes the flu tends to have more serious consequences in patients with heart and lung disease and, in the elderly and immunocompromised. [For instance] South Asians tend to have more diabetes and hypertensions and possibly more coronary disease," says John, who was not one of the signatories to the petition.